Print ISSN: 2706-6207

Online ISSN: 2664-3154

Volume 12, Issue 1

Volume 12, Issue 1, Winter and Spring 2015

In Term of Molecular Technique, Taxonomic and Diagnostic Aspects of Chronic Human Brucellosis in Ramadi City

Ban H. K. Al- Khater; Dr. Mushtak T. S. Al- Ouqaili; Dr. Salah N. Al- Anii

Al- Anbar Medical Journal, 2015, Volume 12, Issue 1, Pages 1-12

Background: The diagnosis of chronic brucellosis is frequently difficult to establish. The disease may clinically mimic any infectious and noninfectious disease. This study has been laid down to evaluate PCR technique in the diagnosis of chronic brucellosis in comparison to conventional techniques.
Patients and methods:- One Hundred Forty Four peripheral blood samples obtained from tow group: one hundred twenty four samples from patients with highly suspicion brucellosis and twenty samples from healthy volunteers. The samples were tested by serology using Rose Bengal test (RBT), serum agglutination test (SAT) and 2- Mercapto-ethanol. Blood culture using monophasic blood culture technique, Castaneda biphasic blood culture technique and lysis centrifugation blood culture method. Also, the samples submitted to polymerase chain reaction using primer sets (B4 and B5) to amplify a 223- bp region coding for 31- kDa Brucella antigen was achieved. Furthermore all positive PCR samples were submitted to PCR cocktail to differentiate Brucella species.
Results:- Out of 124 (86.1%) blood samples from patients with chronic brucellosis, 36 (29.03%) showed strong positive for RBT. On the other hand, 61 (49.2%) cases were positive when SAT≥1/320, 104 (83.9%) cases revealed positive results when the SAT titer ≥1/160 and 118 (95.2%) represented positive cases when SAT titer ≥1/80. Also all blood samples submitted to mono and biphasic blood culture technique were 50 (40.3%) and 64 (51.6%) represented positive results respectively, while only 40 blood samples were submitted to lysis centrifugation blood culture technique, 35 (87.5%) revealed positive results. Also, 103 (83.1%) showed positive results for PCR. Out of these cases, 77 (74.8%) represented positive results (B. melitensis), while 26 (25.2%) showed negative cases. Finally, among the twenty (13.9%) controls, serological test, blood culture and PCR were negative.
Conclusions:- The study suggested that combination of Rose Bengal test and serum agglutination test ensured the diagnosis of brucellosis. Also Castaneda biphasic blood culture method had improved the rate of isolation and reduce the period of incubation. Further, lysis centrifugation blood culture technique showed increase in the rate of isolation especially in chronic stage. On the other hand, the current study suggested that PCR has several advantages over the conventional methods for the diagnosis of human brucellosis such as speed, safety, high sensitivity and specificity. Furthermore, PCR is very specific and highly sensitive technique that can be used not only for detection of Brucella antigen in any stage of the disease but also in differentiating Brucella species by using PCR cocktail which used different sets of primers.

Tooth Socket Preservation Using Beta Tricalcium Phosphate (β-TCP) Clinical and Experimental Studies

Liqaa Shallal Al-Fhdawi

Al- Anbar Medical Journal, 2015, Volume 12, Issue 1, Pages 13-25

Alveolar atrophy following tooth extraction remains a challenge for future dental implant placement. Immediate implant placement and post extraction alveolar preservation are 2 methods that are used to prevent significant post extraction bone loss. Immediate extraction site grafting is a simple and straightforward procedure.
Purpose: To determine the efficiency of Resorb β Tricalcium phosphate (βTCP)bone graft material in preservation alveolar bone after tooth extraction.
Materials and Method: Thirty Patients requiring tooth extraction and alveolar bone regeneration for the resulting bone defects by Resorb β TCP(Bone Medik –DM Bone, Biphasic Calcium Phosphate ,Synthetic Resorbable material Si-HA (60%):β –TCP(40%)bone graft material were included in this study.
Results: Histopathological examination of the biopsy specimen showed new bone deposition. Radio graphical radio densities of the regenerated bone were evident in treated sockets during the follow up period. Statistical analysis indicated that the healing percentage was 70%-80% in 13 patients and the main among 25-35 age group.
Conclusions: Resorb β Tricalcium bone graft material was successful material in reconstruction of bone defects following tooth extraction when compared with other graft materials.

