Introduction and aims: Hypertension (HTN) is a chronic and common condition that causes health issues, such as stroke and heart failure, causing substantial disease burden and mortality. This study aimed to explore the prevalence of HTN and determine its risk factors in Zakho, Iraq. Methodology: This cross-sectional study occurred between 15 January 2024 and 18 March 2024. A multistage sampling method was utilized, with interviewers administering questionnaires to random households selected by a number generator. Results: A total of 537 participants were included, comprising 64.2% (n = 345) males and 35.8% (n = 192) females, with an average age of 35.75 (±13.89). The study showed that the prevalence of HTN was 9.5% (n = 51). A univariate analysis revealed that increasing age (p < 0.001), high waist circumference (p < 0.001), no education (p < 0.001), marriage (p = 0.001), unemployment (p = 0.04), non-smoking (p = 0.03), hyperlipidemia (p < 0.001), and ischemic heart disease (p = 0.003) were significantly associated with HTN. The multivariate logistic regression revealed that hyperlipidemia (adjusted odds ratio (aOR) = 3.729; 95% CI: 1.762-7.891), age (aOR = 1.056; 95% CI: 1.030-1.083), and non-smoking (aOR = 0.333; 95% CI: 0.142-0.781) were significant predictors of HTN, with p-values of 0.001, <0.001, and 0.011, respectively. Conclusions: A high prevalence of HTN was found among those having multiple comorbidities and was significantly associated with age and hyperlipidemia. Public awareness campaigns, targeted intervention for high-risk groups, and healthier lifestyles are crucial to combat HTN.

For efficient undergraduate medical research education at the College of Medicine, University of Zakho, three research modules, known as "Student Selected Components" (SSCs), have been added to the college’s academic curriculum. These modules aim to enhance research skills and encourage problem-solving via community-based health projects. More than 50 peer-reviewed publications and around 30 national and international conference presentations were the result of this program, which was under the mentorship of college academics and external researchers. This project has substantially enhanced the university's academic reputation and approval. This paper investigates the transformational effect of SSCs in fostering students’ research orientation, development, and institutional reputation. Moreover, it represents a successful experience, serving as a model for other colleges in the country to follow.

Background: The rise in antimicrobial-resistant Escherichia coli (E. coli) strains pose a serious threat to global public health, necessitating coordinated efforts from government and the broader community to combat this growing challenge. This study aimed to analyze the antibiotic sensitivity of E. coli isolates from urine samples over a 10-Year Period collected from patients in Duhok, Kurdistan Region of Iraq. Methods: This cross-sectional study was conducted between December 2013 and January 2022. A total of 531 midstream urine samples were collected from patients with confirmed urinary tract infections. E. coli isolates were identified using standard culture methods and confirmed through biochemical testing. Antibiotic susceptibility testing was performed using the VITEK 2 system. Results: E. coli isolates exhibited the highest resistance rates in 2022, particularly against amoxicillin (84.2%). Overall, the most resistant antibiotics were amoxicillin (76.46%), ceftazidime (67.8%), and ceftriaxone (57.63%), while the highest sensitivity was observed for meropenem (95.86%) and imipenem (94.92%). Male patients exhibited higher resistance rates to several antibiotics, including ceftazidime, ceftriaxone, and ciprofloxacin (p ≤ 0.001), whereas no significant gender differences were observed for carbapenems or nitrofurantoin (p > 0.05). Conclusion: The findings indicate that E. coli isolates from urine samples demonstrated high resistance to amoxicillin, ceftazidime, and ceftriaxone, while maintaining high sensitivity to meropenem, imipenem, and amikacin. Gender-related differences in resistance were significant for several antibiotics, with higher resistance rates observed in male patients. Further multicenter studies across broader regions of Iraq are recommended to monitor and address the evolving resistance patterns of E. coli uropathogens.

Background and objectives Hepatitis B virus (HBV) infection remains a significant global health challenge, particularly in developing countries. Despite the availability of an effective vaccine, chronic HBV infection continues to cause substantial morbidity and mortality. This study aimed to determine the prevalence and associated risk factors of HBV infection in Zakho City, Kurdistan Region of Iraq. Methods A population-based cross-sectional study was conducted on 26 February 2025 in Zakho City, Kurdistan Region, Iraq, using a multistage random sampling method. Data were collected from 386 participants through structured face-to-face interviews and serological testing for hepatitis B surface antigen (HBsAg) and anti-hepatitis B core immunoglobulin G antibody (HBcAb) using enzyme-linked immunosorbent assay. Results The overall HBV positivity rate (HBcAb-positive) was 8%, with 7% indicating past infection (HBcAb-positive, HBsAg-negative) and 1% indicating chronic infection (HBcAb-positive and HBsAg-positive). In the multivariate analysis, HBV positivity was significantly associated with older age (P = 0.001) and male gender (P = 0.026). The highest prevalence (32.1%) was observed among participants aged ≥ 60 years. Conclusions The findings demonstrate a moderate prevalence of past HBV infection and a relatively low rate of chronic carriers in Zakho city. Older age and male gender were significant predictors of HBV positivity. These results underscore the importance of continued public health efforts in HBV screening, early detection, and vaccination, particularly targeting older and at-risk populations.

This study aimed to examine the association between breastfeeding practices and the risk reduction of childhood leukemia, and to identify the optimal breastfeeding duration for infant health. A case-control design was used, involving children aged 0–16 years diagnosed with leukemia and a matched control group without leukemia.MethodsData were collected on breastfeeding duration, type of feeding during the first six months, maternal characteristics (age, education, smoking during pregnancy, abortion history, birth control pill use), and child-related variables (sex, age at diagnosis, and birth order). Statistical analysis was conducted using SPSS Version 27. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated, and a p-value of12 months) was more frequent in controls (32%) than in cases (16%). Lower maternal education was significantly associated with leukemia cases (p = 0.001). Logistic regression showed exclusive breastfeeding (OR = 0.501, p < 0.001) and breastfeeding >12 months (OR = 0.721, p = 0.001) were protective.ConclusionExclusive and prolonged breastfeeding significantly reduce the risk of childhood leukemia. Maternal education is also an important factor, underscoring the need for public health initiatives to promote breastfeeding awareness

Background: Hepatitis C virus (HCV) infection continues to be a major public health concern. The advancement of directacting antivirals (DAAs) has transformed HCV therapy, making viral elimination possible. Nonetheless, experiencing a relapse following treatment continues to be a difficulty. Objectives: This research intended to evaluate the rate of HCV relapse 84 months after finishing DAA treatment. Methods: The study included 89 patients who had finished DAA therapy and achieved a sustained virologic response (SVR). These patients were monitored for as long as 84 months, with yearly follow-up appointments. Serological assessments for HIV and hepatitis B surface antigen (HBsAg) and HCV-RTPCR were performed. The average age of the participants was 23 years (±7 years). Results: Among the 89 patients, 41 (46.07%) exhibited genotype 1 (G1), 7 (7.87%) displayed genotype 3 (G3), and 41 (46.07%) represented genotype 4 (G4). The group was made up of 52 males (58.43%) and 37 females (41.57%). A co-morbid condition, thalassemia, was observed in 10 (11.24%). No patients showed positive results for HIV or hepatitis B. During the 84-month followup, no relapses or reinfections were noted. Conclusions: The research validates the effectiveness of DAAs in attaining a sustained virologic response and preventing HCV recurrence. Additional research involving larger groups and extended follow-up times is necessary to confirm these results.

Pseudomonas aeruginosa, a Gram-negative bacterium, causes a range of infections, including those affecting the skin and soft tissues, pneumonia, and sepsis. Its significance lies in its capacity to develop resistance to numerous antibiotic classes. In Iraq, infections caused by Pseudomonas are prevalent, especially within healthcare settings. Studies indicate a concerning level of antibiotic resistance in this microorganism. Information regarding the genetic basis of this resistance is limited in Iraq, with existing research typically involving small sample sizes. The growing resistance to β-lactams in Iraq is a serious concern, especially the extended-spectrum β-lactamases (ESBLs). Metallo-β-lactamases (MBLs) such as VIM and NDM are causing a rise in the resistance to carbapenems. The limited data about the resistance patterns to quinolones and aminoglycosides is another barrier. The high prevalence of Pseudomonas aeruginosa combined with limited data on its resistance pathways in Iraq highlights the need for continued surveillance, stronger infection control measures, and the development of more targeted treatment options to address this challenging pathogen.

Cholera remains a serious public health threat in Iraq. Since the start of the 21st century, the country has experienced multiple outbreaks, with the most recent epidemic occurring in 2022. In this paper, we examine cholera outbreaks in Iraq from 2020 to 2025, focusing on distribution patterns, public health challenges, and the impact of the COVID-19 pandemic on monitoring and control of cholera, with the aim of translating these findings into practical recommendations. Key contributing factors to recurring outbreaks are still prevalent in many areas of the country, including a shortage of access to safe drinking water, inadequate sewage infrastructure, conflicts, internal displacement, and low health literacy. Additionally, the COVID-19 pandemic has substantially impacted Iraq’s already exhausted health system and indirectly hindered cholera preparedness and response. In Iraq, cholera outbreaks tend to follow a geographical and seasonal pattern, with most outbreaks typically peaking between late summer and early winter. Despite predictable patterns, the government’s responses have remained exclusively reactive. A coordinated, forward-thinking approach is needed, with strengthening early alert systems, advancing local monitoring, and funding clean water and sewage facilities to achieve sustainable cholera control.

Introduction: This study aimed to determine the prevalence and associated factors of coronavirus disease 2019 (COVID-19) and long COVID-19 in children in Duhok province and Zakho city in the Kurdistan region. Methodology: The study was conducted as a cross-sectional study and included children aged 5–12 years in Duhok and Zakho, two major neighboring cities in the Bahdenan region of northern Iraq. A total of 330 participants were included and the study was conducted between October 2022 and April 2023. The children were tested for the presence of anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunoglobulin G (IgG) antibodies. A questionnaire was used to collect demographic and personal data, and symptoms of each participant to determine the prevalence of long COVID-19. Results: Out of 330 participants, 302 (91.5%) were positive for IgG, and 156 (51.7%) of them were male. Only 4 participants (1.3%) had pneumonia, and 282 (93.4%) were asymptomatic. Fourteen out of 302 (4.6%) participants had long COVID-19. There were significant associations between long COVID-19 and history of previous COVID-19 episodes (p = 0.001), presence of pneumonia (p = 0.001), and family history of COVID-19 (p = 0.005). Conclusions: There was a high prevalence of COVID-19 among children in Duhok province and Zakho city, and 4.6% of them experienced long COVID-19. Factors such as prior COVID-19, pneumonia, and family history of COVID-19 were associated with long COVID-19. Continued monitoring, education, vaccination, preventive measures, and supportive care are recommended to effectively address the impact of COVID-19 on the pediatric population.

We present this study to investigate various risk factors associated with hepatitis B in the Kurdistan region of Iraq. HBV Positivity. Among the 4091 study participants, 150 tested positive for HBsAg (3.67%). The prevalence of HBV positivity among females was 4.77% (136/2851). This was significantly higher than the prevalence of HBV positivity among males, which was 1.13% (14/1240) (p = 0.001). Risk factors for HBV infection. Various risk factors for HBV infection were considered, and the following factors were found to be statistically significantly associated with the HBV infection: gender, residence, marital status, receiving an injection, general operation, and history of tattoo (p = 0.001, 0.001, 0.0014, 0.001, 0.001 and 0.001 respectively). Multivariate analysis revealed that the association of surgical operation and history of tattoo to HBV infection is not statistically significant (multivariate p = 0.06325 and 0.0645, respectively). To conclude, 3.67% of the participants in this study were HBsAg positive; the predictive factors of infection were female gender, rural residency, and being married. Further population-based studies with larger sample sizes are needed to unify the results and be used to build a strong healthcare infrastructure to screen for hepatitis B.

Background Staphylococcus aureus is a gram-positive bacterium causing various infections, colonizing various human body sites, and leading to a wide spectrum of diseases. Antimicrobial resistance presents a growing and significant danger to worldwide public health, demanding urgent action from both governmental bodies and communities. Objectives This study aimed to analyze the antibiotic sensitivity of S. aureus for common antibiotics isolated from urine samples collected from participants at Azadi Teaching Hospital in Duhok, Iraq. Methods This study was conducted between January 2018 and February 2022. During this five-year period, a total of 396 samples were gathered from patients referring to Azadi Teaching Hospital, Duhok, Iraq. S. aureus strains were confirmed and tested in terms of susceptibility to various antibiotics using the VITEK 2 system (bioMérieux, Inc., Durham, NC). Results S. aureus isolates from urine samples from 2018 to 2022 showed the highest resistance rate in 2022. The highest resistance rate was reported for erythromycin (324, 81.82%) while the highest sensitivity rate was found for levofloxacin (275, 69.4%). Additionally, gender-based differences in antimicrobial susceptibility were negligible (p > 0.05), but generally, males had a slightly higher resistance rate compared to females. Conclusion According to the results, S. aureus isolated from urine samples varied in terms of the antibiotic susceptibility pattern with high resistance rates to erythromycin, penicillin, and oxacillin, while showing high sensitivity rates to levofloxacin, nitrofurantoin, and vancomycin. Further studies are needed with a broader geographical involvement to investigate the antibiotic sensitivity pattern in Iraq.

