Mosul Journal of Nursing

Pregnancy is not a disease, but it is a normal  physiological  process , it is associated with certain  risks to health . Healthy survival of both the woman and the infant she bears is the aim of good antenatal care.
Antenatal care is a preventive method of care it has been shown to be beneficial and cost effective for a pregnant woman who receives in an adequate antenatal care otherwise more complications and poorer  outcomes of pregnancy will appear. The cost of no A.N.C provided  to a pregnant woman is substantially high with increased  rates of complena complications like pre-eclampsia  low birth weight infants both premature and growth retarded and prenatal deaths.
The present study aims to evaluate the cost–effectiveness of the current antenatal care provided by the nurse . A descriptive  observational study was conducted  in AL-Hadba primary health care center Mosul city from 1st of March to 30 April 2004, The study include 2 groups first (group A) examine by the doctor only ( antenatal care without nursel . The doctor completed all information on the pregnant assessment card and physical examination for (100 women) measuring the time need by the doctor to complete this information in first and follow up visit .While was (2-7) min second (Group B) in antenatal care unit the investigator completed the information of pregnant card, gave advice and prepared (50 pregnant women)  for physical examination. The time needed for the nurse to complete the information of pregnant card was (2-7) min.
Analysis of the information in (pregnancy assessment card) indicate non-significant differences in the information gained by both the doctor and the nurse , but the time spend by nurse could  compensate that needed by the doctors for better services and (full pregnant assessment and healthily education). Aiming at reducing the complications such as hypertension which is most prevalent is one example of the cost –effectiveness of the squeal for missing a case of hypertension that will may be end in caesarean section is presented as (a case study).
In conclusion antenatal care should be appointed to a specialized nursing college  graduate Nurse should be appointed in every antenatal care clinic to fulfill their nursing role during the reception & follow up of pregnant  women who consulted the antenatal care the investigator thinks that it is very cost effectiveness to fulfill

Family planning services have potential in China to improve people's lives and economic well-being. Family planning methods have a temporary effect after which the ability to conceive and give birth returns to normal.  Contraception can be used based on the desire of both spouses to delay childbearing and to ensure the health of the mother and the fetus, (2013.http://alghad.com).  The aim of the study was to assess the level of knowledge of women's perceptions about family planning, and a descriptive study was conducted of (100) married women of childbearing at Al-Khansa Hospital and Al-Salam Teaching Hospital in the city of Mosul, the study results were that most of the Tamm were aged 35 years or more.  They forgot about (40%), and female employees the most use of family planning methods by (8%).  The study showed that women's knowledge about the female condom was Btseh (19%) and the condom with ballast (27%) by the official intrauterine device, intramuscular injection and the contraceptive pill got the same percentage (41 96), and this indicates that women do not have information about these  Means and accordingly, the researchers recommend increasing the eastern revolutions for women and the feature of housewives about the importance of family planning, educating women about family planning methods and the importance of each method and the urge to call, and from the periodic review to the Ummah Planning Center and from the scheduled appointments, with the aim of rationing the health risks for mothers that occur in the timetable and frequent work of the bile  Characteristic of very young and old age groups, planning the mortality rate of newborns and providing more opportunity for the mother to remain and breastfeed for a long time

Aims: This study aimed at assess health beliefs about cardiovascular disease among elementary school teachers at AL-Rusafa Side in Baghdad City.
Methods: A quantitative descriptive research used to test the approach to questionnaire items was conducted on teachers at elementary schools in Baghdad city from September 26^th  2020 to May 30^th  2021 to examine their health belief model related cardio vascular diseases. A total of 350 primary school instructors were included in the study. They are chosen using non-probability sampling (convenience sample). Data was collection through the use of a questionnaire and self report. Through the application the descriptive statistic, data were analyzed.
Results: Findings reveals that 233(66.6%) of teachers have unhealthy belief about cardiovascular diseases.
Conclusion: Two third of teachers have unhealthy belief Models regarding cardiovascular diseases, unhealthy belief in susceptibility, severity & barriers domain. Initiate training sessions to educate teachers about risk factors, signs and symptoms of CVD.
Key-wards: Health Beliefs, Cardiovascular Disease, Teachers.