Outcomes for Conservative Management of Traumatic Tympanic Membrane Perforation

Raid M.S.AL-Ani

Al- Anbar Medical Journal, 2015, Volume 12, Issue 1, Pages 26-32

Objectives: To investigate the incidence of spontaneous repair of fresh traumatic tympanic membrane (TM) perforation and to elucidate the risk factors which they might impair its healing process.
Patients and Methods: A cross-sectional prospective study of patients with acute traumatic TM perforation was conducted in otorhinolaryngologic department of AL-Ramadi Teaching Hospital in AL-Ramadi city/Iraq between May 2009 and May 2011. Detailed data matching the diagnosis of traumatic perforation of the TM were analyzed. Clinical examination, pure tone audiogram and regular follow-up were done for all patients.
Results: Seventy-two patients (43-males, 29-females), aged 2–70 years (median = 25) with 75 myringoruptures were studied. Three (4.2%) had bilateral TM perforations, 27 (37.5%) right unilateral and 42 (58.3%) left unilateral. Out of 75 myringoruptures, 63 (84%) heal spontaneously. Spontaneous healing of traumatic TM rupture was better in patients with younger age, small sized perforation, low hearing loss at the initial pure tone audiogram assessment (P<0.05). While other factors: gender of the patient, cause, side and duration of the injury does not affect the healing of TM perforation P>0.05.
Conclusions: The overall percentage of spontaneous healing of fresh traumatic TM perforation was 84%. Large sized perforation, old age patient and more hearing loss at the time of presentation were worse prognostic factors for healing of such rupture. Early surgical intervention of traumatic drum rupture is not indicated

HIV/AIDS Knowledge, Attitudes and Beliefs among Iraqi Women

Ahmed K. Al-Delaimy; Eric C. Lea; Wasna Al-Rawi

Al- Anbar Medical Journal, 2015, Volume 12, Issue 1, Pages 33-41

Background: Since the beginning of the Iraq war in 2003 major societal changes have increased the possibility for a greater prevalence of HIV/AIDS in Iraq. With the potential for this increase, it is pertinent that stigma and knowledge levels HIV/AIDS are examined to help guide prevention efforts.
Materials and Methods: A sample of 209 women, whose ages ranged between 15-49 years, attending a private obstetrical and gynecology clinic in a middle class neighborhood of Baghdad were subjected to a questionnaire between November 1st, 2009 and April 30th, 2010. The questionnaire was designed to assess level of knowledge of HIV/AIDS and attitude towards persons whom have HIV/AIDS.
Results: Only about half of the respondents believed that condoms could help to lower risk of contracting HIV/AIDS (48%), and even fewer believed that abstinence could do so (50.91%). Higher education levels (ie: a college degree), as opposed to lower education levels, did not significantly impact correct knowledge of HIV/AIDS (p > 0.05). Most women indicated that they would not want a teacher with HIV/AIDS to continue teaching (69%) and would not buy fresh vegetables from a shopkeeper, who had HIV/AIDS (72%).
Conclusion: Women in Iraq appear to have limited knowledge about transmission of HIV and misperceptions about AIDS independent of their level of education. This, combined with an overall negative attitude towards those with HIV/AIDS, poses a serious threat to stigmatization and risk of transmission.
Recommendations: Open discourse about the misconceptions regarding HIV/AIDS and awareness programs targeted at expanding knowledge of HIV may be important steps toward combating this problem.

Effect of Life Style on Weight in a Sample of Early Adulthood from Falluja Secondary Schools