Objective This study aimed to study the prevalence of undiagnosed diabetes mellitus (DM) and its associated factors in adults aged over 18 in Zakho City, Kurdistan Region, Iraq. Methods A cross-sectional study was conducted recruiting 537 participants with a mean age of 35.43±13.88 years. Data on sociodemographic characteristics, health behaviors, clinical history, and anthropometric measurements, including body mass index (BMI) and waist circumference, were collected. Results The study sample comprised 345 (64.2%) men and 192 (35.8%) women, with 324 (60.3%) being married and 246 (45.8%) having a university-level education or higher. Regarding health behaviors, 218 (40.6%) participants engaged in physical activity, 180 (33.5%) were smokers, and 196 (36.5%) reported sleep disturbances, averaging 7.10±2.02 hours per night. Anthropometric assessments revealed that 209 (38.9%) were overweight, 131 (24.4%) were obese, and 273 (50.8%) had high waist circumference. The prevalence of abnormal glucose levels was 51 (9.5%) (95% CI: 7.02-11.98) including 14 (2.6%) (95% CI: 1.26-3.95) with undiagnosed DM and 37 (6.9%) (95% CI: 4.75-9.03) with prediabetes mellitus (pre-DM). Multivariate analysis showed significant associations between abnormal glucose levels and increased age (p<0.0001), high BMI (≥25 kg/m²) (p<0.0001), and high waist circumference (p<0.0001). Specifically, age was a significant predictor for pre-DM (adjusted odds ratio (aOR) 1.04; 95% CI: 1.01-1.07), while age and high waist circumference predicted undiagnosed DM (aOR 1.90; 95% CI: 1.03-1.16).

Background Hepatitis B (HBV) and Hepatitis C (HCV) are significant global health challenges, leading to severe complications such as liver cirrhosis and hepatocellular carcinoma. Despite available vaccines and treatments, these infections persist, particularly in regions like Iraq. Objectives and aims This study aimed to assess the prevalence of HBV and HCV among couples attending premarital screening programs in Zakho, Kurdistan Region of Iraq, and explore associated demographic risk factors. Materials and Methodology A retrospective cross-sectional study was conducted from 1st Oct 2019 to 31st Dec 2023, including 15,091 couples. Laboratory screening for HBV and HCV was performed using ELISA, followed by RNA quantification for HCV-positive cases. Results Out of the total of 15,091 couples, the overall prevalence of HBV was 0.92%, and HCV was 0.07%. Males, individuals aged 23-31, and urban residents had higher infection rates. Significant risk factors included being in the age group 23-31, male gender, and urban residency (p < 0.05). Conclusion The prevalence of HBV and HCV among couples in Zakho is consistent with regional data. Higher infection rates in males and urban areas suggest the need for targeted interventions, including public education and screening for high-risk populations.

Background and Objectives Hepatitis B virus (HBV) and hepatitis C virus (HCV) are significant global health challenges, leading to severe complications such as liver cirrhosis and hepatocellular carcinoma. Despite available vaccines and treatments, these infections persist, particularly, in regions such as Iraq. This study aimed to assess the prevalence of HBV and HCV among couples attending premarital screening programs in Zakho, Kurdistan Region of Iraq and explore the associated demographic risk factors. Methods A retrospective cross-sectional study was conducted from October 1, 2019 to December 31, 2023, including 15,091 couples. Laboratory screening for HBV and HCV was performed using enzyme-linked immunosorbent assay, followed by RNA quantification for HCV-positive cases. Results Of the total of 15,091 couples, the overall prevalence of HBV was 0.92% and HCV was 0.07%. Males, individuals aged 23-31 years, and urban residents had higher infection rates. Significant risk factors included age 23-31 years, male gender, and urban residency (P <0.05). Conclusions The prevalence of HBV and HCV among couples in Zakho is consistent with regional data. Higher infection rates in males and urban areas suggest the need for targeted interventions, including public education and screening for high-risk populations.

Background: Peptic ulcer disease (PUD) is a multifactorial disease whose global prevalence has reduced over the past years. Objectives: This study aimed to determine PUD's prevalence and risk factors and the associated risk factors behind this disease. Methods: A cross-sectional study was conducted in Duhok, Kurdistan, Iraq, between August 11 and December 17, 2022. A total of 218 patients (116 males and 102 females) who underwent upper gastrointestinal endoscopy by specialists at Azadi Teaching Hospital were interviewed face-to-face. The participants' ages ranged between 18 and 81. The upper GIT endoscopy was performed using a PENTAXI-scan 5000-type endoscopy. Results: The prevalence of peptic ulcers among the participants was 30 (13.8%), 27 (12.4%) duodenal ulcers and 3 (1.4%) gastric ulcers. Abdominal pain was the primary complaint, reported by (39%) of the participants, followed by heartburn (28.4%) and vomiting (6.9%). Regarding the risk factors for developing peptic ulcer among the studied cases, NSAID use was the highest risk factor (25.7%), followed by spicy food (21.6%), smoking (20.6%), family history (17%), and Helicobacter pylori infection (12.4%). A significant association was observed between H. pylori (P = 0.001) and gender (P = 0.001) with peptic ulcer. Additionally, (5%) of the participants reported melena as a complication, while only (2.3%) reported hematemesis. Conclusions: This study found that 13.8% of individuals undergoing upper gastrointestinal endoscopy exhibit peptic ulcers, with 12.4% manifesting duodenal ulcers and 1.4% exhibiting gastric ulcers. Identified risk factors for peptic ulcer disease include sex and H. pylori infection. Further research is crucial to thoroughly explore the impact of various factors on the development of PUD.

Background and aim The COVID-19 pandemic has globally impacted all sectors. Early vaccine development was crucial to curb the spread of the virus. However, concerns about vaccine safety and side effects have led to hesitancy. This study aims to examine and compare side effects associated with Pfizer/BioNTech, Oxford/AstraZeneca, and Sinopharm vaccines in Iraqi Kurdistan. Materials and methods A population-based study was conducted in the Kurdistan Region of Iraq from September 2022 to April 2023, involving 1,340 participants recruited through face-to-face interviews and online forms. The questionnaire collected demographic data and information on COVID-19 infection and vaccination status. Results Among the participants, 52.76% were females, with a mean age of 29.21 years (±13.09 SD). Of these, 67.84% received the Pfizer/BioNTech vaccine, and 60.9% had a prior COVID-19 infection. About 76.94% experienced post-vaccination side effects, lasting an average of 2.8 days (±1.92 SD). Notably, 60% reported no or mild side effects. Common side effects across all vaccines included injection site pain, fever, headache, and fatigue. Side effects were more frequent after the first dose and were highest with Oxford/AstraZeneca, followed by Pfizer/BioNTech and Sinopharm (p = 0.001). Higher rates of side effects were observed in participants aged 36-60, females, married individuals, those with chronic conditions, previously infected individuals, and those who contracted COVID-19 post-vaccination (p = 0.001). Conclusions This study reveals that most of the participants experienced either no side effects or only mild reactions following vaccination, with none of the side effects being serious. These findings are expected to boost public confidence and increase vaccine uptake, especially with booster doses now available.

Background and aim: The COVID-19 pandemic has profoundly impacted global health, necessitating the rapid development of vaccines to reduce its effects. However, concerns among healthcare workers regarding vaccine safety and side effects have led to increased hesitancy towards COVID-19 vaccination. Therefore, this study aims to assess the severity of adverse effects and associated factors of three COVID-19 vaccines among healthcare workers in Iraqi Kurdistan. Methods: A retrospective cross-sectional study was conducted among healthcare workers in Duhok province, Kurdistan Region, Iraq, with 625 participants aged 18 to 65 years (mean age 38.42±13.96) from August to December 2022. Data were collected through face-to-face interviews. The study questionnaire consisted of two parts: the first part collected demographic information about the participants, while the second part focused on their COVID-19 infection and vaccination status. Results: Of the total participants, 52.8% were female, with a mean age of 38.42 years (±13.96 SD). Approximately 67.5% received the Pfizer/BioNTech vaccine, and 60.9% had a prior history of COVID-19 infection. A significant proportion (82.24%) reported side effects, which were mostly mild or moderate, with 13.6% experiencing severe symptoms. The most commonly reported side effects across all three vaccines were pain at the injection site, fever, headache, and fatigue. Participants aged 36-50 reported significantly higher rates of severe side effects (87.88%, p = 0.047). Individuals with a history of allergies experienced significantly fewer adverse effects (48.93%) (p = 0.001). Those with prior COVID-19 infection also reported more severe symptoms post-vaccination (p = 0.001) and vaccine type-influenced side effects (p < 0.001), with Oxford/AstraZeneca recipients more likely to experience severe reactions compared to Pfizer recipients. Fatigue, chills, tremors, and myalgia were significantly more common in females than males (p < 0.005). Conclusion: This study identified the most common side effects of COVID-19 vaccines among healthcare workers in Kurdistan Region of Iraq. AstraZeneca vaccine was associated with a higher prevalence of systemic effects, including fever, fatigue, headache and myalgia. These findings provide valuable insights into the safety and side effect profile of COVID-19 vaccines in the region.

Sexually transmitted infections (STIs) are posing a challenge to public health, globally. The aim of this study was to determine the frequency of three STIs in married women, clinical characteristics, and their associated risk factors. A cross-sectional study was performed among married women who attended the Gynaecological Hospital in Zakho City, Iraq from October 2021 to April 2022. A total of 150 high vaginal swabs were collected from each subject aged between 18 and 48 years (32.64 years ±8.01 SD). DNA was extracted from swabs to determine STIs using Multiplex Real-Time PCR. The frequency of STIs was 26 out of 150 (17.33%). Chlamydia trachomatis accounted for 17 (11.33%), Trichomonas vaginalis 7 (4.66%), Neisseria gonorrhoeae 2 (1.33%). The highest rates of C. trachomatis, T. vaginalis, and N. gonorrhoeae were reported among young age groups. The level of education (p=0.043) and type of contraceptives (p=0.01) were identified as potential risk factors for T. vaginalis. The number of births (p=0.001) and using contraceptives (p=0.02) were reported as major risk factors for N. gonorrhoeae. Abnormal discharges (p=0.004), vaginal itching (p=0.03), painful intercourse (p=0.04), genital ulcers (p=0.03), and bleeding in the urine (p=0.001) were significantly associated with infections. The frequency of STIs was low in symptomatic patients but high among the reproductive age group. Education level, contraceptive usage, and number of births were identified as potential risk factors. Early detection of these factors is crucial for improving women’s health.

H. pylori is known to increase the risk of developing gastritis, peptic ulcer disease, gastric adenocarcinoma, and gastric lymphoma in adults, worldwide. This study aimed to determine the seroprevalence of H. pylori infection and risk factors associated with such infection among adult in Duhok province, Kurdistan Region, Iraq. This cross-sectional study was conducted among adult population in Duhok Province, Iraq. During the study period from 2018 to 2020, a total of 259 subjects aged more than 18 years who visited the general hospitals were included. H. pylori seropositivity rate was determined using un enzyme-linked immunosorbent assay (ELISA). A standardized questionnaire was administered to all study participants through face-to-face interview. The data obtained from H pylori IgG antibody were analyzed using the chi-square test. The prevalence of anti H. pylori IgG antibody positivity was present in 104 out259 (40.02%) of the adult. Among the studied variables, all the following risk factors were significantly associated with the presence of anti H. pylori IgG antibodies; male (p< 0.043), level of education (p<0.025), history of gastrointestinal diseases (p< 0.001), smoking status (p< 0.001) and a larger sibling number (p< 0.001). This study supports the hypothesis that H. pylori infection in adult is highly related to poor hygiene, smoking status, low level of education and crowded conditions. Therefore, it is crucial to implement effective strategies aimed at enhancing fundamental sanitary conditions, as well as improving educational level and socioeconomic status, in order to reduce the prevalence of H. pylori infection among adults in our region

Methicillin-resistant Staphylococcus aureus (MRSA) is the most common cause of infectious diseases among athletes, globally. There is very little data on the prevalence of these strains in Kurdistan region of Iraq, and none on the carriage among athletes. This study aimed to determine the prevalence and associated risk factors with MRSA and molecular detection of mecA gene among athletes. This study was conducted in Zakho City, Kurdistan Region, Iraq, nasal swabs were collected from 510 participants among various types of athletes following the completion of a questionnaire. Traditional bacteriological methods were used for the isolation of MRSA Staphylococcus aureus and oxacillin susceptibility test was performed as a preliminary step in MRSA identification. Then MRSA isolates were further analysed by PCR in order to detect the mecA gene. Out of 510 participating athletes, MRSA nasal carriage rate was 8.04% (41/510). The highest rate of infection was observed among football (10.71%) followed by gym (9.39%), but there was no significant difference between the various types of sports with MRSA (p=0.41). There was a significant relationship between gender and type of athletes (p=0.018). Nasal colonization of MRSA was significantly influenced by body mass index (p=0.006), previous use of antibiotics (p=0.02), previous surgical operation (p=0.002), duration of training/ day (p=0.025) and number of training sessions/week (p=0.047). mecA gene was then confirmed in 38/40 (95%) MRSA isolates. The MRSA infection rate in our study was higher compared to other studies conducted elsewhere and was significantly higher among male athletes; this was associated with personal hygiene and inappropriate use of antibiotics. More studies were recommended on molecular analysis of virulent genes associated with MRSA in athletes.

he severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic poses a danger to public health across the world. Specific and sensitive testing is vital to tracking and containing the infected individuals. This study examines the characteristics of 705 patients based on gender and age groups, with a focus on their CT (Cycle Threshold) values associated with E- and RdRp gene amplification. Among the patient cohort, 58.87% were male, while 41.13% were female. Notably, all males and females tested positive for the E gene, achieving a 100% detection rate, whereas the RdRp gene exhibited a slightly lower positive rate of 93.4% in males and 89.6% in females. Statistical analysis through the chi-square test revealed no significant disparities between target genes and gender. Additionally, a one-way ANOVA test demonstrated no significant distinctions between target genes and age groups. This study's findings suggest that gender and age do not significantly influence CT values for E and RdRp gene amplification, and there is no preferred gene for detection, providing valuable insights into the molecular characteristics of the studied cohort.