Background and Objective:Sexual abuse is a major global problem that impacts millions of women and claims one survivor every 45 seconds, according to the American Medical Association. It is a significant public health issue, and the societal crisis has grown beyond the limits of social and cultural freedom. Indeed, SA survivors live with the aftereffects of the attack for the rest of their lives. This study aimed to look into Female Sexual Events Referred to Medico-Legal Institutes in Erbil.
Methods:The prospective research is conducted; it covers rape, newly-married, and trauma cases (fall from height or on sharp objects, and traffic accidents). The medico-legal institute received the cases at Rizgary teaching hospital in Erbil governorate between 1st December 2013 and 1st July 2014. It includes a total of 110 cases.
Results: These cases were classified as raped in 50 45%% of cases, traumatic in 30 27% of cases, and married in 30 27% of cases. In raped cases, the age ranged from (2-35) years old, with a mean of (17.446.42), among raped group majority of them have no trauma in the body years (76 % ),  and (64%) in non-use of force and weapon, with the consensual sexual act but regarded as a raped case because they are under 18 years old. And the most common site for the tear in the hymen is at 6 o’clock (i.e.) the posteroinferior area of the vagina. Regarding the duration of the tear in raped cases (32%) is new tear while for traumatic is (70%), and for married is (60%). For the type of sexual act, the most common route is both anal and vaginal, which is (58%). Regarding the frequency of anal injury in sodomy cases (56%), of them have an anal injury (dilated or funnel shape), but dilation with tear is about (2%).
Conclusion:We concluded from our investigation that the presence and extent of the tear in the hymen are critical factors in diagnosing cases of rape and trauma.
Keywords: Sexual Violence, Abuse, Female, Erbil

Background: Formaldehyde is the most widely used chemical in daily life; thus, chronic exposure to formaldehyde has been revealed to have negative effects on different organs in humans and animals.
Objective: This research was designed to investigate variable thyroid changes arising from chronic formaldehyde exposure by measuring different histomorphometry parameters in accordance with estrogen receptor and S-100 protein expression.
Materials & Methods: In this experiment, two hundred (200) rats were used and divided into two groups (100 male and 100 female), each group was subdivided into control and experimental groups each with 50 rats. The rats were exposed to formaldehyde using (20 ml =92.6ppm formaldehyde), 5hrs / d, for 21 days. Animals were sacrificed,  and thyroid sections were examined for histomorphometry using H&E stain and immunohistochemistry for localization of estrogen receptor and S-100 protein Results: Significant decrease obtained in histomorphometrical measurements in the area of the colloids, area of follicles and width, height and number of the follicles in the cells of both experimental groups with no significant effect of gender in both control and experimental groups except in the height of the cells which showed significant decrease in female more than male.  Formaldehyde exposure showed no significant effect on localization of estrogen receptor but significant increase of S-100 protein localization in both male and female groups. Conclusion: Formaldehyde had similar effect on histological structure of thyroid gland in both sexes causing disruption of thyroid follicles. Exposure of Formaldehyde had no effect on estrogen receptor but caused an increase in S-100 protein localization in both sexes.      
 Key words: Formaldehyde, Rat, Estrogen receptor, S-100 protein

Background: Breast lesions form a heterogeneous group of illnesses that affect epithelial and stromal tissues of breast. There are many factors such as demographic, social and biomedical hazard act as breast lesion development; generally, these factors can be grouped into hazard factors that can be altered (modifiable) and hazard factors that cannot be altered (non-modifiable).
Objectives: To identify breast cancer risk factors of breast among women attending to mammographic clinics in Kirkuk City.
Methods: A descriptive study design carried out in Kirkuk City among (100) women getting mammogram screening, selected by purposive (non-probability) sample. The study initiated from (September 26 ^th , 2020 –June 27^th , 2021).
Results: Fifty-one percent of women who visited the mammogram clinics were belong 40-49 years old with average age 44±9 years. Only 9% of women were smoking. While 21% of them were reporting that they were ex-smokers and 55% of them were some one smoked around. Only 6% of women were playing sport as running (3%) and daily walk (3%) that showed significant difference at p-value= 0.041.And the findings showed that 38% of them were eating a lot of sweet, but that was statistically insignificant. Most of women were eating a lot of fat and carbohydrate (84%) that showed significant difference at p-value = 0.029. Meanwhile only 34% of women were eating red meat, 56%, eating white meat, and 71% eating fresh fruit and vegetable but all that were statistically insignificant appeared.
Conclusion: Age and unhealthy physical and dietary behaviour may associate with breast health problems.
 Key words: Risk Factors, Breast Lesions, Women.

