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PubMed2006

Risk factors for pre-term birth in Iraq: a case-control study.

BACKGROUND: Preterm birth (PTB)is a major clinical problem associated with perinatal mortality and morbidity. The aim of the present study is to identify risk factors associated with PTB in Mosul, Iraq. METHODS: A case-control study was conducted in Mosul, Iraq, from 1st September, 2003 to 28th February, 2004. RESULTS: A total of 200 cases of PTB and 200 controls of full-term births were screened and enrolled in the study. Forward logistic regression analysis was used in the analysis. Several significant risk associations between PTB and the following risk factors were identified: poor diet (OR = 4.33), heavy manual work (OR = 1.70), caring for domestic animals (OR = 5.06), urinary tract infection (OR = 2.85), anxiety (OR = 2.16), cervical incompetence (OR = 4.74), multiple pregnancies (OR = 7.51), direct trauma to abdomen (OR = 3.76) and abortion (OR = 6.36). CONCLUSION: The main determinants of PTB in Iraq were low socio-economic status and factors associated with it, such as heavy manual work and caring for domestic animals, in addition to urinary tract infections and poor obstetric history.

Journal Article↗

PubMed1964

A SURVEY OF HISTOPLASMIN SENSITIVITY IN IRAQ.

During the past two decades much has appeared in the medical literature concerning systemic fungus diseases, the reports originating from many areas of the world. None of the reports, however, deals specifically with the existence, prevalence, and distribution of histoplasmosis in Iraq, and a survey was therefore undertaken in 1963 to determine the level of histoplasmin sensitivity in that country. In this survey, 1715 persons, whose ages ranged from under one year to 76 years and who were representative of the whole country, were given a histoplasmin skin-test and a chest X-ray. The majority of the 1461 persons whose tests could be read were non-reactors and the nine (0.6%) positive reactors showed no clinical manifestation of the disease. The authors therefore conclude that histoplasmosis is probably not present in Iraq, or exists at such a low level that it has no public health significance.

Epidemiology↗

PubMed1964

CONGESTIVE HEART FAILURE IN WOMEN IN IRAQ.

Stimulated by the world-wide interest in cardiovascular diseases, the authors made a study of 1001 consecutive admissions to a female medical ward in Baghdad, Iraq, and found that 146 patients were in congestive failure on admission, and an additional 197 patients were suffering from primary cardiovascular disease without failure. Of the group in failure, 47.9% had rheumatic heart disease; none of these patients had been on chemoprophylaxis. Bilharziasis was associated with a considerable number of cases of hypertension and with a small percentage of cases of cor pulmonale. The authors feel that prevention of rheumatic fever and bilharziasis should constitute the corner-stone of any effective control programme of cardiovascular disease at this stage of medical development in Iraq.

Cardiovascular Diseases↗

PubMed2006

Children treated at an expeditionary military hospital in Iraq.

OBJECTIVE: To describe the treatment of children at an expeditionary military hospital in wartime Iraq. DESIGN: Descriptive, retrospective study. SETTING: The 332nd Air Force Theater Hospital in Balad, Iraq, January 1, 2004, to May 31, 2005. PATIENTS: All 85 children (of 1626 total patients) evaluated and treated at the hospital during the study period. INTERVENTIONS: Indicated surgical procedures performed on children. MAIN OUTCOME MEASURES: Age, sex, diagnosis, injury, operations, and complications for children during the study period. RESULTS: The 85 children (age range, 1 day to 17 years; mean, 8 years) represented 5.2% of all patients. Thirty-four (61%) of the 56 children for whom sex was recorded were male. Injury was the diagnosis for 48 children (56%). Of these, the cause was fragmentation wound in 25 children (52%), penetrating trauma in 11 (23%), burn in 9 (19%), and blunt trauma in 3 (6%). The site of injury was the lower extremity in 18 children (38%), head in 11 (23%), upper extremity in 8 (17%), abdomen in 8 (17%), and chest in 3 (6%). Nontraumatic conditions had congenital, infectious, gastrointestinal, and neoplastic causes. During the study, 134 operations were performed on 63 children. There were 5 deaths. CONCLUSIONS: Expeditionary military hospitals will encounter both injured and noninjured children seeking medical care. To optimize the care of these children, it will be necessary to provide the proper personnel, training, and equipment.