Anemia is a very important nutritional issue all over the world. It is most commonly present in preschool children with a prevalence of47.4%. Factors like low socio-economic status, large family size, ignorance and illiteracy are associated with anemia among children less than five years. Aim: To estimate the prevalence of anemia and identify the factors associated with it in children aged 2–5 years. Patients and Methods: A cross sectional study included 798 pre-school children (2–5 years of age) selected from those children who visited health care centres and Heevi Pediatric Teaching Hospital. Dietary, biochemical and anthropometrical, and information were collected through a questionnaire. Children with hemoglobin (Hb) values of <11.0 g/dl were considered anemic. Heights, weights and Body Mass Index [BMI] were measured. Children with [BMI] above 85th centile was considered as overweight and above 95th centile as obese. Data such as past breastfeeding practices, birth weights, time of starting weaning food, duration of breastfeeding, type of weaning food, time of starting infant formula, child’s chronic illness, child’s eating habits, mother’s age, occupation and education were collected. Results: The overall incidence of anemia is 29.8% (238/798). The male: female ratio 1.03:1 in the anemic children. The body weight of the anemic patients was most commonly between 5th and 85th centiles, 155 (65.12%). The most frequent birth weight of the anemic patients was between 2.5 and 4 Kg,191(80.25%). Most of anemic patients had history of breast feeding for equal to or more than six months ,113(47.47%). The weaning foods of most of the anemic patients were cereals, vegetables and fruit 146 (61.34%). About 139 (58.4%) of patients were eating regularly and 156 (65.54%) with the family. Chronic illnesses were present in 63 (26.47%) among anemic patients. About 135(56.72%) of anemic patients had less than three siblings. The age of the mothers was less than 30 years in 112(47.05%). Illiterate mothers were 63(26.47%) among anemic patients and only 18 (7.56%) were employed mothers. The significant association was with the age (p<0.038), the frequency of eating with family (p<0.01) and chronic illnesses (p<0.001). There was a strongly significant correlation between hemoglobin concentration and age group, weight and height. Female was 1.009 times more likely to be anemic. Conclusion: The overall incidence of anemia is 29.8%. The gender, the age of starting weaning foods, the type of weaning foods and the presence of chronic illnesses are significant factors associated with the risk of anemia in the children in Duhok.

H. pylori is known to increase the risk of developing gastritis, peptic ulcer disease, gastric adenocarcinoma, and gastric lymphoma in adults, worldwide. This study aimed to determine the seroprevalence of H. pylori infection and risk factors associated with such infection among adult in Duhok province, Kurdistan Region, Iraq. This cross-sectional study was conducted among adult population in Duhok Province, Iraq. During the study period from 2018 to 2020, a total of 259 subjects aged more than 18 years who visited the general hospitals were included. H. pylori seropositivity rate was determined using un enzyme-linked immunosorbent assay (ELISA). A standardized questionnaire was administered to all study participants through face-to-face interview. The data obtained from H pylori IgG antibody were analyzed using the chi-square test. The prevalence of anti H. pylori IgG antibody positivity was present in 104 out259 (40.02%) of the adult. Among the studied variables, all the following risk factors were significantly associated with the presence of anti H. pylori IgG antibodies; male (p< 0.043), level of education (p<0.025), history of gastrointestinal diseases (p< 0.001), smoking status (p< 0.001) and a larger sibling number (p< 0.001). This study supports the hypothesis that H. pylori infection in adult is highly related to poor hygiene, smoking status, low level of education and crowded conditions. Therefore, it is crucial to implement effective strategies aimed at enhancing fundamental sanitary conditions, as well as improving educational level and socioeconomic status, in order to reduce the prevalence of H. pylori infection among adults in our region

Background and aims Healthcare staff are at high risk of occupational exposure to Hepatitis B and other bloodborne diseases. Lack of education about the knowledge of Hepatitis B virus contributes to an increase in cases. This study aims to determine the knowledge of the Hepatitis B virus among the medical professionals in Duhok province, Kurdistan Region of Iraq, and to determine their knowledge of the importance of vaccination. Materials and methods This cross-sectional study was conducted in Duhok province, Kurdistan Region of Iraq, among medical science students from November 2022 to February 2023 and a total of 511 students participated in the study. A Self-administered questionnaire comprising 22 items categorized into five sections was distributed to the students either electronically or by paper and pen method. The survey utilized a Five-point Likert scale when assessing respondents’ opinions on knowledge, attitude, and practice (KAP). Microsoft Excel and GraphPad Prism 9 were used for statistical analysis. Results A total of 511 responses were collected from medical, dental, pharmacy, and laboratory students. The average age of the participants was 20.74 ±1.43 years. Among the respondents, only 96 (18.8%) were fully vaccinated against the Hepatitis B virus (received 3 or more doses of the vaccine), while 294 (57.5%) were not vaccinated. Lack of vaccination programs was the major reason for not receiving a vaccination (n = 182, 62%). About 286 (55.96%) of the participants had good knowledge, attitude, and practice on Hepatitis B, manifesting median scores of 26, 18, and 20, respectively. Conclusion In our study, half of the students were found to be unvaccinated, mainly due to the absence of vaccination programs. Vaccinated students exhibited better knowledge, attitude, and practice toward the infection than non-vaccinated students. Therefore, we recommend the implementation of a vaccination program as well as training on infection prevention guidelines to increase awareness and encourage vaccination.

Background and aims: Antiphospholipid antibodies are associated with miscarriage and abortion, and this association has been reported in different countries. The aim of this study is to assess the prevalence of antiphospholipid antibodies IgM and IgG among pregnant women with previous history of miscarriage in Zakho City, Kurdistan region, Iraq. Methods: This cross-sectional study was conducted in Zakho city among women who had history of miscarriages from 1 st April 2019 to 31st May 2021. A total of 460 women age ranged between 16-46 years (Average age 29.73± 5.93 STDEV) were recruited in the study. Enzyme-linked immunosorbent assay (ELISA) was used to measure antiphospholipid IgM and IgG antibodies. The relationship between age and level of antiphospholipid antibodies was performed using the Chi-Square test (Fisher Exact Test). Results: The overall rate of antiphospholipid antibodies was 31 (6.74%) for IgM, 16 (3.48%) for IgG and 9 (1.96%) was seropositive for both IgM and IgG antibodies. The study found that the highest IgM was 18 (11.25%) and IgG 10 (6.2%) seropositivity among age group 30 years old. There was a significant association between age groups and IgM seropositivity (P=0.02; OR=0.4; 95% CI 0.2-0.9) but statistically not significant between age groups and IgG seropositivity (P=0.79; OR=0.9; 95% CI 0.3-2). It was also found no significant differences between age groups and both IgM and IgG seropositivity (P=0.28; OR=0.4; 95% CI 0.1-1). Conclusion: The prevalence of antiphospholipid antibodies among aborted women was relatively low compared to other study. There was a positively association between IgM seropositivity and age group. Therefore, it is essential to conduct APA screening for women who have recurrent pregnancy loss and investigate the therapeutic effects of heparin and aspirin; this approach might improve fetal survival by starting anticoagulant treatment early.

The emergence of the SARS-CoV-2 Omicron variant has raised concerns due to its increased transmissibility and potential implications on clinical characteristics and outcomes in infected individuals. The aims of this report were to study the profile of SARS-CoV-2 infection with omicron variant, investigate the infection outcome, reinfection rates with associated factors, antibody levels, and explore the associations between biochemical markers and disease severity. This prospective cohort study was conducted in Duhok city in the Northern of Iraq. All volunteers with confirmed SARS-CoV-2 RT–PCR and confirmed Omicron infection who were older than 18 years old and agreed to participate were recruited for this study. The study was carried out from January to April 2022. There were 234 cases of confirmed SARS-CoV-2 RT–PCR Omicron infection. The mean age was 48.12±17.3 years, 43.2% were vaccinated, and 40.2% were male. Among the recruited patients, 99.1% recovered and did not need hospitalization. In this study,(38.9%) had a history of previously confirmed COVID-19 infection. Reinfection was significantly higher in females than males (p= 0.04; OR= 0.56). It was found that the IgG antibody levels were higher in patients who received Pfizer-BioNTech than in those who received other vaccines (p= 0.001). The levels of IgG were also significantly higher in patients with mild infection (p= 0.046), whereas the levels of D-dimer were significantly higher in patients with severe cases of the infection compared to those with mild or moderate cases (p= 0.001). Additionally, the levels of C-reactive protein (CRP) were observed to be higher in …

Background. Diabetes mellitus (DM) is a chronic, non-transmissible health condition distinguished by high blood glucose levels caused by faulty insulin secretion and impaired insulin activity. People play an essential role in preventing and managing their illnesses. Thus, the misconceptions may negatively influence the prevention and management of DM. The aim of this study was to gauge the extent of knowledge among the general population concerning DM, to determine the prevalence of misconceptions about DM in the community, and to find the factors influencing them. Methods. A population-based study was conducted in Duhok Province, the Kurdistan Region of Iraq. A total of 2,305 adults were enrolled in the study. The study data were collected by face-to-face interview. The survey questionnaire comprised two sections: the first section included basic demographic characteristics of participants, while the second section consisted of ten questions to identify common misconceptions about DM among participants. Results. Among the participants, there were 1,406 (61.0%) females. Participants’ age ranged from 18 to 90 years (the mean age: 54 ± 13.69 years). The most common misconceptions positively responded to were “Will I become addicted to insulin if I start taking it?”, followed by“ Does DM occur because of increased sugar intake?”. Male gender was associated with higher level of misconceptions. In addition, the misconceptions were more prevalent among diabetics as they might seek treatment from non-professionals. There was a significant association between education status and the prevalence of misconceptions. Healthcare workers were found to have a better knowledge about DM compared to the general population. Surprisingly, certain myths were prevalent even among healthcare workers. Conclusions. Certain myths and misconceptions have been pervasive in our society. Actions must be taken to dispel these misconceptions as they lead to an avoidable burden of disease. Therefore, people’s knowledge of DM needs to be enhanced through educational programs, social media, television, newspapers and campaigns.

Background: Candida vaginitis is a major fungal infection of the female genital tract ranging from mucosal to systemic infection. Candida species has remained a major public health issue affecting women globally. Objectives: The aim of this study was to evaluate the prevalence of Candida albicans and its associated risk factors among married women with signs and symptoms of vaginitis referring to Obstetrics and Gynecological Hospital at Zakho City, Iraq. Methods: Vaginal samples were collected from 150 symptomatic women aged 18-48 years from October 2021-to April 2022 using two sterile cotton swabs. Wet mount was initially performed from first swab for the presence of budding yeast cells, and pseudo-hyphae of Candida infection. The second collected swabs were cultured on Sabouraud dextrose agar and incubated at 35°C for 24-48 hrs. C. albicans was then detected using morphologic characteristics of the colony. Candida colonies were finally confirmed by germ tube test. Results: Overall, 58 (38.67%) C. albicans were diagnosed. The highest rate of infection was reported in the age group of 31-40 years (45%) and non-educated people (37%), but statistically not significant (p>0.05). C. albicans was also higher in women who used pills as a contraceptive (45.45%) than other types of contraceptives. Women who had low number of births were significantly associated with C. albicans (OR; 1.01, 95% CI; 0.94-1.26, p=028). C. albicans was also significantly associated among symptomatic patients with vaginal itching (67.19%) (OR; 9.69, 95% CI; 4.52-20.79, p=0.001) and vaginal pH level > 4.5 (OR; 0.39, 95% CI; 0.19-0.82, p=0.001). C. albicans was also significantly higher among participants who had whitish vaginal discharges (96.67%) (OR; 8.0, 95%CI, 3.8-16.85, p=0.001), and yellow-green vaginal discharges (58.62%) (OR; 0.12, 95% CI; 0.01-0.93, p=0.007). Conclusions: C. albicans is a relatively common gynaecological problem among married women in our region. C. albicans is significantly higher among child bearing age women who had vaginal discharges and itching in our study. These results call for preventive measures to protect women against Candidiasis. Therefore, public health education and campaign should be implemented.

Background and aims: Intestinal protozoan parasitic infections are considered one of the most frequent types of infection caused by these parasites and remain a major health problem for communities. This study aims to detect the frequency of intestinal protozoan infections infection among Zakho general population from October 2018 to June 2022. Methods: This study was performed as a cross-sectional study among 2118 patients referring to private medical diagnostic laboratories in Zakho City, Kurdistan Region, Iraq. Samples of faecal matter were collected and subjected to analysis using two different techniques: direct observation under the microscope (wet mount) and formalin-ether concentration methods. Morphological characteristics of trophozoites and cysts were used to identify E. histolytica using microscopical examination. Results: Out of 2118 recruited samples, 1155 (54.53%) were male and 963 (45.47%) were female. The mean age of participants was 20.41 (±19.12) with ages ranging from 1-63 years. The overall prevalence of protozoan infections was 395/2118 (18.65%). Out of these, Entamoeba histolytica was the predominant pathogenic protozoa infection 271 (68.61%), followed by Giardia lamblia 100 (25.31%). A significant association was seen between Entamoeba histolytica and age groups (p=0.003) and gender (p=0.004). The highest infection rate was reported among the age group <15 years (55.72%). We also found a higher rate of Giardia infection among age group <15 years (46%) with significant differences (p=0.002) and a higher rate of Giardia seen in females (55%) with significant association (p=0.014). Conclusion: The frequency of Giardia lamblia and E. histolytica infections in our study was higher than other studies reported in Iraq and other countries, and these infections continue to pose a difficult public health issue and necessitate the implementation of stronger and more effective preventative measures.