The appropriateness of the interactions between Prolactin, gonadotrophins and testicular hormones ensures that normal spermatogenesis takes place in the male. So this study is an attempt to classify male infertility depending on WHO criteria of seminal changes and to evaluate serum Prolactin, Testosterone FSH and LH levels in the participants, also determine the association between serum Prolactin, Testosterone levels and  subtypes of male infertility. This study involved three hundred  infertile males having infertility more than one year (cases group) and three  hundred  age-matched fertile males with definite paternity in past two  years (control group) were included to the study from Jan  2018 -Dec 2020 at Shahid Ali Qader  consultant clinic in the Sulaimanyah city. Serum levels of hormones were measured by electrochemiluminescense immunoassay technique. Approximately half of patient's age ranged between 30- 39 years. Sixty eight percentage of cases complained from primary infertility. About 71.3% of patients had infertility duration between 1 - 5 years. This percentage decreased with increasing the infertility years. Most common infertile group was Asthenospermia (34.3%). A higher significant levels of serum Prolactin, FSH and LH found in cases than controls (p<0.001). However, the serum Testosterone levels was significantly lower in cases than controls (p<0.05). Moreover, serum Prolactin levels were found significantly elevated in all infertile subgroups (except Normospermic subgroup) compared to control group, while serum Testosterone levels were significantly decreased in all infertile subgroups (except Normospermic subgroup) compared to control group (p<0.05). So we conclude that; Poor spermatogenesis is associated with high serum Prolactin, FSH,LH levels and low serum Testosterone levels in patients with male infertility. Moreover, elevated serum Prolactin levels and decreased serum Testosterone levels were significantly associated with A, AT, OAT, Azoo and OA infertile males.
Keywords: Male infertility, primary and secondary infertility, Prolactin, Testosterone, spermatogenesis.

Abstract
Background and Aim: In Wuhan, Hubei Province, China, a new coronavirus, now known as SARS-CoV-2, produced a series of acute atypical respiratory diseases in December 2019. A number of studies have investigated for risk factors in attempt to provide prevention and treatmentoptions for the general public. Obesity, along with other comorbidities such diabetes, hypertension, coronary artery disease, and heart failure, has been recognized as a risk factor for catastrophic outcomes in patients with COVID-19 infection. Thus, the present study aimed to determine the association between the incidence of COVID-19 infection and BMI according to the demographic data.
Materials and Methods: This cross-sectional was conducted in the Iraq-Erbil city between 15th October 2020 to 5th of February 2021. Inclusion criteria were participants that tested positive for SARS-COVID-2. The patients classified according to their weight into 6 classes. The semi‐quantitative analysis of IgG and IgM anti‐SARS‐CoV‐2 antibodies was carried out for 200 enrolled participants by ELISA and also vitamin and ferritin level measured for the patients.
Results: The incidence of COVID-19 infection was higher among male by 4% than female. The highest percentage of COVID19 infection reported among the age group of (30-39) years old. The prevalence of the mentioned infection was higher among class 1 obesity group. A total of 200 IgG and IgM tests revealed that the underweight and class 3 obese patients had the highest percentage of positive cases in IgG testing by (100 %) while the obese patient class 1 reported highest percentage of positive IgM cases (47.36 percent). Furthermore, the highest number of underweight people (100%) had vitamin D3 deficiency among patients and the highest percentage of iron deficiency anemia was among class 3 obese patients (25%).
Conclusions: The present study concluded gender balance in COVID19 incidence. The infection of COVID-19 was found in all age groups. However, middle age group appears to be more susceptible. The highest IgG and IgM reported among obese patients. The highest number of underweight people had vitamin D3 deficiency. In contrast, the highest percentage of iron deficiency anemia was reported in class 3 obese patients
Keywords: Age, Body Mass Index, COVID-19, Gender, Vitamin D.