Yaseen Taha Sarhan

Al- Anbar Medical Journal, 2015, Volume 12, Issue 1, Pages 42-52

Background: Weight and its problems have become of great interest nowadays and many researches are aiming to study how weight would affect a person's life. Many researches reached to a conclusion that life style has a an important role to play on weight and it is known that at early adulthood, the impact of weight will determine whether this person will have a healthy or unhealthy, troublesome life.
Aim of Study: The purpose of this study was to assess how life style and daily habits would affect young adults weight .
Methodology : A cross-sectional study was carried out from March to May 2013 in the City of Falluja , involving secondary school students 15-18 years of age . A simple random sampling was used to select 4 secondary schools out of 11 secondary schools in falluja city center . a systematic random sampling was used to draw a sample of 396 out of 2650 secondary students enrolled in 4 secondary schools .
A questionnaire was applied containing several questions about lifestyle variables, for each individual , height and weight were measured and BMI was calculated .A total of 396 students 15-18 years age 185(46.71%) males and 211(53.28%) females were examined .The variables in questionnaire form and methods used by the investigator were explained briefly to all students in the sample. The data were evaluated using chi-square test . Differences where considered statistically significant at p < 0.05 .
Results: About 7.07% of the students were overweight ,89.39% were normal weight , 3.53% were under weight, the study showed that there was a statistically significant association of weight with between gender(p value 0.001), number of meals(p value 0.000),breakfast(p value 0.005), Sweet cold drinks(p value 0.004), physical activity(p value 0.04), sleeping hours(p value 0.001) and, but no significant association between smoking(p value 0.08) , type of feeding during infancy(p value 0.79) and weight.
Conclusions: The results of this study suggest that the weight problems are not major problem within adolescents in Falluja students in secondary schools , however , abnormal BMI is found to be related to certain variables of lifestyles which were studied , including : number. of meals having a breakfast, cold drinks , sleeping hours, physical activity . Health professionals , teachers , and family environment may play a key role in the promotion of a healthy lifestyle.

Semen Parameters for Sudanese Attending an Infertility Clinic

Eltayeb Tayrab; Badawi S. Badawi; Hosam Aldeen S.M.Saeed; Musa H.A

Al- Anbar Medical Journal, 2015, Volume 12, Issue 1, Pages 53-57

Objectives: This is a descriptive laboratory based study done during 2007 to 2011to assess the seminal profile of infertile men.
Subjects and Methods: One thousand and thirty seven Sudanese men attending Reproductive Health Care Center in Khartoum, Sudan were included. All of them presented with primary infertility for more than one year after marriage. Semen samples were collected after three to five days of sexual abstinence. Physical, macroscopic and microscopic examination of the semen was done as recommended by the World Health Organization (WHO). Sperms were stained using Rapi-Diff II and graded on the basis of the WHO criteria.
Results: 69.9% of the specimens showed normal parameters. The detected abnormal findings include; 27% showed elements of teratozoospermia, 8.4% azoospermia, 21.7% oligozoospermia, 0.4% hyperspermia, 11.2% hypospermia, 19.2% hyperviscousity, 6.1% sperm agglutination and 19.2%showed leucocytospermia.
Conclusion: Azoospermia was counted 8.4% of the studied population as a definite cause of infertility

Perception of Patients and Health Workers About Directly Observed Treatment Short Course (DOTS) Program Implementation in AL-Anbar Governorate

Hammodi F AL-jumaily; Hameed Othman

Al- Anbar Medical Journal, 2015, Volume 12, Issue 1, Pages 58-66

Background:- DOTS Program is widely accepted as an essential strategy for achieving (TB) control. DOTS has been adopted by WHO as hopeful strategy for treatment of TB since early nineties. Iraqi health authorities started DOTS implementation since 2001 in Baghdad. Coverage expanded gradually till it reached 100% in 2003.
Objectives:- This study aimed to assess the application of DOTS program in Al - Anbar governorate ,and to define obstacles that facing the implementation of this program
Patient and Methods :-This Cross –Sectional TB patients and Health employees-based Study was conducted in consultation clinic in Ramadi City and Diagnostic units of Health Centres in Al-Anbar Governorate for the period of October 1 ,2012 to March 31,2013.Direct interviewing was applied by structured questionnaire , which consists of (10) ten questions to (200 TB patients) about the treatment application and their agreement with different aspects of care regarding DOTS program implementation was conducted. While a self-administered questionnaire was applied confidentially with a sample group involving (6o) health care providers for their satisfaction on all aspects of the implementation of DOTs program. Socio-demographic information for this convenient sample were also collected .
Data were analysed using the Epi-Info statistical package. Frequency distribution and frequency rates were calculated ,and compared with other studies.
Results: Out of 200 TB patients 51% were males, and 49% were females with male to female ratio 1.04:1,with a mean age of 28.4 ± 6.5 years ,and 28.5% of male patients were illiterate ,and two thirds of them were unemployed . The agreement result for subjected individuals to structured questionnaire revealed a low assessing score(39.8%) for daily supplying of medication , while social stigma facing subjected patients was of high assessing score(88.3%) ,followed by effect of the disease on work and monthly income was (86.6%) . However ,the satisfaction of 60 health workers regarding motivation with financial monthly income was low (52%) ,followed by satisfaction of Health education given to TB patients was (73.8%), while the overall mean satisfaction of the (60) health workers for the (10) questions was (78.35%) .
Conclusions: Aalthough the proper follow up and health education are the cornerstone of TB management, there was no daily supply of medication to TB patients under supervision. Because of seriousness of the disease and low financial motivations, the health workers showed no desire to work in this program