Background. After COVID-19 emergence, medical education witnessed a shift from face-to-face education to digital education, which inevitably affected medical students. Globally, due to the closure of schools and universities, medical education was shifted to electronic learning (E-learning). This paper aimed to assess the effects of the COVID-19 pandemic on medical education and determine medical students’ knowledge, attitude, and practices towards E-learning in the Kurdistan Region of Iraq. Materials and Methods. An online cross-sectional study was conducted among 500 undergraduate students of seven medical colleges in the Kurdistan Region, Iraq, in November 2021, to assess their state during the COVID-19 pandemic and how this affected their education. Results. There were 50.6% of males and 49.4% of females. The mean age was 20.6 ( ± 1.5 SD) years. Approximately 17% of participants mentioned having financial issues, while 19.2% of students experienced health-related problems. As many as 67% of participants reported that the Internet quality was good or very good, whereas 46.8% of students disagreed that E-learning was a possible substitute for traditional learning. About two-thirds of participants agreed or were neutral that downloadable content was better than live content; however, only 19.2% of students agreed that E-learning could be used in the clinical aspect. A total of 52.2% of participants disagreed that E-testing could replace traditional learning methods. Surprisingly, 86.4% of students stated that they regularly used the Internet in their study. Conclusions. E-learning was the main adjustment made in the educational system, including medical education. The study concluded with insights into how different circumstances could have different consequences on the efficacy of medical education. E-learning showed effective results in continuing learning untilthe educational system switched to a blended system. Training programs for medical education personnel are vital in effective E-learning opportunities

Objectives: The aim of this cross-sectional study is to evaluate the seroprevalence of total antibodies to SARS-CoV-2 and associated risk factors in Zakho City, Kurdistan Region of Iraq. Methods: This cross-sectional study was performed at Zako City, Northern, Iraq. Blood samples were collected from different districts of Zakho city between January and March 2021. Immunoassays were performed to detect the total antibodies against SARS-CoV-2, and the associations between several variables were investigated. Results: A total of 315 participants were agreed and enrolled in the study. The average age of the participants was 32.87±13.25 years. Among the participants, 214/315 (67.93%) were found to have antibodies against SARS-CoV-2. Among those who had positive antibodies, 169/214 (78.97%) were asymptomatic and 45/214 (21.03%) had a history of COVID-19 related symptoms. The most common symptom was fever (95.56%), followed by loss of smell (84.44%) and myalgia (80.0%). We found that antibody levels significantly associated with age (P=0.021). The presence of symptoms was significantly higher among subjects with a history of comorbidity diseases (P=0.038), and older people (P = 0.015). A significant association was found between antibody levels and the marital status (P=0.014), chronic diseases (P=0.001), presence (P=0.015) and duration of symptoms (P=0.028). Conclusion: A significant association between antibody levels to SARS-CoV-2 and age, chronic diseases, presence and duration of symptoms were found in this study. Seroprevalence studies of antibodies to SARS-CoV-2 among general population are of utmost importance to develop infection prevention programs in our society.

The aim of this letter is to discuss the pandemic management measures, including social distancing and community containment, taken in Duhok city in Northern Iraq, where a few patients were infected with COVID-19. During the first three months of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, 15 patients were diagnosed with SARS-CoV-2 in Duhok city. All the patients were asymptomatic and were discharged to their home within 10 ± 3.2 days after throat swabs indicated a negative SARS-CoV-2 Real Time Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) test. The social distancing and lockdown measures taken by the city were implemented in three stages. In the first stage, all educational institutions including schools, colleges and universities were closed. In the second stage, all gatherings were banned. Finally, state-imposed community-wide containment was declared. The social distancing measures helped control infections in the city. Gradual reopening is recommended to avoid the spread of infection.

Objective This study aimed to investigate the breakthrough infection rate and safety profile of the AstraZeneca vaccine. Methods The breakthrough COVID-19 infection rate was defined as a positive polymerase chain reaction test 14 days after the vaccine dose. Safety was assessed as local reactions and systemic events that occurred within 14 days of receiving vaccine doses. Results The average age of the 265 participants was 43.85 years and 169 (63.77%) were male. . After the second dose, 18 (6.71%) participants contracted the infection. The SARS-CoV-2 delta variant was responsible for all infections but no participants required hospitalisation. We found significant correlations between post-vaccination IgG levels and post-vaccination infection (P = 0.001; odds ratio [OR] = 0.959; 95% Confidence interval [CI]: 0.944–0.974), and between a history of previous infection and post-vaccination infection rates (P = 0.005; OR = 0.1; 95%CI:0.009–0.6). IgG levels were significantly higher in women than in men (P = 0.006) and in patients who developed side effects after vaccination than in those without side effects (P = 0.04). A significant association was found between a history of COVID-19 infection prior to vaccination and IgG levels (P = 0.001). Conclusions The vaccine is effective in preventing severe disease, with few side effects.

Bacterial Vaginosis (BV) is a leading cause of reproductive tract problem affecting mostly of reproductive age group, worldwide. The aim of this study is to detect the infection rate of BV and then evaluate the risk factors associated with this bacterium among married women in Zakho city, Iraq. This cross-sectional study was performed among 150 reproductive age women group from October 2021 till April 2022. The administered and structured questionnaire was designed to measure demographic, risk factors and clinical characteristics. The vaginal swabs were collected from each subject and used for microscopical examination including wet mount, vaginal pH, germ tube and Gram stain methods to analyze the infection rate. The analysis of univariate regression analysis was applied to determine the relationships between BV and associated risk factors and clinical characteristics. The average age of participants was 32.64 years (±8.01 SD). The prevalence of BV was 41 (27.33%) among married women. About 12 (8%) and 1 (0.67%) of participants had mixed infections with Candida albicans and Trichomonas vaginalis, respectively. BV was found mostly among the age group less than 20 years (41.67) followed by age group of 40-50 years (37.93%). We found a higher infection rate among subjects from rural area (34.78%), but statistically not significant (p=0.17). Higher number of births was statistically associated to BV (OR 1.17, 1.006-1.37; p=0.003). BV was also highly associated among symptomatic patients with abnormal vaginal discharges (OR 4.18, 1.89-1.9.23; p=0.002), genital ulcer (OR 0.34, 0.13-0.84; p=0.01), and vaginal pH level more than 4.5 (OR 0.009, 0.002-0.043; p=0.001). BV is still prevalent among the married women in our region. The higher infection rate was significantly associated with higher births number, vaginal discharges, genital ulcer and higher vaginal pH. There is an urgent regular required screening for bacterial vaginosis among symptomatic women. Therefore, the early detection of risk factors associated with bacterial vaginal growth is critical to enhance the health condition of married women, in order to prevent the risk of BV.

Background Despite vaccine and antiviral treatment availability, hepatitis B virus (HBV) continues to circulate among pregnant women in Iraq. HBV spread is due to many factors. This study evaluated HBV prevalence among pregnant women and Syrian refugees residing in Zakho city, Iraq, and identified risk factors associated with infection. Materials and methods Demographic data were collected from 2,054 pregnant women via a questionnaire assessing risk factors associated with HBV infection. Blood samples were collected for hepatitis B surface antigen (HBsAg) and were screened using an enzyme-linked immunosorbent assay. Results Tests revealed that 1.1% of pregnant women in Zakho and 11.3% of Syrian refugees (p = 0.001) were positive for HBsAg. The average age of HBsAg-positive patients was 31.4286 ± 6.6746 years (p = 0.002). Average rates of parity and abortion in HBV-infected subjects were 3.5 ± 2.6874 and 0.1785 ± 0.5479, respectively (p = 0.044 and 0.012, respectively). The following were identified as associated risk factors for HBV infection: nationality, (Zakho versus the city centre), tattoos, and polygamy (p = 0.001, 0.03, 0.007, and 0.001, respectively). No significant associations between HBV prevalence and blood transfusion, prior injection history, dental procedures, or surgical procedures were found. Conclusion The prevalence of HBV infection among Syrian refugees was higher than that of indigenous participants. Several risk factors were significantly associated with HBV positivity, which may facilitate effective preventive program implementation and decrease mother-to-child transmission risk. This will likely reduce infant and childhood HBV chronicity, and mortality rates.

Background and aims: Staphylococcus aureus is a leading cause of infectious diseases and responsible for outbreaks among athletes’ team. This study aimed to analysis the prevalence rate of S. aureus among athletes, and evaluate the antibiotic resistance and associated risk factors. Materials and methods: This cross-sectional study was performed to evaluate the nasal carriage rate of S. aureus among athletes applying different sports. Nasal swabs were collected from 510 athletes aged between 14-55 years. Conventional bacteriological methods were used for the isolation and identification of the S. aureus. According to the Clinical and Laboratory Standards Institute (CLSI), the profile of antibiotic sensitivity test was performed. Results: Out of recruited samples, S. aureus carriage rate among athletes was 30.2% (154/510) The highest infection rate was reported among boxing athletes 33.33% (8/24) and gym 32.65% (80/245). S. aureus colonization was significantly higher among the athletes who had low body mass index (p=0.001), longer duration of training/day (p=0.001) and higher number of training session /week (p=0.012). S. aureus carriage was significantly higher among male athletes 77.27% (119/154) than female athletes 22.73% (35/154) (p=0.002). The oxacillin resistance rate was 26.61%. S. aureus isolates were highly susceptible to rifampicin (100%), gentamycin (98.05%) and fusidic acid (98.7%). Conclusion: The prevalence of nasal carriage of S. aureus is comparatively high and the highest prevalent reported among male athletes. It is suggested that the control prevention program to be applied to reduce nasal carriage rate of infection, and associated risk factors with S. aureus among athletes. More studies on carriage rate of S. aureus should be applied using molecular study

Background: Escherichia coli (E. coli) are known to be a major cause of uropathogen among women globally. Urinary tract infection in pregnant women continues to pose clinical problems, which is a big burden for physicians. The emergence of antibiotic resistance to E. coli is inevitable and one of the critical health-associated problems. The present study aimed to determine the E. coli isolates, risk factors, and antibiotic resistance profile of the UTI among pregnant women. Methods: We conducted this cross-sectional study on pregnant women who attended maternity hospital in Zakho City, Kurdistan Region, Iraq. From October 2020 to January 2021, 196 subjects were recruited in the present experiment. Uropathogenic E. coli were detected from mid-stream urine of the participants. Subsequently, we performed antibiotic sensitivity test using microbiological standard tests. Through the use of designed questionnaires, the required data were collected, processed, and analysed via the Fisher’s exact test and Chi-square. Results: Out of a total of 196 subjects, 34 (17.34%) were culture positive for E. coli infection among pregnant women. A high rate of infection was detected in the age group of between 25-34 years (21.6%). Additionally, the highest rate of E. coli belonged to illiterate people (19.4%), followed by those with higher education (18.9%). The assessment of the risk factors associated with E. coli indicated that diabetes (P=0.028), a history of UTI infection (P=0.049), and the presence of symptoms during infection (P=0.001) were statistically significantly different. The antibiotics sensitivity profile in urine samples of pregnant women showed that E. coli were extremely sensitive to Nitrofurantoin (82.4%), Meropenem (79.4%), and around 67.6% for both Amikacin and Ciprofloxacin. Conclusion: The prevalence rate of E. coli infection is quite lower among pregnant women compared to that in non-pregnant ones. The major risk factors associated with E. coli during pregnancy were diabetes mellitus, a history of UTI, and the presence of symptoms during infection. E. coli isolated from urine samples seem to be different concerning antibiotic sensitivity pattern. During their regular follow-up, pregnant women should also be examined for major risk factors and antibiotic susceptibility.

Objectives: The aims of this study were to determine the prevalence of HBV infection and investigate the HBV-related risk factors in the Kurdistan region of Iraq. Methods: Sera samples were collected from 3423 patients visiting three centers and tested for HBV positivity by enzyme-linked immunosorbent assay. A questionnaire was prepared and used by the volunteers who collected data, including age, marital status, and different HBV-related risk factors, through face-to-face interviews. Results: The mean age of the recruited participants was 28.94 ± 11.17 years. In addition, 873/3423 (25.47%) were males, and 3024/3423 (88.34%) were married. Furthermore, HBV infection had a prevalence of 1.37% (47/3243). Multivariate analysis was conducted to identify the predictive factors of HBV infection, which revealed that a history of tattoos and age were predictive factors (p<0.05). We then stratified our data according to sex. No association was found between the various factors and HBV positivity in males. On the other hand, in females, a significant association was found between the history of tattoos or age and HBV positivity (p<0.05). Conclusions: In conclusion, the prevalence of HBV infection was low. Our study showed that a history of tattooing and older age were predictive of HBV infection. Our results could be used as a basis for local elimination programs.

Objectives: Helicobacter pylori infection is predominantly acquired in early childhood and persists for decades before causing disease. This study aimed to detect the prevalence of H. pylori infection and identify potential factors associated with infection in Duhok province, Iraq. Methods: This cross-sectional study was conducted in Duhok Province, Kurdistan Region, Iraq. Over a four-year period from 2016 to 2020, a total of 381 children aged four to 18 years who attended the hospitals and were evaluated for specific IgG antibodies against H. pylori using serological tests were included. A questionnaire was completed at the start of the study. H. pylori serology data were analyzed using the chi-square test. Results: The seroprevalence of H. pylori IgG-specific antibodies among the study participants was 31%. The infection rate significantly increased with increasing age of the participants (p<0.001), from 19.8% among four to five-year-olds to 42.9% among 16 and 18-year-olds. The infection rate was significantly higher in girls (35.9%) than that in boys (26.5%) (p<0.047). Infections were also higher among university students (41%; p<0.001), children from the country-side population (41%; p<0.001), children from crowded households (67.3%; p<0.001), and children with a history of gastrointestinal pain (44.4%; p>0.001). Conclusion. The prevalence rate of H. pylori infection among children in Duhok province is quite similar to that reported in previous studies in the Kurdistan region, Iraq, and increases with age. University attendance, history of gastrointestinal pain, countryside population, and overcrowding were risk factors associated with H. pylori infection. Valuable approaches to improve sanitary purposes and educational and socioeconomic status should be emphasized and promoted to reduce the risk of H. pylori infection among children.