Adolescent↗

PubMed2004

Acute eosinophilic pneumonia among US Military personnel deployed in or near Iraq.

CONTEXT: Acute eosinophilic pneumonia (AEP) is a rare disease of unknown etiology characterized by respiratory failure, radiographic infiltrates, and eosinophilic infiltration of the lung. OBJECTIVES: To describe a case series of AEP, illustrate the clinical features of this syndrome, and report the results of an epidemiologic investigation. DESIGN, SETTING, AND PARTICIPANTS: Epidemiologic investigation of cases of AEP identified both retrospectively and prospectively from March 2003 through March 2004 among US military personnel deployed in or near Iraq. Survivors were offered a follow-up evaluation. MAIN OUTCOME MEASURE: Morbidity and mortality related to AEP. RESULTS: There were 18 cases of AEP identified among 183,000 military personnel deployed in or near Iraq during the study period, yielding an AEP incidence of 9.1 per 100,000 person-years (95% confidence interval, 4.3-13.3). The majority of patients (89%) were men and the median age was 22 (range, 19-47) years. All patients used tobacco, with 78% recently beginning to smoke. All but 1 reported significant exposure to fine airborne sand or dust. Known causes of pulmonary eosinophilia (eg, drug exposures or parasitic disease) were not identified. Epidemiologic investigation revealed no evidence of a common source exposure, temporal or geographic clustering, person-to-person transmission, or an association with recent vaccination. Six patients underwent bronchoalveolar lavage (median eosinophilia of 40.5%). All patients developed peripheral eosinophilia (range, 8%-42%). Mechanical ventilation was required in 67% for a median of 7 (range, 2-16) days. Two soldiers died; the remainder responded to corticosteroids and/or supportive care. Twelve individuals were reevaluated a median of 3 months after diagnosis. At that point, 3 patients reported mild dyspnea and 1 reported wheezing. All patients had finished treatment and had either normal or nearly normal spirometry results. None had recurrent eosinophilia. CONCLUSIONS: AEP occurred at an increased rate among this deployed military population and resulted in 2 deaths. Failure to consider AEP in the differential diagnosis of respiratory failure in military personnel can result in missing this syndrome and possibly death. The etiology of AEP remains unclear, but the association with new-onset smoking suggests a possible link.

Acute Disease↗

PubMed2006

Clinician to frontline soldier: a look at the roles and challenges of army clinical psychologists in Iraq.

Psychologists have a long and respected history of service during wartime that dates back to World War I. From the early days of scientific personnel selection, clinical psychologists have made a number of wartime contributions. Today, Army clinical psychologists serving in Iraq are providing behavioral health services as both clinicians and prevention specialists in order to meet the psychological and emotional needs of service members abroad. They are also performing as Army officers and soldiers contributing to the success of military operations as a whole. The authors, two clinical psychologists and Army officers currently deployed to Iraq, provide a small glimpse into the clinical and personal opportunities and challenges faced by wartime Army clinical psychologists.

Autobiographies as Topic↗

PubMed2005

Embedded journalists in the Iraq war: are they at greater psychological risk?

The current war in Iraq saw an alliance between the media and the military, a process called embedded journalism. The aim of this study was to explore whether this process affected the journalists' vulnerability to psychological distress. Eighty-five of 100 journalists approached agreed to participate; 38 (44.7%) were embedded. There were no differences between embedded and unilateral (non-embedded) journalists on demographic measures or in their exposure to traumatic events. Similarly, the two groups did not differ on indices of posttraumatic stress disorder, depression, psychological distress, and substance use. Based on General Health Questionnaire scores, one third of all journalists were psychologically distressed. There is no evidence from the recent war in Iraq suggesting that embedded journalists are at increased risk for psychological problems.

Adult↗

PubMed1980

Leishmania spp. in Iraq. Electrophoretic isoenzyme patterns. II. Cutaneous leishmaniasis.