Background: Psychological stress has an obvious effect on vital signs of patients with covid-19 The body responses to psychological stress includes tachypnea, pulse rate, blood pressure, and temperature. which will lead to increasing the respiratory rate and increase the length of hospitalization therefore, this study was endeavored to examine the causal relationship between hospitalization-related Psychological stress and change vital signs among the targeted subjects.
Aims (s): Examining the impact of psychological stress on the vital signs prognosis of hospitalized adult patients with Covid-2019 in respiratory isolation wards This can be done by  determining  the difference between the prognosis of stressed & non-stressed patients.
Design: A longitudinal design was used to accomplish the above-mentioned goals.
Methods: A purposive sample of 140 patients with Covid-19 who were hospitalized in respiratory isolation wards in two public hospitals, in Baghdad city. The data collection process started December 25^th - 2020 – April 15^th  2021. Two measures were conducted at seven-days intervals. The Depression Anxity Stress scales (DASS) was the selected tool to examine the study main variables.
Result: There is a statistically significant difference of respiratory rate in response to psychological stress between the 1^st and 2^nd measures (P=0.004, Sig=0.001 ).
Concluation: The study show, There is a statistically significant difference of respiratory rate in response to psychological stress between the 1^st and 2^nd measures (P=0.004, Sig=0.001 ).
Recommendation: mointoring vital signes, Provide psychological support to the patient with covid-19.   And all adult age groups must be careful of infection with the virus.
Keywords: Covid-19, vital signs, prognosis, psychological stress.

Research Question: What is the knowledge of nurses in assessing patients with delirium in critical care units in Baqubah?
Aim of this study: An evaluation of nursing knowledge regarding delirium assessment in adult Critical care units.  
Method:  A quantitative descriptive survey was carried out among 36 staff nurses working in Critical care units in Baqubah teaching hospital. A self-reporting questionnaire was used to collect data to answer the research question. 
Sample: All qualified nursing staff meeting outlined criteria and working in the Critical care clinical areas in the selected hospital were invited to participate in the study. A response rate of 80% (n=36) was achieved.
Findings: More than half of the nurses reported that they don’t using validated tools to assess for delirium during their practice. However, critical care clinical practice in Baqubah lacks established protocols to screen for delirium resulting in non-adherence to clinical practice guidelines. Barriers and poor perceptions were identified in this survey in relation to delirium screening. This information can inform future care planning and care to be used to improve standards and quality of care in intensive care units.
Keywords; Nurse, Nurse Knowledge, Delirium, Critical care units, Adults.

Background: There is effect of sertraline on oxidative stress in patients with depression.
Objective: To assess the oxidative stress and total antioxidant capacity in patients with depression, and  evaluate the effect of antidepressant (sertraline) on the oxidative stress and total antioxidant status.
Design: comparative case-series study. 
Setting: The study was conducted in consultatory clinic outpatient departments  of psychiatry physicians.
Methodology: The study period between Nov.1st, 2020 and April.1st, 2021. Thirty female patients newly diagnosed with depression and thirty, sex and age-matched healthy volunteers as control group were participated in the study. Malondialdehyde (MDA) and total antioxidant status (T-AOC) were measured control group and also measured in patients with depression before and after taking sertraline therapy for two months duration.
Results: Depressed patients have higher MDA values than that of the control group (9.191 ± 2.796 and 3.21 ± 0.94 nmol/ml respectively) (P-value = 0.001) and lower level of T-AOC (9.44 ± 3.210 U/ml)  in depressed patients than that of control group (11.26 ± 2.98 U/ml) P-value = 0.027)
MDA values of newly diagnosed patients(9.191 ± 2.796 nmol/ml) were significantly higher than that of patients taking sertraline treatment for 2 months (6.123 ± 1.889 nmol/ml) (p<0.001). The T-AOC values of newly diagnosed patients (9.444 ± 3.210 U/ml) were significantly lower than that of patients taking sertraline treatment for 2 months (10.142 ± 2.362 U/ml) (p<0.122).
Conclusion:  The present study demonstrated that depressed patients have increased level of malondialdehyde and decreased level of total antioxidants capacity than the control group while depressed patients treated with sertraline for two months  have decreased level of MDA and increased levels of T-AOC than their levels before treatment. This result may give a new insight that sertraline may exhibit its effect in the management of depression by acting as an antioxidant.
Keywords: Depression, Oxidative Stress, Sertraline.