Since the discovery of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the coronavirus disease (COVID-19) pandemic has become the most important health-care crisis globally, having spread to millions of people worldwide. Patients who recover from COVID-19 are still susceptible to reinfection. In this report, we present the case of a patient who had recovered from COVID-19. Recovery was defined as the resolution of symptoms accompanied by two consecutive SARS-CoV-2-negative real-time reverse transcriptase-polymerase chain reaction (RT-PCR) test results. Two months after the first infection, the patient tested positive for anti-SARS-CoV-2 antibodies. Three months after this test, the patient presented with mild COVID-19 symptoms that was confirmed by RT-PCR. These findings indicate a possible reinfection case. If the occurrence of reinfections is demonstrated to be true, then it may change the strategy of community-based disease prevention. More research is needed to confirm the concept of reinfection.

Introduction: The severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) causes severe respiratory infection. Gastrointestinal symptoms have been reported in up to 10% of patients. Case Presentation: We here report a case of COVID-19-associated acute mesenteric ischemia in a patient presenting with fever and abdominal pain, deteriorating over a four-day period. The diagnosis was initially missed due to a low suspicion level. COVID-19 infection was confirmed by chest CT scan and RT-PCR. Then the patient underwent an emergency laparotomy showing segmental small bowel ischemia of about 2 meters (between the lower jejunum and upper ileum). Resection of the ischemic segment was performed by end-to-end anastomosis. He was then discharged from the hospital after recovering from COVID-19. Conclusions: The present case report highlights the importance of being vigilant about mesenteric ischemia symptoms in the patients with COVID-19, presenting with progressive abdominal pain for timely ordering appropriate diagnostic and therapeutic procedures

Background: Hepatitis B and C virus (HBV and HCV) infections are major global health issues and the leading causes of liver cirrhosis and hepatocellular carcinoma. Objectives: The aim of this study was to investigate the prevalence of HBV and HCV infections in couples attending a premarital screening program in Zakho city, Kurdistan region, Iraq. Methods: This cross-sectional study was carried out in Zakho city, Kurdistan Region of Iraq, between January and October 2019. During this period, 2123 couples were screened for HBV and HCV as a part of premarital screening. The age of couples ranged from 18 to 63 years old. ELISA test was used to detect HBsAg, HBc IgG, and HCV Ab. Hepatitis C virus Ab positivity was then confirmed by HCV RT-PCR, and all HCV positive patients were then tested for genotyping. Results: Among the recruited subjects, 38/4246 (0.89%) patients were positive for HBsAg. Of these, 12/2123 (0.57%) were females, and 26/2123 (1.22%) were males. Hepatitis C virus RT-PCR confirmed HCV positivity for one female patient who was further confirmed to be infected with HCV genotype 4. Conclusions: To conclude, the present study showed a relatively low prevalence of HBV and HCV infections in the couples tested through the premarital screening program in Zakho city. The prevalence of HBV seropositivity was higher in males than females. Therefore special attention should be paid to males during prevention strategies.

Novel coronavirus disease (COVID-19) or SARS-CoV-2 infection was discovered in December 2019 in Wuhan City, China. The infection became a global pandemic over a period of few months. Post-infection immunity and susceptibility for reinfection is still under investigation. In this report, we present a case of a COVID-19 reinfection in patient who had recovered from an initial infection. Case Report: 41-year-old male, nurse working in emergency hospital, presented in August 2020 with two days history of fever, sore throat, myalgia, lower back pain, shortness of breath. Then, his oxygen saturation dropped to 80%. COVID-19 infection was proved by a positive RT-PCR for SARS-CoV-2 and CT scan of the chest demonstrated bilateral ground glass opacities. After clinical improvement, the patient was discharged from hospital. On 26th of October, he developed fever, and fatiguability. RT-PCR for SARS-CoV-2 resulted as positive twice. The infection was mild and no specific treatment was administered to the patient during the second infection. On 6th of November, the patient was asymptomatic. On 7-8 th of November, he consecutively tested negative for SARS-CoV-2 twice. Conclusions: Mild SARS-CoV-2 reinfection may occur rarely due to repeated exposed to the virus in hospital setting. If the occurrence of reinfections is demonstrated to be true, it may change the strategy of infection prevention. Further studies are needed to confirm the possibility of COVID-19 reinfection

Objective This population-based study aimed to evaluate the seroprevalence of antibodies to SARS-CoV-2 in Duhok City, Kurdistan Region of Iraq. Methods We analyzed the national COVID-19 database that contains data regarding COVID-19 testing, management, and clinical outcomes in Duhok. For this study, different subdistricts within each district of Duhok were considered distinct clusters. Blood samples were collected from and questionnaires were administered to eligible and consenting participants who were members of different families from the subdistricts. Immunoassays were conducted to detect antibodies against SARS-CoV-2, and the associations between certain variables were investigated. Results The average number cases of COVID-19 before November 2020 was 23141 ± 4364, which was significantly higher than the average number of cases between November 2020 and February 2021 (3737 ± 2634; P = 0.001). A total of 743 individuals agreed to participate and were enrolled in the study. Among the participants, 465/743 (62.58%) were found to have antibodies against severe acute respiratory syndrome coronavirus 2. Among the participants with antibodies, 262/465 (56.34%) denied having any history of COVID-19-related symptoms. The most common symptom was fever (81.77%), followed by myalgia (81.28%). We found that antibody levels increased steadily with age (Pearson correlation coefficient = 0.117; P = 0.012). A significant association was found between antibody levels and the presence of symptoms (P = 0.023; odds ratio = 1.0023; 95% confidence interval = 1.0002-1.0061). Conclusions A significant reduction in the number of COVID-19 cases was observed. This might be due to the high prevalence of SARS-CoV-2 antibodies in Duhok. However, infection-prevention measures should be followed as it remains unclear whether acquired immunity is protective against reinfection. It expected that the infection rates during the next wave will not be as high as the first wave due to the high infection rate in the society.

Abstract: Background/Objectives: Coronavirus disease (COVID-19) is an emerging viral respiratory disease that has currently reached pandemic status. This study aimed to assessCOVID-19 knowledge, attitudes, and practices among the Kurdish population in Iraq. Methods: This cross-sectional study was conducted from July 15 to September 15, 2020 among the Kurdish population in Iraq. A total of 885 subjects were interviewed. All subjects were aged 15–75 years. Knowledge scores, attitudes, and practices of subjects were analyzed according to demographic characteristics. Results: The study subjects were largely male, the average age was31.79 years, and 41.92% subjects were from Erbil province. Approximately 85.31% subjects had enhanced knowledge regarding disease prevention and control. The lowest subscale scores were related to clinical manifestations of the disease. Knowledge scores were significantly associated with age, place of current residence, and level of education. A large number of participants believed COVID-19 would be controlled and the fight against the pandemic would be won. Subjects’ attitudes toward success differed significantly by demographic characteristics, except marital status. Approximately 40.03% subjects reported that they had not visited a crowded place, and 60.22% of these subjects wore face masks when leaving home. Conclusions: This study found good knowledge, positive attitudes, and proper practices among the general population regarding the COVID-19 pandemic. However, community-based health campaigns in the region should encourage optimistic attitudes and appropriate practices regarding virus containment and dissemination. Our findings may be used as a baseline for planning health education campaigns in the region.

The salivary glands have an important role in the functions of digestion by making lubrication fluid, respiration, speech, and overall homeostasis, and they also contain antibodies. Generally, the salivary gland tumors might be categorized into non inflammatory, inflammatory, and neoplastic swellings such as calculi, benign tumors like Warthin tumor, oncocytoma, pleomorphic adenoma, malignant tumors involving undifferentiated carcinoma, adenoid cystic carcinoma, and adenocarcinoma. Methodology: This epidemiological study is carried out at the Department of histopathology, Zakho general hospital, thirty salivary glands cases are involved in this work in a period of 15-years. Results: There are 30 patients with major salivary gland tumors, while 26 patients (86.666) had parotid and 4 patients (13.333) had sub-mandibular major salivary gland tumors. In the presented work, 26 (86.666) cases from a total of 30 salivary tumor cases have been benign, while only 4 (13.333) are malignant, from a total of 26 patents of parotid tumors, overall of 20(76.923) cases have been identified in superficial lobe, whereas only 6(23.076) cases have been in deep lobe, from a total of 30 salivary gland tumors, overall of 26(86.666) cases are pleomorphic adenoma and just 3 (11.538%) cases are mucoepidermoid carcinoma and only single case (3.333%) has been acinic cell carcinoma. Conclusions: The parotid gland has been defined as the major site of origin which is related to benign as well as malignant tumors, also the pleomorphic adenoma is the major benign salivary gland tumor and mucoepidermoid carcinoma is the major common malignant tumor. The rest of the cases are autoimmune disease and minor salivary gland tumors.

Background and Aim: Infection with hepatitis C virus (HCV) is a public health threat worldwide. The World Health Organization aims to eliminate HCV. However, the coronavirus disease (COVID‑19) pandemic has led to a severe compromise in health services, and this has halted efforts to eliminate HCV. Herein, we report our experience with the initiative of HCV elimination in Duhok city, Kurdistan

Background and Aim: Infection with hepatitis C virus (HCV) is a public health threat worldwide. The World Health Organization aims to eliminate HCV. However, the coronavirus disease (COVID‑19) pandemic has led to a severe compromise in health services, and this has halted efforts to eliminate HCV. Herein, we report our experience with the initiative of HCV elimination in Duhok city, Kurdistan Region of Iraq, with a focus on the effect of the COVID‑19 pandemic on the HCV elimination plan. Materials and Methods: An anti‑HCV antibody test was used to screen subjects. All positive results were then confirmed by reverse‑transcription polymerase chain reaction (RT‑PCR) testing. All patients with current HCV infection were treated with direct‑acting antiviral regimens. Results: During the study period, 459,015 subjects were tested for anti‑HCV antibody positivity, with a monthly average of 9,562 tests for HCV. This number dropped to zero during the lockdown period between 1March and 31May 2020. Among the tested samples, 0.29% (1350/459015) tested positive for anti‑HCV antibodies. RT‑PCR testing of all positive samples revealed that 0.020% (93/459015) were positive. Of the 93 recruited subjects, 3 patients did not complete the treatment course due to the lockdown. All patients who finished the treatment course were cured as determined by sustained virologic response 12 (SVR12) weeks after finishing the treatment course. Conclusion: During the COVID‑19 pandemic, reductions in health facility utilisation led to a significant decrease in services offered for HCV screening and treatment. Such a decrease in services has had a negative impact on HCV elimination. An urgent plan is needed to resume the services, and strict follow‑up is needed for patients whose treatment was interrupted.

Background: The impact of COVID-19 on mental health outcomes of medical residency is an important concern. Currently, evidence regarding this issue is not sufficient. Objectives: The current study aimed to demonstrate the impact of the COVID-19 pandemic on residency training programs as well as its psychological consequences for both individuals and their families in the Kurdistan Region, Iraq. Methods: This online cross-sectional study was performed at the Kurdistan Region, Iraq, from 12 - 25 August 2020. In total, 275 residents participated. Data were collected online, and the items were sent through specific Facebook and Viber groups of residents. Data were analyzed using descriptive statistics (i.e., frequency and percentage). Besides, the Chi-square and Fisher's exact test were used to compare the participants based on their sociodemographic characteristics. Results: Of 275 participants, 50.9% were female and mostly older than 30 years (52.4%). Surgical (36.4%) was the most commonly cited specialty, followed by medical (22.2%). Around 40% of residents were forced to changes the hospital due to the COVID-19 pandemic. Also, 50% of them had close contact with COVID-19 patients, and only 12.7% had enough training for the proper use of personal protective equipment (PPE). Moreover, 90% of the residents felt anxious and concerned about the situation. Nearly 10% of residents were infected with COVID-19, and 24% of them had an infected family member. Approximately 92% reported a reduction in training activities due to the COVID-19 outbreak. Of those with surgical specialties, 83% reported a significant reduction in the number of surgeries since the onset of the pandemic (P < 0.024). Conclusions: The COVID-19 pandemic has caused high levels of psychological distress of medical residency. The combination of psychological disorders with high infection rates among students of residency in our region may cause a critical impact on the residency training program. Besides, the quality of programs may also be influenced. An urgent plan is required to reduce the psychological stress and protecting doctors against the infection.