Leishmania organisms isolated from the sores of patients in Iraq suffering from cutaneous leishmaniasis were compared between themselves and with Leishmania major, L. tropica and L. donovani, all of which had been identified on clinical and geographical grounds. The comparisons were made by examination of the electrophoretic mobilities of seven soluble enzymes: malic enzyme E.C.1.1.1.40; glucose phosphate isomerase E.C.5.3.1.9; glucose-6-phosphate dehydrogenase E.C.1.1.1.49; phosphoglucomutase E.C.2.7.5.1; malate dehydrogenase E.C.1.1.1.37; aspartate aminotransferase E.C.2.6.1.1 and alanine aminotransferase E.C.2.6.1.2. following thin-layer starch-gel electrophoresis. The Iraqi isolations of Leishmania spp. from cutaneous lesions fell clearly into two groups, one of which gave isoenzyme patterns identical to those of a marker stock of L. major isolated in the USSR, and the other which gave patterns identical to those given by L. tropica also from the USSR. Previously it had been thought that L. tropica alone was responsible for cutaneous leishmaniasis in Iraq. The L. tropica and L. major isoenzyme patterns clearly differentiated these organisms from L. donovani.

Electrophoresis, Starch Gel↗

PubMed2005

Multiple sclerosis in Iraq: does it have the same features encountered in Western countries?

OBJECTIVES: To characterize the clinical, demographic and epidemiological features of MS patients from the only specialised MS centre in Iraq. METHODS: Data for consecutive Iraqi MS patients attending the Baghdad Multidiscipline MS Clinic between 2000 and 2002 who fulfilled Poser et al. criteria for clinically definite (CD) and clinically probable (CP) MS were reviewed. RESULTS: We identified a total of 300 MS patients (164 females, 54.7%; 136 males, 45.3%) with a mean age of onset being 29.2+/-7.8 years and the duration being 8.6+/-5.9 years. According to the year of clinical onset of MS, a progressive increase in cases in the last two decades and a trend towards more females was noted. Initial symptom was reported as motor in 31.7%, sensory in 28.3%, optic nerve in 24% and brainstem or cerebellar in 22.3% of patients. The course was relapsing-remitting in 199 (66.3%) patients, secondary progressive in 56 (18.7%) and primary progressive (PP) in 45 (15%) patients. CONCLUSIONS: MS is not rare in Iraq; its demographic and clinical data were, in general, similar to those reported in Caucasian populations. There was some evidence for North-South gradient and a possible increasing incidence characterized by an increase in female preponderance during the last 2 decades.

Adult↗

PubMed2006

A neurosurgeon in Iraq: a personal perspective.

The practice of neurosurgery in a war zone provides enormous challenges and risks for the individual surgeon working in such an austere and hostile environment, but also provides a unique opportunity to treat a high volume of severe penetrating and blast injuries to the head, neck and the spine. The purpose of this article is to present the author's personal experiences and perspective as a military neurosurgeon working in the US Airforce Hospital in Balad (the 332nd Expeditionary Medical Group) Iraq in for 3 months in 2004. Strategies for managing the mass casualties, and the severe penetrating craniofacial trauma are presented and the reasons for the low mortality of troops injured in Iraq are discussed.

Craniocerebral Trauma↗

PubMed2005

Analysis of battlefield head and neck injuries in Iraq and Afghanistan.

OBJECTIVE: At the time of this study, the 1st place that an injured or ill American soldier in Iraq or Afghanistan would have been evaluated by an ENT-head and neck surgeon was at a tertiary care medical center as a result of air evacuation out of theater: Landstuhl Regional Medical Center (LRMC), Ramstein, Germany. By examining the ENT-related diagnoses of all air evacuations from downrange, we were able to match the patients classified as having battle injuries to determine the percentage with head and neck trauma. STUDY DESIGN: A prospective review of 11,287 soldiers air-evacuated from Afghanistan and Iraq, representing the 1st year of combat operations. A new, computerized patient-tracking system was created by our team to merge several disparate databases to generate and compile our data. RESULTS: The ENT-head and neck surgery department evaluated and primarily managed 8.7% of all patients evacuated out of theater by air to Germany. Other medical and surgical services managed 7.3% of all patients evacuated out of theater with overlapping ENT diagnoses. The number of potential ENT patients increased to 16% when one looked at all head and neck pathology instances seen by all medical and surgical departments hospitalwide. Of all patients air-evacuated and classified as having battle injuries, 21% presented with at least 1 head and neck trauma code. CONCLUSIONS: This is the 1st paper focusing on the role of the ENT-head and neck surgeon in treating a combat population and also the patterns of illness and head and neck injuries in a deployed force in our modern military. Improved soldier body armor has resulted in distinctly new patterns of combat injuries. Unprotected areas of the body account for the majority of injuries. SIGNIFICANCE: These findings should be used to improve the planning and delivery of combat medical care.

