Maternal Risk Factors and Birth Defects in Kirkuk City/Iraq

Background: Birth defects can be defined as those conditions that occur before or during birth. The purpose of this study was to find out the association between some maternal factors and birth defects, as well as to identify the socio-demographical characteristics of the child and the mother in Kirkuk city. Methodology:  A non-probability, descriptive (convenient) sampling technique was used to select (60) children that attending visits to two locations (Azadi Teaching Hospitals and Kirkuk Rehabilitation Center) in Kirkuk city from the period November 11th 2015 to May 5th 2016. The children age ranged from birth to 12 years old. An interview questionnaire was used to collect the data. The data was analyzed by frequency, percentage, mean, standard deviation and chi-square. (p≤0.05) was considered statistically significant. Birth defects were grouped into cerebral palsy (CP), Erb’s palsy (EP) and Spina bifida (SB). Results: A total of 60 children were included. Of these 40 (66.7%)had cerebral palsy, 13 (21.7%) had Erb’s palsy and 7 (11.7%) had spina bifida. A significant association was found between some maternal risk factors, such as birth weight, maternal age at delivery, type of delivery, gravida, and birth defects. Conclusions and Recommendations: Some maternal factors can play a role in birth defects. Women need to attend antenatal care centers regularly to identify any abnormality. Further studies with larger samples are needed in the city of Kirkuk. Keywords: Birth defect, Risk factor, Maternal, Congenital malformatio

Raised maternal body mass index and caesarean section

Phd ThesisIntroduction Maternal obesity (defined as a body mass index (BMI) ≥30kg/m2) and overweight (defined as BMI 25-29.9kg/m2) have adverse implications for both the mother and the baby, including an increased risk of caesarean section. The prevalence of caesarean section among the UK obstetric population has been increasing in recent years. Evidence suggests that caesarean section in obese women may carry a higher risk of postoperative complications, such as haemorrhage, wound infection and delayed healing. These complications may result in a longer length of stay in hospital after caesarean delivery. To date, UK evidence on the association between maternal BMI and caesarean section has been limited. Aim The overall aim of my PhD was to investigate the association between maternal BMI and caesarean section within the North East of England. Methods and Results My PhD consists of three phases: Phase one: a review of the available published literature that investigated the association between maternal BMI and caesarean section rate. The review found that most studies been carried out in the US with only six from the UK. The review highlighted the need for further research in the UK. Phase two: an investigation of the association between maternal early pregnancy BMI and caesarean section using an existing dataset of 42,362 deliveries in five hospitals in the North East of England. The objectives of this phase were; to identify the caesarean section rate among five hospitals in the North East of England; to describe the caesarean section rate by booking BMI; and to examine the independent impact of BMI on caesarean section, adjusting for potentially confounding variables including maternal age, gestational age, birth weight, ethnicity and socio-economic status in overweight and obese pregnant women compared to pregnant women with recommended BMI. In phase two, the overall caesarean section rate was 20.6%; 28.4% of obese and 21.9% of overweight women delivered by caesarean section, compared to 17.8% of women with recommended BMI. After adjusting for available confounding factors, the adjusted odds ratio (aOR) for caesarean section among obese women was 1.81 (95%CI: 1.67-1.97; p<0.0005) and 1.29 (95%CI: 1.20-1.39; p<0.0005) among overweight women compared to women with recommended BMI. Thus, there was an almost two-fold increased risk of delivery by caesarean section among women who were obese at the start of pregnancy and an increased risk for women who were overweight. Phase three: a case note review of 205 women with a singleton pregnancy in 2008, aged ≥16 years and delivered by caesarean section in a district general hospital in the North East of England. The study hypothesis was that overweight and obese pregnant women have more post-caesarean section complications than pregnant women with recommended BMI, resulting in a longer length of stay in hospital. The results of this study showed that from 205 cases (28% of all caesarean section deliveries in 2008), 86 (42.0%) were to women with recommended BMI, 54 (26.3%) to overweight and 65 (31.7%) to obese women. The median length of maternal stay in hospital was three days, with an inter quartile range (IQR) of 2-3. Twelve (18.5%) obese women stayed in hospital after caesarean section for four days compared to five (9.3%) overweight and eight (9.4%) women with recommended BMI, (p=0.44) but this was not significant. There were no significant differences in postoperative complications or length of stay in hospital between overweight and obese pregnant women compared to women with recommended BMI. Conclusion Overall, my study confirms that obese and overweight women in the North East of England are at increased risk of caesarean section. Among women delivered by caesarean section, however, there was no association between maternal BMI and post-operative complications or length of stay in hospital.Iraqi Ministry of Higher Education and Scientific Research