Introduction: The COVID-19 pandemic is a major challenge to healthcare services in the world. It has negatively impacted surgical practice, and health workers. We aimed to assess the impact of the COVID-19 pandemic on surgical practice in the Kurdistan Region, Iraq. Methods: An online cross-sectional study using an online survey was performed between 13 April to 29April, 2020 in the Kurdistan Region, Iraq. An online cross-sectional study using an online survey was performed between 13 April to 29 April, 2020 in the Kurdistan Region, Iraq. A total of 241 surgeons, aged28e70 years (mean range 22.2±7.9 SD), were recruited to this study. The questionnaire was designed to evaluate the impact of the COVID-19 pandemic on surgeons' practices. Participants completed a self-developed online questionnaire. Results: The majority of participants (44.39%) were general surgeons, followed by urologists (17.01%).Approximately 82.57% of surgeons performed surgeries during the COVID-19 pandemic and 60.31%undertook emergency surgeries only. There was no significant difference between men and women(P¼0.41) and different age groups (P¼0.08). Only 28.22% of surgeons had access to full personal protective equipment (PPE), and 41.18% believed that wearing PPEs severely affected their skills. Results also found that surgeons aged between 28 and 34 years were more pledged to the use of PPEs, than other age groups (P¼0.001). The use of PPEs during surgeries was significantly higher in the Sulaymaniyah province (P¼0.001). The surgical services were also severely impacted in the Sulaymaniyah province than in the other provinces (p¼0.001).Conclusion: The COVID-19 pandemic severely affected surgical practice in the Kurdistan Region, particularly in the Sulaymaniyah province. Males, and young surgeons showed a higher commitment level for using PPE. Additional training and precautions are needed to increase awareness about COVID-19 among surgeons, and the importance of using PPE during surgery

Background: Urinary Tract Infections (UTIs) are one of the most common bacterial infections worldwide. The study of bacterial uropathogens in a local area and their susceptibility to antimicrobial agents is required to determine empirical therapy. Objectives: This study aimed to assess the profile and antibiotic resistance patterns of bacteria, causing urinary infections isolated from female patients in Duhok province, Iraq. Methods: A total of 530 urine samples were collected from females clinically suspected of UTIs over three years between January 2017 and February 2020. The samples were inoculated directly on MacConkey and Blood agar media and then incubated aerobically for 24 h at 37°C. Samples that gave up colony counts of ≥ 105 CFU/mL were considered as positive growth. Purified colonies were identified through standard bacteriological tests, and their susceptibility to different antibiotics was determined using the Vitek-2 system. Results: Out of 530 urine samples, 450 (84.9%) contained Gram-negative bacteria, while the other 80 (15.1%) harbored Gram-positive bacteria. Escherichia coli was the most common uropathogenic isolate (58.5%), followed by K. pneumoniae (14.3%), Staphylococcus spp. (8.9%), P. mirabilis (6.6%), E. faecalis (3.2%), and S. agalactiae (3.02%). The majority of Gram-negative uropathogens were resistant to ampicillin, aztreonam, ceftriaxone, and cefepime and around 95% were sensitive to ertapenem and imipenem. Most Gram-positive isolates showed high resistance to benzylpenicillin, oxacillin, gentamicin, and erythromycin, and high susceptibility to linezolid, tigecycline, and nitrofurantoin. Conclusions: It was concluded from this study that E. coli is the predominant pathogen causing UTIs in female patients in Duhok province, Iraq. There were increasing antibiotic resistance rates, particularly to ampicillin, aztreonam, ceftriaxone, benzylpenicillin, and erythromycin. Therefore, empirical antibiotic therapy should be based on local sensitivity patterns rather than international guidelines.

Background and Aim: The World Health Organization (WHO) declared the novel coronavirus infection COVID‑19 as a pandemic on March 11, 2020. Adherence to infection control measures is potentially influenced by people’s knowledge, attitudes, and practices (KAP) about the infection. This project was performed to assess the KAP toward COVID‑19 of university students in Kurdistan Region, Iraq. Materials and Methods: An online cross‑sectional study was performed in April 2020 to evaluate KAP about coronavirus infection among university students in Kurdistan Region, Iraq. A total of 1959 students were recruited in this study and ages ranged from 18 to 55 years old. Results: Among the respondents, 55.03% were female, 93.8% were from Duhok province, and the majority of participants (93.4%) were undergraduate students. The overall correct answer rate of the knowledge questions toward COVID‑19 was 75.8% with an average score of 9.1 ± 2.1 SD out of 12. Participants showed better knowledge of infection prevention with around 86.2% correct answers, while the lowermost subscale scores were (67.7%) for questions toward the mode of the transmission of the infection. We found a significant difference in knowledge scores across genders, marital status, program of study, and among different colleges/institutes (P < 0.001). The majority of participants agreed that the local authority will control the infection successfully (69.8%) and showed confidence that the battle against the virus will be won by Kurdistan Regional Government (86.7%). The majority of the recruited sample (93.0%) had not been in any area with crowd and 57.3% used facemasks when leaving out, recently. Conclusion: Students demonstrated good knowledge, appropriate practice, and positive attitude about the infection. These findings indicated that local health education plans to improve people’s knowledge about the infection are valuable in protecting the community. The results may be helpful in tailoring an educational program for better containment of the infection and halting the spread of the virus.

ABSTRACT: Background: Nasal colonization with Methicillin-resistant Staphylococcus aureus (MRSA) can predispose to subsequent infections in surgical and non-surgical patients, making the management challenging with increased rates of morbidity, mortality and cost burden. Objectives: The present study was carried out to evaluate the risk factors of MRSA nasal colonization in preoperative patients in Azadi Teaching Hospital in Duhok Province - Kurdistan Region-Iraq. Methods: Nasal swabs were obtained from 150 patients after completing a questionnaire. Conventional laboratory methods were carried out to identify Staphylococcus aureus (S. aureus) and antimicrobial susceptibility test was conducted for recognizing MRSA isolates. Results: A total of 41 (27.3%) of 150 patients were MRSA carriers. The mean age of participants MRSA carriers was 35.27±20.40 years old. The highest prevalence rate of nasal colonization with MRSA was in males (27.94%) than females (26.82%). In logistic regression analysis, no significant differences was detected between MRSA carriage and the associated risk factors including age [OR: 0.99 (95 % CI: 0.97- 1.01); P = 0.45], gender [OR: 1.05 (95 % CI: 0.51- 2.17); P = 0.87] and medical comorbidities [OR: 1.11 (95 % CI: 0.42- 2.92); P = 0.82]. Conclusions: Age, gender and medical comorbidities were not associated common risk factors for nasal colonization of MRSA in preoperative patients. This study should be considered preliminary and studies with larger sample sizes and with using advance molecular tools are needed in the future.

Background: Helicobacter pylori infection is associated with peptic ulcer diseases and gastric adenocarcinoma. Accordingly, the aim of this study was to assess the efficiency of tetracycline quadruple therapy versus levofloxacin-based regimen (LBR) for the eradication of H. pylori. Methods: To this end, 197 subjects with H. pylori infection were recruited in this randomized clinical study in Kurdistan region, Iraq between October 2018 and May 2019 and randomly divided into 2 groups. The LBR group received levofloxacin 500 mg one time per day, amoxicillin 1000 mg two times per day, and omeprazole 20 mg two times per day for two weeks. In addition, the tetracycline-metronidazole-bismuth (TMB) group received bismuth sub citrate 140 mg, metronidazole 125 mg, and tetracycline 125 mg plus omeprazole 20 mg twice per day for 10 days. Finally, 28 days after the completion of the treatment course, the eradication of H. pylori was evaluated by the 14C urease breath test. Results: The total eradication rate of H. pylori infection was 149/197 (75.6%). Although the success eradication rate in the LBR regimen was 70/112 (62.5%), the eradication success rate was 79/85 (92.9%) in the TMB regimen (P = 0.001, odds ratio = 7.9, confidence interval = 3.17-19.7). Finally, gender and age represented on the effect of the eradication rate. Conclusions: In general, the bismuth-based regimen could eradicate a high rate of H. pylori infection. Therefore, this regimen can be used to overcome treatment failure in areas with a high prevalence of antibiotics resistance. Keywords: Helicobacter pylori, Levofloxacin, Iraq, Bismuth, Ampicillin

Background: Hepatitis C virus (HCV) is a public health issue. Successful treatment of HCV infection results in sustained virologic response (SVR) in the majority of subjects. Subsequent recurrence of HCV, either from late relapse or reinfection, may occur. The aim of this study was to assess the recurrence rate of HCV in Iraqi patients. Methods: In this study, 113 patients who completed anti-HCV therapy successfully were recruited. While 23 patients received a classical regimen of peg-interferon plus ribavirin, 90 patients received direct-acting antiviral therapy. Those patients were followed up for three years. HCV recurrence rate was calculated using events/ person years of follow-up (PYFU). Results: Among the recruited patients, HCV RT-PCR was positive in 1 (0.88%) patient giving a recurrence rate of 2.95 per 1000 PYFU. When the data were stratified according to the treatment regimen, the recurrence rate was 14.49 per 1000 PYFU in patients who received the classical regimen of interferon and ribavirin. Conclusions: The overall recurrence rate was low in Iraq. No recurrence was recorded in patients received direct-acting antiviral therapy. Further studies are needed with a larger sample size and longer follow-up to determine the relapse rate in Iraq.

Background: Klebsiella pneumoniae is an important opportunistic enteric bacterial strain, which is a major cause of pneumonia and urinary tract infection. Antimicrobial resistance is an increasingly severe threat to the Global Public Health, requiring immediate action across governmental sectors and communities. Objectives: The present study aimed to determine the sensitivity pattern of K. pneumonia isolated from various clinical specimens for common antibiotics in Duhok City, Iraq. Methods: This study was conducted in Duhok City during January 2017-February 2019 on 130 clinical samples of urine, blood, sputum, wound swabs, central venous lines, and oral swabs. K. pneumoniae strains were confirmed and tested in terms of susceptibility to various antimicrobial drugs using the VITEK-2 compact system. Results: In total, 130 positive K. pneumoniae cultures from various clinical samples were examined. The isolates were more predominant in the females (n = 99; 76.2%) compared to males (n = 31; 23.8%). The antibiotic resistance rate of K. pneumoniae varied among different isolate clinical sample sources. Overall, high resistance rates were recorded for ampicillin (96.9%), ceftriaxone (65.8%), and cefepime (60.8%). However, ertapenem (93.8%) and imipenem (82.3%) showed the highest susceptibility rate against the isolates. Conclusions: According to the results, K. pneumoniae isolated from various clinical specimens varied in terms of the antibiotic susceptibility pattern with high resistance to common antibiotics, particularly ampicillin. Ertapenem and imipenem were the most effective antibiotics against the isolates. Our findings could help physicians and clinicians to select appropriate antimicrobial therapies in the region.

To the editor. Coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is an emerging infectious disease that was identified in December 2019 in Wuhan, China. In February 2020, the first cases of COVID-19 were recorded in Southern Iraq. With the appearance of these cases, strict control measures were implemented in the Kurdistan Region. These measures included the closure of schools and universities, the closing of borders and airports, cancellation of public and religious gatherings, and mandatory quarantine for persons returning from traveling abroad and contacts of confirmed cases. Despite these measures, the first case of COVID-19 was diagnosed in the region on March 1, 2020. All individuals diagnosed with SARS-CoV-2 infection were admitted to designated COVID centers regardless of symptoms and were treated according to the Ministry of Health guidelines. This report describes the first three months of the SARS-CoV-2epidemic in the Kurdistan Region of Iraq, including the case fatality rate and the recovery rate and factors related to COVID-19-related deaths.

Background and aims The coronavirus disease-2019 (COVID-19) pandemic impacted healthcare services for kidney disease patients. Lockdown and social distancing were mandated in Kurdistan, Iraq to combat the transmission of the infection. The report analyzed the impact of the COVID-19 pandemic on kidney disease patient care in Duhok City, Kurdistan Region of Iraq. Methods This study took place in the Duhok Kidney Disease and Transplant Center and compared data from February–April 2019 and 2020. Results The average number of patients visiting the consultation unit per week was reduced from 68.67 ± 13.6, to 33.42 ± 29.36 (P = 0.001) during the pandemic. In the dialysis unit, weekly hemodialysis sessions were reduced from 341.5 to 306.42 sessions (P = 0.002). The number of patients visiting the kidney transplant consultation unit was significantly reduced (135.7 ± 37.7 versus 102.5 ± 26.3; P = 0.005). The number of kidney transplant operations per week was reduced from 1.167 to 0.5 (P = 0.025). Conclusions The COVID-19 pandemic interrupted healthcare services and may continue to impart long-term negative consequences for kidney disease patients.

Recurrent abortion is a worldwide issue. Anticardiolipin antibodies (ACA) are found to be among the most important factors related to recurrent spontaneous early pregnancy loss. This study aimed to investigate the prevalence of anticardiolipin IgM and IgG antibodies in women with recurrent abortion in Kurdistan Region of Iraq. The present study was conducted in Duhok and Zakho cities for the period from April 2014 to May 2019. A total of 1230 women aged between 18 to 46 years old were included in this study. ELISA was used for the detection of anticardiolipin antibodies. Among the studied subjects, the prevalence of anticardiolipin antibodies was 74 (6.02%) for ACA IgM and 56 (4.6%) for ACA IgG. It was also observed that 16 (1.3%) subject were positive for both ACA IgM and IgG antibodies. Additionally, the highest anticardiolipin antibody positivity rates were recorded in patients older than 30 year old (p value <0.01). The IgM ACA positivity was higher in Zakho city 45 (7.2%) when compared to Duhok city 29 (4.6%) (P value < 0.04). In conclusion, anticardiolipin antibodies can have a positive association among women with recurrent abortion. Therefore, it is suggested that woman with recurrent abortion should be screened for anticardiolipin antibodies; this could increase fetal survival by initiating early anticoagulant therapy when other causes of abortion are excluded.

Background: Urinary tract infection (UTI) is one of the most common infectious diseases at the community level, worldwide. Objectives: This study aimed to assess the prevalence and antimicrobial susceptibility patterns of the main pathogens responsible for male UTI in the community. Methods: Urine samples were collected from 211 subjects with UTI between January 2017 and February 2020. The samples were inoculated directly on MacConkey and Blood agar and then incubated at 37°C for 24 h. Samples with a colony count of 105 CFU/mL bacteria were considered positive. Bacterial colonies were determined by standard culture and biochemical characteristics, and their susceptibility to different antibiotics was identified by the Vitek-2 compact equipment. Results: The vast majority of the bacteria were Gram-negative (170 [80.6%]), while 41 (19.4%) of them were Gram-positive. The highest infection was by Escherichia coli (52.6%), followed by Pseudomonas aeruginosa (14.2%). Staphylococcus spp. were the most common Gram-positive bacteria (13.8%). The highest susceptibility of Escherichia coli isolates was found to imipenem (96.4%), and the highest resistance rate was to ampicillin (96.4%). Pseudomonas aeruginosa was resistant to all commonly used antibiotics, and around 86% was susceptible to ertapenem (86.7%). It was also found that Staphylococcus strains were resistant to benzylpenicillin (100%) and sensitive to linezolid (100%), tigecycline (100%), and nitrofurantoin (100%). Conclusions: E. coli isolates were the most frequent pathogens causing UTI in males, followed by P. aeruginosa and Staphylococcus spp. The vast majority of isolates were resistant to commonly prescribed antibiotics such as ampicillin, ceftriaxone, cefepime, benzylpenicillin, oxacillin, and erythromycin. This is an alarming situation, and an urgent plan to control antibacterial resistance is required in the region.