Background and objectives: Gastrointestinal endoscopy is a valuable diagnostic and therapeutic tool for the care of patients with gastrointestinal and pancreaticobiliary disorders. Compliance with accepted guidelines for the reprocessing of gastrointestinal endoscopes between patients is critical to the safety and success of their use. This study aimed to assess the nurses' infection control practice and identify the prevalence of fungal and bacterial growth on gastroscopy and colonoscopy instruments.
Methods: A descriptive study was carried out on a purposive (non-probability) sample of all nurses who worked in the gastrointestinal endoscopy units at Hawler and Rizgari Teaching Hospitals in Erbil City from January to June 2016 from where the sample specimens were also taken. The questionnaire consisted of three parts. The first part included sociodemographic data, the second part contained nurses' infection control practice before, during and after the endoscopy procedure including pre-cleaning, leak testing, manual cleaning rising, disinfection, rinsing, drying and storing instruments. The third part of the questionnaire was used to document 80 endoscopic specimens, which were collected from the endoscopic instruments.
 
Results: The findings of the study revealed that the majority of nurses (38.5%) were within the 25-35 years age group, 61.5% were males and having less than 5 years experience. The infection control practices for endoscopy procedure showed that a majority (69.2%) of nurses practised at a fair level. The Grams stain smear results showed positivity of 65.62% for fungus and 34.375% for bacteria. All the fungi isolated belonged to the Candida species.    
Conclusion: The study concluded that the infection control of endoscopic procedures performed by nurses was inadequate. The swab cultures from the automated endoscope reprocessors, in combination with other bacterial isolates, showed that the Candida species were present in the endoscopic specimens. 

Background:Treatment of recurrent breast cancer, like treatment of early-stage breast cancer, is based on consideration of  tumor biology and clinical history. Thus, characterization of tumor hormonal and HER2 status is critical for all patients, and a detailed assessment of past treatment, including timing of therapies as well as patient symptoms and functional assessment, is essential. Determination of hormone receptor status and HER2 status should be repeated in all cases of first recurrence when diagnostic tissue is obtained because there may be discordance between the primary and recurrent tumors.
Aim of study: 1-To determine the rate of discordance of estrogen ,progestron and epidermal growth factor2 (HER2) receptors between primary and recurrent breast cancer.
2-To study the effect of the discordance on patient's disease free survival
 Patients and method: The study was conducted retrospectively and included 100 Iraqi female patients attended Baghdad oncology teaching hospital between January 2012 and December 2017 for whom estrogen receptors , progesteron receptors status were known at time of diagnosis and had been obtained on new tissue biopsy at time of recurrence.
 Results: 1-The rate of discordance for estrogen receptors ,progestron receptors and HER2 receptors between primary and recurrent tumor are 24%,27%,17% respectively
2-There was not statistically significant difference in the disease free survival between concordant and discordant cases for both estrogen receptors and progestron receptors while there is a significant difference in form of increase disease free survival of the epidermal growth factor 2 receptors discordant cases compared to concordant ones.
Conclusion:The effect hormonal receptors discordance on disease free survival not statistically significant ,while the gain of HER2 receptors after recurrence is associated with better survival.

Background : stress is one of the chief psychological and social difficulties that individuals and organizations suffer from both, negatively disturbing the health of the individual and his professional achievement, as well as the good running of the institution.
Objectives : a descriptive design was used to examine the levels of stress of nurses working in general wards at teaching hospitals in Baghdad City.
 Methods : correlational study; the study took place between November 16, 2020 and April 19, 2021. Using a non-random convenience sample 70 nurses from Baghdad Teaching Hospitals' general wards. The data was collected using sociodemographic,) Gender, age, marital status, number of children, nursing qualification, years of service at work, and years of experience are among the seven variables).and Work-related psychological stress scale.
Finding: No association was found between the Work-related psychological stress and gender, age, marital status, do you have children, Nursing qualification and Years of servicing nursing of staff nurses working in general wards.
Conclusion : Implementation of programs aimed at education nurses how to deal with work stress and its effects as well as enhancing the capabilities of nurses regarding Coping and problem solving strategies. The need for future research that should be directed at the effects of stress management.