Prevalence of Obesity and Overweight among Public Primary School Students in Kirkuk City

Background: The prevalence of childhood obesity is increasing in both developed and developing countries. The purpose  of this study was to identify the prevalence of overweight and obesity among public primary school student's and to find out the relationship between BMI and some socio-demographical characteristics for the child and his family in Kirkuk city.Methodology: A cross sectional study (multistage) random sample, were carried out for a period from the 1st of November ,2013 to the 1st of March ,2014, it consisted of (566); (306) boys and (260) girls. The sample age ranged between (6 -12) years. A constructed questionnaire conducted for data collection. Height and weight were measured by the researchers in the school. The data was analyzed through the application of descriptive statistical analysis (Frequency, Percentage %) and inferential statistic (chi-square).Results: The prevalence of overweight and obesity among public primary students was 24.2%, (18%) for overweight, (6.2%) for obese. A significant association was found between BMI category and some demographical characteristics for the child such as, age, grade, and being the only child in the family.Conclusions and Recommendations: The total prevalence of overweight and obese was (24.2%) among public primary school students. Further study needed to find out the association between body mass index and eating patterns among primary school students in Kirkuk city Keywords: Prevalence, BMI, Public Primary School, Overweight, Obesit

Level of Psychosocial Problems among Children in a Refugee Camp in Kirkuk City

AbstractObjective of the study: The purpose of this study is to identify the demographic characteristics and to find out the level of psychosocial problems among refugee children as well as, the relationships between some demographical factors and psychosocial problems among children in Yahyawah refugee camp in city of Kirkuk.Methodology: A descriptive study was designed from September 1stand up to November 15th 2015. A non-probability purposive sample of 60 children with age ranged from four to twelve year, who displaced and lives with their families in Laylan, Yahyawah refugee camp in the city of Kirkuk participated in the current study. A designed questionnaire was used for the study. This questionnaire is a modified version of pediatric symptoms checklist (PSC) and it consists of two parts, a basic demographic characteristics and secondly, a part forms the inventory. The inventory comprised of 38 items organized into five subcategories. Three choices were for each item. The total score of the inventory was ranged from 38 to 114. The data was collected through interview with one of the parents. The data analyzed through the application of descriptive statistical analysis (Frequency, Percentage %) and inferential statistics.Result: The results found that) 53.3%) of the study sample were male and (40%) of them aged from (10-12 years) old. The psychosocial assessment showed that from (38) items, there was (35) items reported low level assessment concerning psycho – social aspect for children.A highly significant association (p<0.007) found among child’s psychosocial problem and monthly income of the family.Conclusion: the study concluded that socio-economic status has a great effect on the psychological status of the children in refugee camps.Recommendation: Refugee camps need to be observed directly by the government in addition to the civil society organizations and provide these camps with suitable requirements and specific care particularly for children's, so they can grow in healthy environment.Key Word: Psychosocial problems, Children, Refugee Camp

Evaluation of nurse-midwives practices related to the preventive measures for TORCH diseases in maternity teaching hospitals in Babylon Province/Iraq