Assessment of Providers' Performance in Implementing Child Health Services in Primary Health Care Centers in Al-Ramadi City

Mahasin A. Altaha; Abd Alfatah Rashed

Al- Anbar Medical Journal, 2015, Volume 12, Issue 1, Pages 67-78

Background: The demand for high quality health care for children has been constantly increasing. Performance assessment of primary care providers in this context facilitates the control of whether objectives are being achieved by primary health care settings and gives information about which areas of their performance should be improved.
Objectives: The aim of the study was to assess primary health care providers' performance in the implementation of selected child health care Programmes: 1- Acute respiratory tract infection Programme , 2- Expanded Programme of immunization, and 3- Growth monitoring Programme.
Methodology: A cross sectional observational health center- based study was conducted during the period from October 2012 to February 2013 in ten PHC centers in Al-Ramadi City, 7main and 3 sub centers, chosen randomly and constituted 25% of all PHC centers in the area.The providers' performance was assessed and validated in case management for 638 children under 5 years of age, attending those centers with acute respiratory infection. Providers' Performance in implementing EPI and growth monitoring Programmes on 300 children was also evaluated through observation of process.
Results: Results showed that history taking and examination performed were less than adequate for the majority of cases in both main and sub centers. The sensitivity of doctors in charge to diagnose pneumonia and severe pneumonia was very low (23.2%) in main centers, and their specificity was 99.4%. While the sensitivity of medical assistants in sub centers was 0% and specificity of 100%.
Providers performance was very satisfactory in the technique of vaccine administration in both main and sub centers, and satisfactory in recording 66.3% of vaccination cards in main centers and only for 6.2% in sub centers. On the other hand, their performance in health education on vaccination was poor for 30% of vaccinated children in main centers, and for all (100%) of children attending sub centers.
Results also showed that Providers performance in weight and growth monitoring was satisfactory for nearly half of attending children in main centers, but poor in sub centers. Their performance in nutritional education was poor for 50% of children in main centers and in all (100% ) in sub centers.
Conclusion: Providers' performance in implementing child health care Programme was suboptimal in main primary health care centers and poor in sub centers.
The study highlights the need for Programme planners and health policy makers to undertake a major review of the quality of child health care delivery focusing more on issues relating to providers' performance, and with particular emphasis on health workers training and appropriate use of standard case management guidelines

Epidemiological Aspect of Stroke Cases in Al- Ramadi City

Salah N. Dalli Ali; Gaith H. Shaya; Hameed I. Ali AL-Zagroot; Majeed Khadhem Al- Dulami

Al- Anbar Medical Journal, 2015, Volume 12, Issue 1, Pages 79-82

Objectives: To study the subtypes of stroke, prevalence among age groups, sex, and the effect of some risk factors.
Patients and methods: 182 Stroke cases admitted to Al-Ramadi General Hospital during the period from November 2001 to August 2002 were studied. Clinical diagnosis of stroke was documented by spiral computerized tomography of the skull. Risk factors analysis was made based on history, clinical examination and laboratory investigations.
Results: The study showed that peak of stroke cases was in the sixth and seventh decades of the life with a mean age of 62.77± 12.7 and the incidence in males was 55.5% (101) while in females was 44.5% (81). The frequency of stroke subtype was 71.6% (130) of infraction type and 28.4% of hemorrhagic type.
Risk factors were found in 83.6% of cases and hypertension was the most common risk factor and the least one was previous history of transient ischemic attack. These results were nearly similar to other studies in Iraq.
Conclusions: Stroke is a common medical problem Al-Ramadi city. Majority of patients were having risks factors and the most common were hypertension cardiovascular disease, and diabetes mellitus