Adult↗

PubMed2000

Epidemiology of Echinococcus granulosus in Arbil province, northern Iraq, 1990-1998.

During the period 1990-1998, 99 cases of human cystic hydatidosis (12.4 cases per year) were surgically treated at the two main hospitals in Arbil province, northern Iraq, and from this the human occurence for the province was estimated to be 2 per 100,000 inhabitants. In the same area, 1270 sheep, 550 goats and 320 cattle were examined at slaughter for hydatid cysts and prevalence rates were found to be 15.0%, 6.2% and 10.9%, respectively. A decreasing tendency in livestock prevalences was found towards the end of the study period. As in humans, most of the hydatid cysts in livestock were located in the liver. Fertility of sheep cysts, i.e. those containing protoscoleces, was found to be significantly higher (64%) than that of goats (35.7%) and cattle (29.8%). The percentage of fertile cysts containing viable protoscoleces varied between 63 and 82% in the livers and between 72 and 79% in the lungs of the different animal species. A total of 97 stray dogs were examined post-mortem in the years 1991, 1992 and 1998, and Echinococcus granulosus worms were found in the intestines of 48 dogs (49.5%). High worm burdens (> 1000) were observed in 37% of the dogs, medium worm burdens (200-1000) in 41%, and low worm burdens (< 200) in 22%. In 1998, the prevalence of canine echinococcosis (24.3%) was found to be significantly lower than in 1991 (70.4%) and 1992 (60.6%). The prevalence of human hydatidosis did not differ significantly over the years, but the study confirmed that hydatidosis is endemic in northern Iraq, and that housewives, labourers and farmers appear to be at the greatest risk of infection.

Adolescent↗

PubMed1992

Effect of the Gulf War on infant and child mortality in Iraq.

BACKGROUND: Increased malnutrition and morbidity among Iraqi children after the onset of the Persian Gulf war have been reported by several fact-finding missions. The magnitude of the effect of the war and the economic embargo on child mortality remains uncertain, however. METHODS: We conducted a survey of 271 clusters of 25 to 30 households each, chosen as a representative sample of the Iraqi population. The households were selected and the interviews conducted by an international team of public health professionals independent of Iraqi authorities. In each household all women 15 to 49 years of age were interviewed, and the dates of birth and death of all children born on or after January 1, 1985, were recorded. RESULTS: The study population included 16,076 children, 768 of whom died during the period surveyed (January 1, 1985, to August 31, 1991). The age-adjusted relative mortality for the period after the war began, as compared with the period before the war, was 3.2 (95 percent confidence interval, 2.8 to 3.7). No material change in the relative risk was observed after adjustment for region of residence, maternal education, and maternal age. The increase in mortality after the onset of the war was higher among children 1 to less than 12 months old (relative risk, 4.1; 95 percent confidence interval, 3.3 to 5.2) and among those 12 to less than 60 months old (relative risk, 3.8; 95 percent confidence interval, 2.6 to 5.4) than among those less than 1 month old (relative risk, 1.8; 95 percent confidence interval, 1.4 to 2.4). The association between the war and mortality was stronger in northern Iraq (relative risk, 5.3) and southern Iraq (relative risk, 3.4) than in the central areas (relative risk, 1.9) or in Baghdad (relative risk, 1.7). CONCLUSIONS: These results provide strong evidence that the Gulf war and trade sanctions caused a threefold increase in mortality among Iraqi children under five years of age. We estimate that more than 46,900 children died between January and August 1991.