With the appearance of first cases of Coronavirus disease (COVID-19), strict control measures were implemented in the Kurdistan Region of Iraq to combat the infection. These measures included the closure of schools and universities, the closure of borders and airports, cancellation of public and religious gatherings, and mandatory quarantine for persons returning from traveling abroad. Such measures have played a major role in the control of COVID-19 spread. However, due to social and economic pressures, the government relaxed the lockdown. After relaxing the measures, a sharp increase in the number of patients was noticed. Besides, there was a significant increase in the number of symptomatic patients and the case fatality rate was doubled. In addition, the outbreak and outbreak response led to the loss of trust and a breakdown in relations between the society and local authority. To minimize the consequences for population health, local authority should have a plan that balances between health imperatives and socioeconomic imperatives. Finally, to be successful in controlling the infection, the government must rebuild public trust in the handling of COVID-19 outbreak and compensate people for lost earnings.

Coronavirus Disease 2019 (COVID-19) was first diagnosed in Wuhan, China, in December 2019 (1). Since then, the infection has spread to all countries around the world. The World Health Organization declared the infection a pandemic on 11 March 2020. in the Kurdistan Region, educational institutes moved to new ways of teaching and assessing during the lockdown. The main challenges were the lack of required infrastructures, skills, availability of gadgets, the achievement of adequate practical training, and the format of examinations. Good preparedness is needed to overcome the obstacles in the next academic year if the COVID-19 pandemic continues.

Cutaneous leishmaniasis (CL) is endemic in Iraq. After the last war in Iraq against Islamic State in Iraq and Syria (ISIS), the number of CL cases has peaked particularly in children. International guidelines do not provide an insight on how to choose treatment regimen of CL in children. The aim of this paper was to study the efficacy of intralesional sodium stibogluconate (SSG) therapy for school age children with CL. In the period between June 2016 and June 2019, 288 internally displaced school age children (6‐12 years old) from Ninewa city were recruited in the study. All patients received intralesional SSG twice a week for a maximum of twelve sessions. All patients were followed up for 12 weeks after the last treatment session. The mean age of recruited patients was 8.6 ± 2 years and 164/288 (56.9%) were male. 202/288 (70.1%) of the patients presented with single lesion. The total number of lesions was 417 of which 141/417 (33.8%) lesion were nodular and the rest were ulcerative lesions. The treatment success rate was (282/288) 97.91%. No significant association was found between age, gender, number of lesions, or duration of lesions and the treatment outcome. Mild local pain, mild bleeding at the site of injection and itching at the site of injection were the most common side effects. Intralesional SSG infiltrate is effective and minimal side effects. Further studies including clinical trials are required to provide robust data on the efficacy and the safety.

Background: Escherichia coli (E. coli) is one of the most common causative agents of bacterial infections. The emergence of multidrug-resistant E. coli is a major public health threat worldwide. Objectives: This study aimed to determine the antibiotic susceptibility profile of clinical isolates of E. coli from different samples. Methods: A total number of 454 clinical samples, including urine, wound, cervical swab, blood, semen, ascetic, and cerebral spinal fluid samples were collected from patients between January 2017 and February 2020. Then, E. coli was confirmed and susceptibility to different antibiotics was determined using the Vitek-2 compact system. Results: Escherichia coli isolates were more frequent in females (70.7%) than in males (29.3%). In the case of urine samples, E. coli was found to be highly susceptible to ertapenem (97.6%) and imipenem (96.4%) but resistant to ampicillin (87.8%). For wound and cervical swabs, E. coli was 100% resistant to ampicillin and cefepime but 100% sensitive to ertapenem and imipenem. It was found that E. coli isolates from blood samples were 100% resistant to ampicillin, ceftriaxone, and cefoxitin, and around 75% of them were sensitive to ertapenem, ciprofloxacin, and levofloxacin. Finally, E. coli isolated from other clinical samples were highly sensitive to ertapenem, imipenem, levofloxacin, nitrofurantoin, and cefazolin. Conclusions: Escherichia coli isolated from various clinical specimens showed differences in antibiotic sensitivity patterns, with high resistance to commonly used antibiotics. The most effective antibiotics against E. coli isolates were ertapenem, imipenem, and nitrofurantoin. However, the clinical isolates of E. coli displayed high resistance rates to ampicillin, ceftriaxone, and cefepime. Therefore, it is proposed to perform antibiotic sensitivity testing by physicians to select the most effective antibiotics

Cutaneous Leishmaniasis (CL) is caused by protozoan parasites called Leishmania. CL is endemic in Iraq and caused by L. tropica and L. major species. Between August 2014 and September 2019, 104 patients with CL were recruited. Among those, ten patients were excluded because they did not follow the protocol of treatment, changed address before finishing treatment, or received treatment from more than one clinic and so they were excluded from further analysis. The mean age of patients was 13.6±2.7 months, and 47/94 (50%) were male.60/94 (63.8%) of the patients presented with a single lesion. The total number of lesions was 155, of which 51/155 (32.9%) lesion were nodular, and the rest were ulcerative lesions. Our findings showed that intralesional sodium stibogluconate resulted in a 100% cure rate. Intralesional sodium stibogluconate infiltration seems safe, effective, and well-tolerated with minimal adverse effects. Further studies, including clinical trials, are required to provide robust data on the efficacy and the safety of intralesional sodium stibogluconate leading to the development of clinical guidelines for the treatment of CL in this age group.

This study was carried out on seven flocks of ewes suffered from late abortion and neonatal death with prevalence rate of infection was 13.95%. Blood and tissue samples were taken from aborted ewes in several flocks of Duhok province, Kurdistan Region-Iraq. Serological analysis confirmed that all aborted ewes were positive agglutination reaction for T. gondii antibody. Gross finding of aborted feti were showed blood stained fluid in the thoracic and abdominal cavity and most of the aborted feti also revealed enlarged, congested and friable liver and lungs. The placenta was swollen, reddish and friable and its cotyledons were also spotted with whitish foci. T. gondii tachyzoites were also demonstrated from placental sections of some aborted ewes. Severe congestion, necrosis, and infiltration of multinucleated cells were the most predominant histopathological changes of aborted fetuses as well as presented tissue cysts, tachyzoites and bradyzoites in the liver, brain, heart and lung. There were also several clusters of dark purple banana-shape of T. gondii tachyzoites within the brain and heart tissue in most of examined aborted feti in different flocks. T.gondii Tachyzoites were also clearly detected from the peritoneal ascites of mice inoculated 12 days post infection experimentally. T. gondi tissue cysts were also detected from impression smears of mice brain after 32 days post infection. This result was concluded that the demonstration of T. gondii parasites in Giemsa stained impression smears associated with characteristic histopathological changes from different organs are of great fundamental method for diagnosis of T. gondii in aborted cases.

Social distancing is important to decrease the interactions between people in the society. As a set of measures, social distancing is taken to reduce infections transmitted by droplets. To achieve its aim, social distancing should include the cancellation of funerals and weddings, the closure of schools and universities, and the cancellation of mass gatherings (1). In a study conducted in China during the epidemic outbreak of coronavirus disease 2019 (COVID-19), the death rate was about 10% in the epicenter of the epidemic whereas the death rate was 1% in other areas. It was concluded that the high death rate was due to the breakdown of the healthcare system owing to the large number of patients. It was then recommended that social distancing may help in preventing the breakdown of healthcare system (2). In another study in China, it was concluded that social distancing can reduce the number of infections by 98% and the number of deaths by 99% (3). The first case of COVID-19 in Kurdistan region was diagnosed in beginning of March 2020, and from that time 324 confirmed cases have been recorded onwards. The region is divided into four cities: Duhok (15 COVID-19 cases), Erbil (168 cases), Sulaimani (120 cases), and Halabja (21 cases). The age range of COVID-19 patients was from 10 months to 70 years old. Amongst the 324 patients, 52% were female, 80% were asymptomatic and diagnosed while in the quarantine, and 0.9% passed away (4). The regional government in Kurdistan, northern Iraq imposed strict measures to stop the spread of the infection. These measures included the closure of educational institutions, workplaces, roads, and the cancellation of public gatherings including Friday prayers, church gatherings, funerals, and weddings. Besides, measures included mandatory quarantine of uninfected subjects with a history of travel or exposure to SARS-CoV-2. However, imposing these rules was challenging in the area. On March 23, 31 cases of COVID-19 were diagnosed in Erbil city which was the highest number of patients discovered in one day. Careful examination and tracing revealed that those patients had attended unpermitted funerals. Healthcare authority in the city launched a tracing operation to quarantine and test all the people attended the funeral. This resulted in the diagnosis of 98 funeral-related patients in the city. This also represented 129/168 (76.78%) of the patients diagnosed in Erbil. In another incidence in Sulaimani city, 15/120 (12.5%) patients were diagnosed after attending unpermitted funeral in the city. Totally, these patients comprised 44.4% of the patients diagnosed in the region. It appeared that breaching the lockdown and social distancing increased the number of patients sharply in the region and particularly in Erbil city. Therefore, it seems imposing social distancing must be accompanied with health education programs to educate the people about the consequences of cancellation of gatherings and importance of lockdown in preventing the transmission of the virus. To conclude, the strict social distancing measures helped in limiting the spread of infection. However, breaching the lockdown increased the number of patients sharply. Health education is required alongside in order to increase the awareness of the people and ensure better commitment.

Background and aim: Hepatitis B and C virus (HBV and HCV) infections are considered as major global public health concerns. Chronic infections may lead to liver cirrhosis, hepatic failure, and hepatocellular carcinoma. Therefore, the aim of this study was to investigate the prevalence of HBV and HCV infections in patients with end-stage kidney disease (ESKD) and on regular hemodialysis in Duhok located in the Kurdistan region of Iraq. Methods: A cross-sectional study was conducted in Duhok, Iraq between January 2019 and October 2019. During this period, a total of 143 patients within the age range of 9-72 years old with ESKD visited the Duhok dialysis center for regular hemodialysis. Enzyme-linked immunosorbent assay (ELISA) was conducted to test HBV and HCV positivity and then HBV viral load was tested by the real-time polymerase chain reaction (RTPCR). Finally, HCV positivity was confirmed by the Xpert HCV quantification assay. Results: Among the recruited samples, 5 out of 143 (3.49%) patients were positive for HBV while HBV viral load for those patients was undetected. On the other hand, 3/143 (2.1%) patients tested positive for HCV Ab. All these 3 patients were also confirmed positive by the RT-PCR. Conclusions: ESKD patients on regular analysis showed a low prevalence of HBV and HCV in the Duhok dialysis center. An effective infection control program, vaccination, and treatment of HCV make the elimination of HBV and HCV feasible in such a group.

Background: In pregnant women, primary infection with rubella and herpes virus may lead to serious complications, including abortion, stillbirth, and severe birth defect. The objective of the present study was to determine the prevalence of rubella and herpes IgG and IgM antibodies in pregnant women. Methods: A cross-sectional study was conducted in Zakho city, Kurdistan, Iraq. A total of 200 women aged 18-45 years with a history of miscarriage and stillbirth were recruited. Samples were collected from Private Clinical Health Centre at Zakho City between January 2015 and December 2018. All samples were then tested by Enzyme Linked Fluorescent Assay (ELFA) (VIDAS instrument) for detection of rubella and herpes specific IgG and IgM classes of antibodies. Results: Of the total study participants, 166 (83%) were seropositive for anti-rubella IgG antibodies while nine (4.5%) were positive for anti-rubella IgM antibodies. In addition, seroprevalence of IgG and IgM antibodies to Herpes simplex virus was observed in 154 (77%) and 10 (5%) subjects, respectively. As far as age is concerned, the highest seropositivity of specific IgG and IgM antibodies to Rubella and Herpes was found in participants younger than 30 years, but statistically not significant differences were found (P<0.45 and 0.73 for Rubella and P<0.86 and 0.19 for Herpes, respectively). Conclusion: This study provided pilot data on Rubella and Herpes virus infections among women in Zakho city, Kurdistan, Iraq. Data from the present study showed a high anti-Rubella and Herpes IgG and a low IgM positivity in the recruited subjects. Screening women with miscarriage or stillbirth might be conducive to specifying the causes of abortion or stillbirth.

Background: Toxoplasma gondii and Cytomegalovirus (CMV) can cause a range of diseases in pregnant women and may lead to adverse fetal outcomes. Therefore, the detection of these infections is necessary during pregnancy. Objectives: The aim of this study was to estimate the seroprevalence of Toxoplasma and Cytomegalovirus infections among the pregnant women with history of abortion in Zakho city, Iraq. Methods: Over a period of five years (2014-2018), blood samples were collected from 500 subjects aged 16-45 years old and tested to identify the presence of specific IgG and IgM to Toxoplasma and CMV infections by Enzyme Linked Fluorescent Assay (ELFA) method. Results: Of 500 pregnant women, 145 (29%) and 7 (1.8%) were seropositive for anti-Toxoplasma IgG and IgM, respectively. IgG seropositivityto T. gondii infection varied significantly between age groups (P=0.05). Additionally, the seroprevalence of IgG and IgM antibodies for CMV was 475 (95%) and 9 (1.8%), respectively. Estimation of age specific subgroups showed high CMV IgG seropositivity rates for all age groups with no significant difference between them. Altogether, 145 cases were verified seropositive for specific IgG antibody against both pathogens and only 2 cases were positive for specific IgM against both agents. Conclusion: Anti-Toxoplasma and CMV IgG and IgM antibodies positivity rates among pregnant women determined in the present study are quite similar as compared to other studies reported in Kurdistan Region, Iraq. Though, infection with those pathogens is not a major cause of abortion; it is useful to screen women with recurrent abortion for such infections in order to avoid undesirable fetal outcomes and other serious complications.