Prevalence of Congenital Heart Disease in Fallujah General Hospital , western of Iraq ( 2007-2011)

Mohammed Tafash Dagash; Ismael shallal; Saleh Kamal Saleh

Al- Anbar Medical Journal, 2015, Volume 12, Issue 1, Pages 83-95

Background: Congenital heart diseases (CHD) comprise the most common group of congenital malformations. Despite recent developments in interventional and surgical techniques, heart disease in children continues to be an important cause of morbidity & mortality .( 1 )
Aim of study : Our aims were to assess the prevalence, age-wise distribution,& clinical spectrum of congenital heart disease , among children in the Fallujah district region in Iraq, during the years 2007 , 2008, 2009 ,2010 & 2011 ,referred to FGH .
Methods: This is a hospital based descriptive study based on retrospective & prospective collecting all cases referred to Fallujah General Hospital (FGH) to identify all patient with CHD ,born between the 1st of January 2007 & December 31, 2011 ,in FGH. 2nd of big referral hospital in Anbar Governorate ,Iraq .Ethical approval was granted by the scientific committee in Fallujah hospital & Anbar medical college .
Live newborns delivered in this hospital are 2414 , 4753 , 5551 , 7011 & 7320 in 2007,2008,2009,2010,& 2011 respectively ( total 27049 ) excluding live newborns that occur outside the FGH . During the study period ,new born & children was done examined & screened for CHD & follow –up for this 5 years.
Clinical examination, 2D echocardiography and color Doppler and sometime cardiac catheterization either in Baghdad or later on in FGH were considered as definitive tools for diagnosis of CHD.
Result :Out of the 533 cases of CHD there were 281 males ( 52.72 % ) & 252 females (47.27 % ) (Fig.1).Out of the 533 cases of CHD there were 59 ( 11.06% ) cases in 2007 ,44 (8.25% ) cases in 2008 , 49 (9.19 %) cases in 2009 ,167 ( 31.33% ) cases in 2010 & 214 ( 40.15% ) cases in 2011 ( Fig .2 ).
The overall prevalence of CHD live births during this 5-year period was 19.7 / 1000 live births. CHD was found to be slightly more common in male than female births (10.38 versus 9.31 per 1000).
ASD was the commonest lesion 193 , followed by , VSD 164 , other (various types of CHDs existing together including rare type of CHDs. ) 52 , PDA 34 , VSD +ASD 31 , PFO 28 , TOF 18 and PS 13 . Fig.( 3 ) .
The rate of CHD was 24.44 per 1000 live birth in 2007 , 9.25 per 1000 live birth in 2008, 8.82 per 1000 live birth in 2009 , 23.81 live birth in 2010 & 29.23 per 1000 live birth in 2011. Figures 4,5.6.7,& 8.
In 2007 & 2008 VSD was the commonest CHD , & PS lowest rate in 2008. Fig ( 4,5).While ASD was the commonest CHD in 2010 & 2011 Fig ( 6,7,& 8 )
Depend on geographical distribution ,the highest rate of CHD was in center of the city 223( 41.83 %) cases ,followed by other ( villages at the city boundaries) 125 (23.45 %) , then eastern region ( Karma ) 97( 18.19%) , Amria 57 ( 10.69%) & lowest rate was in western region Saqlawya 31 ( 5.81%) . Fig. ( 9 )

167 ( 31.33 % ) of the affected newborns had a positive family history of abortion , & 88 ( 16.51 % ) had a maternal history of drugs & X-ray radiation .Fig. ( 11 ).
Conclusion : 1. The present study shows, for the first time, the prevalence and pattern of CHD in Fallujah region in western Iraq.
2. These findings will help establish a database for future studies, which will focus on etiology and ethnic disparity of CHD in the region.
3.The findings can help to establish valuable changes in health policies for the improvement of diagnostic and therapeutic facilities.
4. The present high prevalence rate of CHD in Fallujah need advance research & registration system to apply in Al-Anbar & Iraqi medical offices .
5. The catastrophic successive wars imposed on Iraq undoubtedly have played some role in this problem .
6. The overall pattern of CHD is similar to the finding in other countries