Background: Birth traumacommonly occurs in the 2 nd stage of labor due to forces of labor,contraction, twisting, traction of neonates through birth canalor as a sequel of obstetric intervention.The aim of current study was to assess the prevalence,types and risk factors predisposing for birth trauma among newborn babies atAl-Ramadi Maternity and Children Teaching Hospital,western Iraq. Methods: A case-control study conducted atAl Ramadi Maternity and Children Teaching Hospital, west of Iraq from October 2014 to February 2015. Neonates with birth trauma were involved and compared with other normal neonates as controls. Collected data included gender of neonate, birth weight, gestational age, occipito-Frontal Circumference, maternal age, residence, antenatal care maternalHypertension, Diabetes Mellitus, parity, plurality and mode of delivery.Results: The prevalence rate of birth trauma was 17.47 per 1000 live births. Male sex, LBW, overweight, prematurity, post-term babies, macrocephaly, maternal age, primigravida, irregular ANC, twin pregnancy, maternal diabetic, instrumental deliveries were significantly correlated with birth trauma. However, residence and maternal hypertensionwere found to be not associated with birth trauma. Cephalohematoma, Intraventricular Haemorrhage, subdural hematoma, soft tissue injuries, Erb's palsy were also causes of birth trauma. Conclusion: Birth trauma had remarkably high prevalence among newborn babies in our population. Early identification of fetal and maternal predisposing factors, enhancement of practical skills of birth attendants with elective caesarian deliveries for high risk pregnancies can reduce birth trauma.

Background: The appointment system is a common practice in primary health care clinics in developed countries. The patients and health care providers in the primary health care setting perceived the appointment system as an indicator of good quality service. Objective: The aim of this study was to survey patients’ and health care providers’ attitudes towards the introduction of an appointment system and their satisfaction with the existing ‘walk-in’ system in the primary health care setting. Subjects and Methods: A questionnaire survey was conducted included a convenient sample of 234 patients as well as 76 health care providers from two primary health care centers in Al-Karkh district, Baghdad governorate. The study used two separate questionnaires, for patients and staff. Results: Approximately half of the patients (51.7%) and the majority of the health care providers (85.5%) agreed on the introduction of the appointment system. The employee’s patients, highly educated patients, and patients with chronic illness showed a significant agreement to this idea. Most participants, patients, and providers agreed that reduction of workload, provision of quality care to the patient, and improvement of patient-provider relationship are the most important advantages of the application of an appointment system. While the lack of flexibility of this system was the main perceived disadvantage. Conclusion: Respondents showed great acceptance to the idea of introduction of the appointment system to be run concurrently with the existing walk-in system (mixed system) in the primary care setting in Iraq, and they preferred this system to be flexible and responsive to the needs and preferences of the patients as well as health care providers.

Background: Thyroid nodules are very common in clinical practice. Although most of thyroid nodules are benign, it is crucial to checkout which nodules are more likely to be malignant. Ultrasound is a major diagnostic tool for screening and evaluating thyroid diseases because it is safe, non-invasive, non-radioactive and effective.Objective: The aim is to identify the role of ultrasound in assessing thyroid nodules and to review various ultrasound criteria predicting malignancy.Patients and methods: A case series study conducted during the period from January 2015 to February 2016 at the First Surgical Unit, Department of Surgery, Baghdad Teaching Hospital by a team of surgeons. One hundred eighty Patients who underwent surgical intervention for nodular thyroid disease were included in the study. The ultrasound features of these patients were analyzed with respect to the number of nodules (solitary or multiple), size, echogenicity, consistency, the presence of calcification, border definition, vascular pattern and whether there was lymphadenopathy and / or local invasion to adjacent structures. The final diagnosis was confirmed by histopathological examination after surgery. The ultrasound features of thyroid nodules were studied for their correlation with benign and malignant lesions.Results: Among 180 patients with nodular thyroid disease, thyroid malignancy was found in 22 (12.2%) patients. Ultrasound features of thyroid nodules included significant echogenicity, consistency, calcification, border definition, vascular pattern and the presence of local invasion. Ultrasound features suggesting malignant nodules are solid and hypoechoic nodules, ill-defined borders, nodules with local invasion to adjacent structures, the presence of microcalcification and nodules that show increased vascularity on doppler study.Conclusion: Ultrasound is useful in evaluating nodular thyroid disease and is valuable for identifying many malignant and potentially malignant nodules. Despite that, no single ultrasound feature is reliable in making the diagnosis of thyroid malignancy, combining ultrasound suggestive criteria could aid in predicting malignant nature of a given nodule.