Background: Some infections are more common, but all of them need to be prevented as the primary infections of Toxoplasma, other infections (like a varicella-zoster virus, hepatitis B), Rubella, Cytomegalovirus, and herpes simplex virus (TORCH) diseases. Objectives: to evaluate nurse-midwives’ practices and to find out the relationship between nurse-midwives’ practices and demographic characteristics. A descriptive design study was conducted on (138) nurse-midwives in maternity teaching hospitals in Babylon province using observation checklist questionnaires. The data were analyzed by using descriptive statistics (frequency and percentage). A chi-square test was used to analyze categorical variables. The P-value was determined using a P-value of 0.05 to determine statistical significance. The majority of the sample (37.7%) was reported to be between the ages of (21 and 30) years. The majority of the study participants (69.6%) had no prior knowledge of TORCH diseases. The level of knowledge regarding TORCH disease prevention measures was low (63% of nurse-midwives). A significant relationship between nurse-midwives’ practices of TORCH diseases and their years of experience and training sessions at a p-value of (0.05).&nbsp

Nurse-midwives’ knowledge related to the preventive measures for TORCH diseases in maternity teaching hospitals in Babylon Province/ Iraq

TORCH infections cause congenital anomalies throughout the gestation period that can cross the placenta and damage the fetus. The study aimed to assess the nurse midwife’s knowledge regarding preventive measures for TORCH infections. A descriptive design study was conducted on 138 nurse-midwives in maternity teaching hospitals in Babylon province using self-administered questionnaires. The data were analyzed by using descriptive statistics (frequency and percentage). A chi-square test was used to analyze categorical variables. The P-value was determined using a P-value of 0.05 to determine statistical significance. Results: The mean age and standard deviation (SD) for nurse-midwives in the study was 34.11+8.967; the majority of the sample was (37.7%) reported at age 21–30 years. The majority of the study participants (69.6%) had no prior knowledge of TORCH diseases. The level of knowledge about TORCH disease prevention is low.93% of nurse-midwives had moderate knowledge. There was a significant relationship between nurse-midwives’ knowledge of TORCH diseases and their education level, their years of experience, and training sessions at a p-value of 0.05.&nbsp

Long-term visual outcomes of endophthalmitis and the role of systemic steroids in addition to intravitreal dexamethasone

Abstract Background The purpose of this study was to evaluate the role of systemic steroids in post-procedural endophthalmitis as the role of intravitreal steroids in treatment algorithms of endophthalmitis remain controversial. Methods This is a retrospective analysis from a single tertiary referral center of all patients older than 18 years old that developed presumed post-procedure endophthalmitis and were treated at our center from 2009 to 2018. Results Eighty-three patients were followed after being treated for post-procedural endophthalmitis that either received systemic steroids or did not around the time of diagnosis. Almost 30 % of all patients regained a final visual acuity of 20/40 or better, while 31.2% had poor visual outcomes of count fingers or worse. Non-clearing debris was the most significant long-term complication. Visual improvement plateaued in 67.7% by 1 month after diagnosis and initial treatment in both groups. There was no difference in visual outcomes when comparing the sixteen patients that received systemic steroids and the sixty-seven that did not; however, no enucleation or evisceration was required in patients receiving systemic steroids. Five patients that did not receive systemic steroids required an enucleation or evisceration due to a blind, painful eye. Conclusions The use of systemic steroids does not seem to worsen long-term outcomes of endophthalmitis compared to those patients that did not receive them and they may prove beneficial in the most severe cases by reducing the risk of losing the globe altogether.http://deepblue.lib.umich.edu/bitstream/2027.42/173592/1/12886_2020_Article_1449.pd

Effective testing for pulmonary tuberculosis using Xpert MTB/RIF assay for stool specimens in immunocompetent Pakistani children