Background: Infections with hepatitis B virus (HBV) and hepatitis C virus (HCV) are major global public health problems. Infection with such viruses is commonly associated with liver cirrhosis and hepatocellular carcinoma. Objectives: The aim of this study was to determine the prevalence rate of HBV and HCV in women in Zakho City, Kurdistan Region of Iraq. Methods: A cross sectional study was performed in Zakho City, Iraq between January 2019 and October 2019. A total of 2223 females aged between 18 to 52 years old were included in this study. ELISA test was used to determine HBsAg, HBc IgG, and HCV antibodies positivity. HCV positive samples were then confirmed by Xpert HCV quantification assay. Results: Among the studied subjects, 12/2223 (0.54%) samples were positive for HBs Ag. All these 12 patients showed also positivity for HBc IgG. Only 1/2223 (0.045%) sample was positive for HCV antibodies. The result of HCV-RT-PCR confirmed the positivity for this patient. Conclusions: The low prevalence rate of HBV and HCV infection among women in Zakho City was less than that reported in other studies. Population-based study is needed to estimate the prevalence of infection.

his study performed molecular detection and analysis of the heterogeneity of the 18S rRNA gene isolates obtained from equids such as horse, mule, donkey and pony from Erbil province, Kurdistan region of Iraq. Multiplex polymerase chain reaction (PCR) indicated that 76/136 (55.88%) of equine were infected with piroplasms, with Theileria equi (P=41.91%; CI=3.76-14.77%) more prevalent than Babesia caballi (P=8.82%; CI=1.00%), while mixed infection was less (P=5.15%; CI=0.21-1.46%) with a significant difference (P<0.001). There was a significant association between the prevalence of T. equi and recreation (p<0.03) or racing (p<0.02), and but neither the type of equids nor the gender and age groups was significantly associated with prevalence. The obtained sequences were utilized for characterizing the genotypes and phylogeny of both the protozoa. BLAST analysis indicated 98-100% similarity to species isolated in Turkey, Malaysia, Egypt, Sudan, Jordan, Iran, Brazil and South Africa. Four 18S rRNA genotype clades were observed for T. equi (A, B, C and D) and two for B. caballi (A and B). Genetic variation found among the equids in Erbil province is probably due to introduction of equines from other countries without quarantine measures. This study indicates that infection with T. equi is more prevalent than that of B. caballi in the studied area.

Background and Aims: Hepatitis C virus is a major global health problem that primarily affects the liver which lead to liver cirrhosis, liver failure and hepatocellular carcinoma. The aim of this report was to investigate the genotypes of HCV in patients on regular hemodialysis in Iraq. Materials and Methods: A cross sectional study was conducted to investigate the genotypes of HCV in patients on regular hemodialysis in 7 centers across Iraq. A total of 255 subjects with positive anti-HCV antibodies were recruited in this study. Results: To confirm the positivity, RT-PCR was performed. Amongst all samples, 31% (79/255) was positive by RT-PCR. Then, we genotyped all the RT-PCR positive samples, it was found that 39/79 (49.4 %) of our samples were typed as HCV genotype 1 including 26 samples (66.7%) as HCV 1a and 13 samples (33.3%) as HCV 1b. HCV genotype 4 was found in 34/79 (43%) of the samples while 6/79 (7.6%) of the samples typed as HCV 3 Conclusion: HCV genotype 1 was the most prevalent genotype followed by genotype 4. Further population-based study is required to investigate the prevalence of HCV genotypes.

Salmonella Enteritidis is an important cause of human salmonellosis and food-poisoning associated with consumption of contaminated chicken eggs and poultry products. Objective of the study was to develop a serological diagnostic testfor the recognition of different Salmonella serovars in chickens. Here, phage peptide libraries were screened against 9 IgY samples from chickens infected with S. Enteritidis and 9 IgY samples with S. Hadar and the individual peptide binders were then identified using NGS. Twenty-nine peptides were identifiedin silico assessmentas being enriched specifically against IgY from multiple chickens infected with S. Enteritidis compared to those infected with S. Hadar. Twenty Nine peptides identifiedin silico assessmentwere thentested by both training and test cohorts of chicken IgY samples in ELISAs. The training set of samples was made upof IgY from 9 chickens infected with S. Enteritidis and 9 infected with S. Hadar. Seventeen peptides were selected as the most recognized specific peptides against S. Enteritidis infection and were then used against IgY samples from10 birds infected with S. Enteritids and20 birds with S. Typhimurium as a test cohort. Overall, for both training and test cohorts the peptide ELISA assay sensitivity and specificity were 90 % for detecting infections. The most discriminatory peptides by ELISA test were AEGEFEPQSARPS and AEGEFFVNRALINQ. The data demonstrated that the NGPD method could identify peptides that represented serovar-specific epitopes/mimotopes, these peptide have potentially important applications for the development of peptide based immuno-diagnostic assays for the recognition of Salmonella Enteritidis in chickens.

Acute Anaplasma ovis infections can cause severe clinical symptoms and might lead to significant economic losses in small ruminant flocks. However, little information has been provided related the prevalence of anaplasmosis in Angora goats. The study was designed to investigate the prevalence of Anaplasma ovis serologically (cELISA) and microscopically (Giemsa stained blood smears) among Angora goats from Duhok districts of the northern part of Iraq. A total of 92 blood samples were randomly collected from three localities of Duhok city; Zakho, Batel and Sumil during the study period from April to October 2009. The infection rate of A. ovis was 38.04% by Giemsa stained blood smear and 66.3% by cELISA. The prevalence of A. ovis in female goats was higher than that in males, but statistically not significant difference (P>0.05) by using both methods. The prevalence was also significantly higher (P<0.05) in goats more than three years old than in younger ones. The highest prevalence of A. ovis was found in Zakho, whereas the lowest was reported in Sumail. Results of hematological parameters indicated microcytic hypochromic type of anemia.It is concluded that A. ovis can infected Angora goats in district Duhok, Kurdistan region, Iraq and this might be due to high distribution of the disease and its transmitters which were lead to substantial effect followed by high mortalities

Serological surveillance and vaccination are important strategies for controlling infectious diseases of food production animals. However, the compatibility of these strategies is limited by a lack of assays capable of differentiating infected from vaccinated animals (DIVA tests) for established killed or attenuated vaccines. Here, we used next generation phage-display (NGPD) and a 2-proportion Z score analysis to identify peptides that were preferentially bound by IgY from chickens infected with Salmonella Typhimurium or S. Enteritidis compared to IgY from vaccinates, for both an attenuated and an inactivated commercial vaccine. Peptides that were highly enriched against IgY from at least 4 out of 10 infected chickens were selected: 18 and 12 peptides for the killed and attenuated vaccines, respectively. The ten most discriminatory peptides for each vaccine were identified in an ELISA using a training set of IgY samples. These peptides were then used in multi-peptide assays that, when analysing a wider set of samples from infected and vaccinated animals, diagnosed infection with 100% sensitivity and specificity. The data describes a method for the development of DIVA assays for conventional attenuated and killed vaccines.

Mapping polyclonal antibody responses to infectious diseases to identify individual epitopes has the potential to underpin the development of novel serological assays and vaccines. Here, phage-peptide library panning coupled with screening using next generation sequencing was used to map antibody responses to bacterial infections. In the first instance, pigs experimentally infected with Salmonella enterica serovar Typhimurium was investigated. IgG samples from twelve infected pigs were probed in parallel and phage binding compared to that with equivalent IgG from pre-infected animals. Seventyseven peptide mimotopes were enriched specifically against sera from multiple infected animals. Twenty-seven of these peptides were tested in ELISA and twenty-two were highly discriminatory for sera taken from pigs post-infection (P < 0.05) indicating that these peptides are mimicking epitopes from the bacteria. In order to further test this methodology, it was applied to differentiate antibody responses in poultry to infections with distinct serovars of Salmonella enterica. Twenty-seven peptides were identified as being enriched specifically against IgY from multiple animals infected with S. Enteritidis compared to those infected with S. Hadar. Nine of fifteen peptides tested in ELISA were highly discriminatory for IgY following S. Enteritidis infection (p < 0.05) compared to infections with S. Hadar or S. Typhimurium.

Salmonellosis causes significant economic losses to the pig industry and contaminated pork products are an important source of Salmonella for humans. The EU ban on the use of antibiotic growth promoters in pig production, and the emergence of antibiotic resistance has meant there is a pressing need for alternative control strategies for pathogenic bacteria such as S. Typhimurium in pigs. Here, we determined the effects of prebiotic, probiotic and synbiotic diet regimes on antibody responses to oral Salmonella challenge of pigs. The data demonstrate that the inclusion of the probiotic Lactobacillus plantarum B2984 in the diet of piglets (∼1×1010 cfu/animal/day) enhanced serum IgM (P<0.001), IgG (P=0.001) and IgA (P=0.039) responses to S. Typhimurium infection including cross-reacting antibodies to S. Enteritidis. Similarly, inclusion of the prebiotic lactulose at 1% (w/w) of the feed on a daily basis in the diet enhanced serum IgM (P=0.010), IgG (P=0.004) and IgA (P=0.046) responses to S. Typhimurium infection and also cross-reacting antibodies to S. Enteritidis. Inclusion of both additives in the synbiotic diet also elicited an enhanced immune response with IgM (P=0.009) and IgG (P=0.046) levels being increased, however a significant interaction of the pre and probiotics was observed when considering the immune responses to S. Typhimurium (IgM P=0.004; IgG and IgA, P<0.001 for interaction). With respect to immune responses, the effects of pre or probiotic administration were the same or reduced in the synbiotic diet compared to when used in isolation. The data support the use of Lactobacillus plantarum B2984 or lactulose as strategies to contribute to the protection of weaned piglets from zoonotic bacterial pathogens, but caution must be taken when combining dietary supplements as combinations can interact.

An investigation into ectoparasites of sheep and goats was carried out in Duhok province North West region of Iraq, during six months of a year, from January to June 2010. One thousand and two hundred forty eight (1248) sheep and 954 goats in 110 flocks from 80 villages were examined. Among them overall animals (66.89%) were infested with one or more species of ectoparasites. Of 720 (57.7%) and of 753 (78.9%) sheep and goats, respectively were infested. Five different types of ectoparasites, ticks (46.7%, 34.9%), lice (3.8%, 33.8%), mites (7.1%, 0.1%), fleas (2.8%, 7.75%) and ked (1.2%, 4.5%) were identified sheep and goats, respectively. Five species of hard ticks (Ixodidae) were identified in both sheep and goats, namely Hyalomma anatolicum anatolicun (48.37%, 13.5%), H. marginatum (18.01%, 8.1%), Rhipicephalus sanguineous (21.09%, 39.93%), R. turanicus (16.8%, 49.54%) and Haemaphysalis ssp. (2.5%, 0.9%). Two species of lice were infested each one of animal these namely, Damalinia Ovis (75%) and Linognathus stenopsis (33.3%) on sheep, and D. caprae (80.74%) and L.stenopsis (19.2%) on goats. Sheep were highly infested with two species of mites, Sarcoptes scabiei (25.84%) and Psoroptes Ovis (74.15%) than the goats, which one goat was found (0.1%) infested with S. scabiei. Three species of fleas were found infested both sheep and goats. Out of 106 collected fleas (47.2%, 43.4%, 9.4%) were Ctenocephalides felis felis, Pulex irritans and Xenopsylla cheopis, respectively. However, the only one species of Ked Melophagus ovinus were infested (1.2%) of sheep and (4.5%) of goats.

The prevalence of Theileria hirci and Babesia motasi was studied in goats in the Duhok area of Iraq from April to September 2010. A total of 500 local black breed goats represent 35 flocks of different localities were clinically and then in laboratory examined for the presence of piroplasmosis in blood smears. The study revealed that 20.8% of the goats infected with T. hirci and 4% infected with Babesia motasi. Prevalence of piroplasms infection between male and female and between different age groups of goats was statistically significant. Hematological findings, showed a significant decrease in red blood cell, hemoglobin concentration, and packed cell volume beside the significant increase in the mean corpuscular volume. No changes in mean corpuscular hemoglobin, and mean corpuscular hemoglobin concentration values were noted. Macrocytic and normochromic type of anemia was found.

The objectives of the present work were done to investigate the prevalence of Anaplasma ovis infection in goats in Duhok area, Kurdistan Region, of Iraq from April to September 2009. A total of 460 local black breed goats represent (35 flocks) of different localities were examined for the presence of Anaplasma ovis by Giemsa stained blood smears and serologically by competitive inhibition enzyme-linked immunosorbent assay (cELISA) for antibodies against A. ovis. The results revealed that 257 (55.86%) and 346 (75.22%) of goats were infected with A. ovis by Giemsa stained and by (cELISA) respectively. Statistically significant difference was encountered between males and females and among the different age groups of goats, high infection rate was detected in goats more than 3 year old 146 (31.74 %) , where as goats 1-3 years old and those less than one year old of 84 (18.26%) and 27 (5.86%) respectively. The percentage of parasitemia ranged between 2.8-12.2% with mean of (7.12 %). The hematological parameters were estimated from positive cases of Giemsa stained. The mean values of erythrocyte count (5.9 ± 1.17) 106/μl, packed cell volume (19.5 ±2.68) % and hemoglobin concentration (6.3 ± 0.83) g/dl were statistically significant decrease (P 0.05). Also there was a statistical significant increased (P 0.05) in mean corpuscular volume (MCV) (33.9 ± 5.88) fl, while there was no statistical significant in mean corpuscular hemoglobin (MCH) (10.8 ± 1.76) pg and the mean corpuscular hemoglobin concentration (MCHC) (32.3 ± 2.19) g/dl. This indicated evidence of macrocytic normochromic type of anemia, whereas no significant differences were encountered in the differential count of leukocytes.