Child, Preschool↗

PubMed1978

Experimental studies on the suitability of aquatic snails as intermediate hosts for Paramphistomum cervi in Iraq.

Three of the most common species of aquatic snails in Iraq were examined for their susceptibility to infection with Paramphistomum cervi. Bulinus truncatus was the only susceptible species. No development occurred in Physa acuta or Lymnaea lagotis euphratica. These findings and a previous field observation that infection of B. truncatus with amphistome larvae is not uncommon indicate that B. truncatus is an intermediate host of P. cervi in Iraq. Young snails of B. truncatus were more susceptible to infection than older ones.

Animals↗

PubMed1983

Alveolar hydatid disease of the liver: first case report from man in Iraq.

Hydatid disease is endemic in Iraq, mainly in the north. At least 500 cases of infestation by Echinococcus granulosus are recognized each year. The first documented human case of E. multilocularis in the liver is reported from Iraq. The patient was a 40-year-old female farmer from the north who had never travelled outside her native town of Zakho.

Adult↗

PubMed2003

Annual mortality rates and excess deaths of children under five in Iraq, 1991-98.

Data from two parallel household surveys conducted in Iraq by UNICEF in 1999 show that under-5 mortality declined steadily from 1974 to 1990, reaching about 63 per 1,000 live births in the period 1986-90. It then rose dramatically to 118 per 1,000 in 1991, the year of the Gulf War. The number of 'excess' under-5 deaths (i.e., the number in excess of the number predicted from past trends) in Iraq between 1991 and 1998 was calculated assuming that, instead of the rates measured by the 1999 survey for this period, either (a) average mortality rates for the period 1986-90 had been maintained, or (b) mortality had continued to decline at the rate observed between 1974 and 1990. According to these calculations, the estimated number of excess deaths resulting from the Gulf War and its aftermath up to 1998 was between 400,000 (assumption a) and 500,000 (assumption b).

Child, Preschool↗

PubMed2006

Molecular characterization of beta-thalassemia in the Dohuk region of Iraq.

beta-Thalassemia (thal) is an important health problem in the Dohuk region of northern Iraq because of its high carrier rate and the frequency of consanguineous marriages. Thus, the need to establish an effective preventative program is paramount. As part of this effort, we initiated this study to determine the molecular basis of this disorder in the region. For the latter purpose, either parent of 104 registered beta-thal major/intermedia patients had their full blood counts, hemoglobin (Hb) electrophoresis, Hb A2 and Hb F quantitation performed. Their DNA was extracted, amplified and reverse hybridized to specific oligonucleotide probes to detect 20 beta-thal mutations. The testing detected 12 beta-thalassemic mutations. The eight most frequent were: IVS-II-1 (G-->A), codon 44 (-C), codon 5 (-CT), IVS-I-1 (G-->A), codon 39 (C-->T), IVS-I-6 (T-->C), codons 8/9 (+G) and IVS-I-5 (G-->C). These mutations accounted for 81.7% of the thalassemic defects in the studied individuals. The less frequent mutations were: codon 8 (-AA), IVS-I-110 (G-->A), codon 30 (G-->C) and codon 22 (-7 bp), and the beta-thalassemic defects remained uncharacterized in 11.5% of cases. This is the first study of beta-thal mutations from Iraq, and shows a frequency of thalassemic defects different from those reported in surrounding countries. It provides a foundation for prenatal genetic testing that will be part of a thalassemia prevention program in the Dohuk region.

Adult↗

PubMedDate not supplied

'Iraq Water Treatment Vulnerabilities': a challenge to public health ethics.

A formerly classified US document, 'Iraq Water Treatment Vulnerabilities,' provides evidence that ill health was knowingly induced in the population of Iraq through the ruination of that country's water purification system. We believe that the uncovering of this document should stimulate the public health community to clarify principles of public health ethics and to formulate statements giving voice to these principles. We propose here two statements, one dealing with the broad issue of public health ethics and international relations, and one dealing specifically with public health ethics and water purification.

Alum Compounds↗