Objective/background: Childhood tuberculosis (TB) is largely a paucibacillary disease and difficult to diagnose. It is difficult to obtain a sputum or gastric aspirate (GA) sample, and patients are often undiagnosed and treated empirically. Stool is a noninvasive specimen not usually used for TB testing in Pakistan. We investigated the value of Xpert MTB/RIF to diagnose Mycobacterium tuberculosis (MTB) in children with pulmonary TB cases, by performing comparative testing of GA and stool samples. Method: We recruited 60 children aged 1–15 years, suspected of TB, from the Department of Pediatrics, Civil Hospital, Karachi, Pakistan and The Aga Khan University Hospital, Karachi, Pakistan. All were immunocompetent. Patients had a Kenneth Jones TB score of ≥5. Paired GA/sputum and stool samples were collected for testing. All GA samples were tested by Xpert MTB/RIF assay and MTB culture, while stool was tested by Xpert MTB/RIF. Results: The study participants included 27 males and 23 females with a mean age of 6 years and a mean TB (Kenneth Jones) score of 7. Stool was received in the laboratory within 1–2 days of the GA sample for all but one participant, who expired. The rates of MTB detection were as follows: 22% (11 cases) based on Xpert MTB testing of GA, 21% (10 cases) based on MTB culture of GA, and 21% (10 cases) based on Xpert MTB testing of stool. No rifampicin resistance was detected. Overall, there was concordance between testing of GA and stool. One case had GA with low positive Xpert and positive MTB culture, but negative stool Xpert result. In another case, there was low positive GA Xpert, positive GA MTB culture, and positive stool Xpert. A positive Xpert MTB stool test was associated with a higher TB score (>5) and a greater bacillary load. All 11 cases of TB diagnosed were put on antituberculous therapy and responded well to treatment. Conclusion: Use of Xpert MTB/RIF assay for stool-based diagnosis of pulmonary TB in immunocompetent children is useful in a resource poor setting. This is a valuable and noninvasive diagnostic alternative for the diagnosis of childhood TB and can be adapted by pediatric arms of national TB programs

COMPARISON OF FATIGUE RELATED ROAD TRAFFIC CRASHES ON THE NATIONAL HIGHWAYS AND MOTORWAYS IN PAKISTAN

&nbsp; Driver Fatigue is one of the leading causes of Road Traffic Crashes (RTC) in Pakistan . An attempt has been made in this research to compare the proportion of driver fatigue related RTC on the Motorways and National Highways of Pakistan. Data were collected from the National Highways and Motorway Police (NHMP). Data for 2003 to 2012 of all RTC on Motorways and 2003-2011 on the National Highways (N-5) were examined extensively by applying Australian Transportation Safety Bureau (ATSB) criteria for determining fatigue related RTC. The Total number of RTC on Motorways during 2003-2012 was 1750 out of which 497 were fatigue-related. The total number of RTC on (N-5) during 2003-2011 was 5080 out of which 483 were fatigue-related. The average percentage of fatigue related RTC on Motorways was 28%, however on National Highways (N-5) it was found to be 10%. Fatigue-related RTC is thus more prevalent on the Motorways. It was also discovered that fatigue-related RTC result in mostly fatal accidents on the Motorway (54%) and serious injuries on N-5 (41%)

Purification of Sewage Wastewater though Sand Column Filter for Lessening of Heavy Metals Accumulation in Lettuce, Carrot, and Cauliflower

Sewage wastewater is one of the richest sources of mineral nutrients contributing toward plant growth and yield. However, the accumulation of heavy metals in the edible parts of vegetables and fruits can be dangerous to life. The current research aimed to evaluate the performance of a sand column filter for the elimination of heavy metals from sewage wastewater applied to selected vegetables. The contents of heavy metals, i.e., Pb+2, Ni+2, Cu+2, and Fe+2, were estimated to be higher in untreated sewage wastewater than in treated water. The number of leaves, fresh and dry weights of leaves, roots, and total biomass of lettuce, carrot, and cauliflower were improved due to the irrigation of unfiltered sewage wastewater compared to sewage wastewater. The curd diameter, fresh and dry weights of curd, stem fresh weight of cauliflower, and the root length and diameter of carrot increased after irrigation with the unfiltered sewage wastewater in comparison to the treated sewage wastewater. The accumulation of heavy metals, i.e., Pb+2, Ni+2, Cu+2, and Fe+2, was higher in the roots, leaves, and edible parts of the selected vegetables. In the present study, the Cd+2 and Cr+2 concentrations were not affected by the filtration process through a sand column filter. Conclusively, filtration through a sand column filter is effective for the removal of heavy metals from sewage wastewater used to irrigate agricultural land