Epidemiology of viral hepatitis B and C in Iraq: a national survey 2005-2006

Viral Hepatitis Type Band C is serious public health challenge throughout the world. Hepatitis B and C viruses still remain to be the major causes of chronic hepatitis. It is estimated that around 350-400 million people in the world are chronic carriers of HBV, which represents approximately 7% of the total population whereas infection with HCV is found in approximately 3% of the world population, which represents 160 million people. Hepatitis B infection has a wide range of seroprevalence in the Mediterranean countries ranging from intermediate [=>2%] to high prevalence [=>7%]. World Health Organization estimated a prevalence rate for HCV infection of about 4.6% in Eastern Mediterranean in 1999. During the eightieths years of the last century, Iraq was considered to be of intermediate endemicity with hepatitis B as reflected by 3% seroprevalence of HBsAg in normal population. Hepatitis C was found to be of low endemicity among blood donors 0.5%. There were no national wide epidemiological studies regarding the prevalence of hepatitis Band C accordingly we conduct this study to determine the prevalence of both types all over the Iraq. From the 1[st] of January 2005 to 31[st] of December 2006, a community based cross-sectional study was conducted all over Iraqi governorates. A total of 9610 persons, recruited by surveying a nationally representative random sample of households were analyzed. A stratified random sample proportional to size of each of the 18 Iraqi governorates, both urban and rural areas were included. Prevalence estimates were therefore weighted and age-adjusted. Five [5ml] of blood samples were taken from the study subjects, and tested for hepatitis B surface antigen, antibody to hepatitis B core antigen antibody to hepatitis B surface antigen and hepatitis C antibodies. The national prevalence rate of HBs Ag was 1.6% and correlated positively with age. The prevalence rate of anti-HBs antibodies was 17%. The prevalence of anti-HBc was 9.7%. The prevalence of anti-HCV was low [0.4%]. The prevalence rate of anti-HBs anti-bodies in <10 years children is only 32.2%, which raise the issue of incomplete coverage of hepatitis B vaccine during the years preceding the study years. The findings revealed that Iraq is of low prevalence with HBsAg. On the other hand, hepatitis C was found to be of very low prevalence. As a marker of exposure to hepatitis B, Anti HBcIgG was found to increase with age

Epidemiology of poisoning in hospitalized children: a 10 years cross-sectional study in a teaching pediatric hospital, Baghdad, 1993-2002

Poisoning is an important cause of childhood and adolescence hospital emergency presentations and admissions and a major health problem in this population sector. The present study was designed to describe the epidemiology and pattern of poisoning in addition to its case fatality rate. A total of 1450 pediatric cases with poisoning admitted to the Central Teaching Hospital of Pediatrics, Baghdad, during the 10 years study period extending from the 1st of January 1993 to 31st of December 2002 were analyzed. The peak age for poisoning cases in the present study was 1-4 years, constituting about three quarters of total pediatric admissions with poisoning. Males were more frequent than females in the present work, and this gender bias was more evident in younger ages and less evident in teenagers. Non-medicinal substances were responsible for the major part [three-quarters] of poisoning cases, especially petroleum products and pesticides. The overall case-fatality rate was 2.6%. The risk of death was higher in the more vulnerable age groups [infants and neonates]. It was also higher in males and in cases with poisoning by other noxious substances eaten as food, followed by metals [mainly lead], systemic antibiotics and pesticides. However out of a total of 37 deaths attributed to poisoning that occurred during the present study period of 10 years, non-medicinal substances [especially petroleum products, pesticides and metals] were responsible for three-quarters of these deaths. Children under 5 sears of age are the most-vulnerable group for poisoning incidents. In addition Petroleum products, insecticides and lead metal were responsible for the highest proportion of poisoning admission and fatality necessitating special steps directed towards the prevention of these problems

Effect of disease duration and age on validity parameters of rk39 dipstick test in diagnosis of visceral leishmaniasis in Iraq

Visceral leishmaniasis is an important endemic disease in Iraq. To evaluate the performance characteristics and validity of rk39 dipstick test in diagnosis of visceral leishmaniasis, taking into account the effect of age and duration of the disease on validity. A sample of 300 inpatients with a provisional diagnosis of visceral leishmaniasis and available results of rk39 dipstick test were studied. The standard for establishing the disease status was a combination of classical clinical features together with good response to treatment with Pentostam. The longer the duration of symptoms the higher is the sensitivity and to a lesser extent the specificity of rk39 test. The sensitivity was significantly higher one week after the start of fever [96.8%] compared to the group of patients tested during the first week of their illness [61 .2%]. The specificity was slightly higher during the 2[nd] and 3[rd] week of starting fever [100%] compared to the first week of illness [94.4%]. On the other hand the age of patient had no impact on the validity of rk39 test. Both the positive and negative rk39 test results were highly reliable in confirming and excluding the diagnosis of visceral leishmaniasis assuming the clinical suspicion of the disease is in favour of clinical opinion and provided that the patient is symptomatic and the duration of fever is longer than one week

Analysis of small bowel tumors

Small bowel tumors are remarkably rare. The colon is affected 40 times than the small bowel. Even though the small intestine accounts for 80% of the length and 90% of the mucosal surface of the gastrointestinal tract, only 3-6% of the gastrointestinal malignancies arise from the small bowel. The aim of the study is to enlighten the subject in our community including: therapeutic intervention, the histopathologic types, the risk factors and outcome. Between January 1997 and January 2002, 40 patients with primary small bowel tumors were followed in Baghdad Hospital, Gastroenterology and Hepatology Hospital, Al-Mansour Hospital for Pediatrics at Medical City Teaching Centre and the Al-Zahraa Private Hospital, for presentations, preoperative investigations, operative procedures and outcome. Chi-square test or where appropriate Fishers exact test was used to assess for the statistical significance of the site of the tumor and outcome. The relative risk [RR] and odds ratio [OR] where possible, were used to measure the magnitude of developing a certain outcome [like death] in the presence of risk factor compared to its absence. P value less than the 0.05 level of significance is considered statistically significant. The 95% confidence interval was used to express the expected range of incidence rate of certain outcomes in the target population. The most frequent age group affected is 46-60. The most frequent symptoms in decreasing order were abdominal pain [75%], vomiting [72.5%], and weight loss [52.5%]. The most sensitive diagnostic procedure was barium study [84.6%]. Lymph nodes were the most common site of metastases 15 [37.5%]. The duration of follow up was from 2-60-months. The site: duodenum has the highest case fatality rate [62.5%] with an RR=9.9 which was statistically significant [p=0.006] as compared to the jejunum [25%] that has an RR=3.9 [p=0.16 NS]], then the ileum [6.3%]. Overall, the prognosis for patients with small intestinal tumors is poor. The duodenum as a site of the small bowel tumors was the only significant risk factor with regard to case fatality rate. Despite current advanced diagnostic modalities, the small intestine remains a difficult area to image with both radiographs and the endoscope