Background and Aim: Home quarantine or home isolate is an uncomfortable experience for most people because it restricts their freedom and causes them to be fearful of losing their employment, being bored, becoming isolated from others, fearing illnesses, experiencing sadness, and experiencing anxiety. This study aimed to assess the prevalence and associated factors of anxiety, depression, and stress among graduating class students. The purpose of this study was to determine the degree of stress, anxiety, and depression among university students. To explore the relationships among mental health state (stress, anxiety, and depression) and demographic variables (gender, marital status, occupation, residence, and family Infected with COVID- 19. 
Method: A cross-sectional design using online data collection using Google forms was carried out from 27th June 2021 through 29th September 2021 to achieve the present study's objectives. A probability sample (random) consisted of 252 students consist of (150) male, (102) females were from the University of Mosul. The DASS is a 42-item questionnaire that contains three self-report measures for measuring depression, anxiety, and stress.
Results: Male students scored higher average scores than female students in stress and depression, while females scored higher average scores in anxiety. Single students scored higher average scores than married in stress, anxiety, and depression. Students who had work scored higher than others in stress and depression.
Conclusions: stress, anxiety, and depression were significantly positively correlated with each other (Ps < 0.01). Also, stress, anxiety, and depression were significantly correlated with each occupation and marital status (Ps < 0.01). Students who had Relatives infected with COVID-19 were significantly positively correlated with each stress and depression.
Recommendations: Students' psychological state must be constantly measured, especially those who were infected with the virus or a member of their family, as well as lost their job and have a wife and children because they are the most psychologically affected groups due to the Corona pandemic.

Aim: The primary aim of this study is to determine the effect of clobetasol ointment with nitroglycerin ointment on the prevention of superficial phlebitis caused by Angio catheter. Secondary aim is to compare the effect of mentioned ointments on prevention of phlebitis.
Design: prospective randomized trial
Method: the study did not receive any funding. The target sample is 144patients admitted to surgical ward, randomized to 3 groups. The intervention involves application of clobetasol and nitroglycerin ointment in the distal part of the cannula; while the usual care group did not receive any tropical ointment in cannulation site. the data collection tools included demographic information, information about intravenous treatment and phlebitis measurement scale. In the intervention groups, after venipuncture, 1.5 cm (about 2 g) of ointment was applied, and the site was dressed with sterile gauze. In three time periods of 24, 48 and 72 hours from the time of venipuncture.
Results: the age group of 18 to 30 years was the most common age group. The most common site of cannulation was the back of hand.in the first 24hours after the placement of cannula, there was no significant difference between the three groups. But at 48 and 72 hours after placement, the difference between intervention and control groups was significant (P <0.0001).
Conclusion: it is recommended to use clobetasol ointment and nitroglycerin ointment to prevent the occurrence of phlebitis in patients who need long-term use of Angio catheter (more than 48 hours).
Trial registration: NCT04685031 registered on https://www.clinicaltrials.gov/

Background: Breastfeeding is a factor in the health of both the kid and the mother. However, research on how a manner of birth affects breastfeeding is scarce. Caesarean section rates are high, and breastfeeding rates are low, which are major public health problems in all developing countries.
Objective: The study aimed to evaluate the impact mode of delivery on breastfeeding practices.
Methods: A quantitative/prospective longitudinal study was conducted in a maternity teaching hospital from April 24 to October 5, 2021. The study included 215 patients, 105 of whom had a cesarean section and 110 of whom had a vaginal delivery. The participants were followed for two months after childbirth. A questionnaire was used to collect demographic information and the kind of delivery. In-person interviews were used to finish all of the subjects.Using SPSS version 24 software, researchers analyzed and interpreted data using descriptive statistical analysis, inferential chi-square test, and multivariate conditional logistic regression statistical analysis.
Results: The study found that women who gave birth vaginally were more likely than those who had a cesarean section to breastfeed during the first hour following birth. In terms of skin-to-skin contact immediately after birth, rooming-in, the initiation of breastfeeding, from delivery to first breastfeeding duration, barriers to exclusive breastfeeding, and many lactations per day, there was a statistically significant difference between mothers who had vaginal deliveries and mothers who had caesarean deliveries.
Conclusion: After two months of follow-up, the study found a statistically significant relationship between mode of delivery and breastfeeding practice.