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). Conclusion This study provided the first estimate of undiagnosed DM in the Kurdistan Region. The current study showed that the prevalence of undiagnosed DM and impaired fasting glucose were significant emphasizing age, BMI, and waist circumference as significant risk factors. These findings suggest the need for targeted screening and preventive strategies in this population to improve DM detection and management.

Helicobacter pylori (H. pylori) is a globally prevalent bacterium, infecting roughly half the global population, with higher prevalence rates in developing countries. This study aimed to investigate the prevalence of H. pylori among symptomatic dyspeptic patients in Zakho City, Iraq, evaluate its association with various risk factors, as well as evaluate the effectiveness of treatment in curing this bacterium. Of a total of 150 dyspeptic patients, 50 who had received antibiotics were excluded, leaving 100 patients without antibiotics enrolled in this study. These participants, aged 11-67 years, visited the private Nawroz Laboratory in Zakho City, Kurdistan, Iraq, between June 2021 and October 2022. These patients were tested using the Helicoprobe 14C-Urea breath test and data on various factors, including age, gender, smoking, family size, drinking water source, education level, BMI, hemoglobin levels, and blood group, were collected through structured interviews. In this study, the prevalence of this bacterium was 50%, with no significant difference observed between males and females as well as BMI, smoking, source of drinking water, and blood groups while significant associations were found between infection and increasing age, low Hb levels, and educational level. Notably, 46.7% of patients failed to respond to standard triple therapy, possibly due to antibiotic resistance. The ineffectiveness of standard triple therapy for H. pylori highlights the need for tailored treatments based on local antibiotic resistance patterns to improve prevention and treatment strategies with further investigation studies.

ABSTRACT Objective: This retrospective cross-sectional study aimed to explore the prevalence of hyperuricemia among patients with type 2 diabetes mellitus and identify associated factors. Methods: A total of 228 adult patients diagnosed with type 2 diabetes mellitus were included in this study. Data including demographic characteristics, clinical parameters, and serum uric acid levels were collected from medical records. Patients were categorized into two groups based on uric acid levels: hyperuricemia (≥7 mg/dL for males, ≥6 mg/dL for females) and non-hyperuricemic. Descriptive statistics and unpaired t-tests were utilized for analysis. Results: A total of 228 patient were included (60.53% of them were female), according to standard guidelines hyperuricemia was defined as (≥ 7 mg/dl for male and ≤ 6 mg/dl for female) among them, 39.47% exhibited hyperuricemia. Mean uric acid level was 5.84±2.03. Significant associations were observed between uric acid levels and age (p = 0.0003), marital status (p = 0.0358), duration of diabetes (p = 0.0013), and HbA1c levels (p < 0.0001). However, other factors such as gender, smoking status, family history of diabetes, body mass index, and waist circumference did not show significant associations with uric acid levels. Conclusion: This study highlights a notable prevalence of hyperuricemia among patients with type 2 diabetes mellitus. Factors such as older age, longer duration of diabetes, and poorer glycemic control were associated with higher uric acid levels. These findings underscore the importance of monitoring and managing uric acid levels in diabetic patients to mitigate potential metabolic complications. Further prospective studies are warranted to elucidate the underlying mechanisms and clinical implications of this relationship.

Abstract 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.

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 individuals with moderate cases of infection than in mild and severe cases (0.001). Individuals who contracted the Omicron strain generally had positive outcomes. Reinfection with the Omicron variant was relatively high. IgG levels were higher in patients with mild disease, implying that they were associated with decreased disease severity. We found significant associations between D-dimer levels and the severity of the disease. Additional research is required to investigate the long-term effects of Omicron infection. Keywords: Infection Outcome, Reinfection, SARS-CoV-2 Antibody, Omicron Variant, RT-PCR

Abstract Aim: This study investigated the clinical characteristics and outcomes of patients with severe coronavirus disease 2019 (COVID-19) who were involved in the home management scheme in Duhok city. Materials and Methods: This prospective descriptive study enrolled Kurdish patients diagnosed with severe COVID-19 between June 1 and November 1, 2020, and were treated at home. Results: The average age of the patients was 59.77 ± 14 years and 51 (56.04%) of them were males. Seven of these patients (7.69%) were smokers. Most patients (72.52%) had one or more comorbidities. Fever (87.1%) was the most commonly presented symptom in older patients. The case fatality rate was 3/91 (3.29%). This rate was not found to be associated with sex, history of smoking, or comorbidities. The age of deceased patients (40 ± 25 years) was significantly lower than that of cured patients (60 ± 13 years) (p = -0.025). Conclusions: The case fatality rate of patients enrolled in this scheme was comparable to those who received treatment in hospitals. Therefore, this scheme could provide a good alternative for treating patients with severe COVID-19 and family physicians could lead the scheme through the primary care network. Keywords: COVID-19, Duhok, family physician, home management scheme, Kurdistan

Introduction: The characters of coronary artery disease with its risk factors and coronary angiograms studied elsewhere revealed differences in different populations. We, here, assess the regional characters of coronary artery disease with its major risk factors and coronary angiographic profile in Duhok, Kurdistan region of Iraq. Methods: We conducted this cross sectional study at the Azadi heart center in Duhok, Iraq. A consecutive sampling procedure was used to enroll a total of 300 adult patients with coronary artery disease (145 men and 155 women) who had undergone coronary angiography. Direct interview was used with designed questionnaire to collect demographic, cardiovascular risk factors and angiographic profiles. Results: The mean patient’s age was 55.5 (10.4) years. The most prevalent risk factor was hypertension (55.3%), followed by dyslipidemia (42.7%), type 2 diabetes mellitus (29%), smoking (11%) and ex-smoking (9.3%). Apart from smoking all other risk factors were more frequent in women. Angiographic analysis revealed normal angiograms in (29.3%) versus single vessel disease (23.3%), double vessel disease (14.3%), triple vessel disease (21.3%) and non significant (11.7%). As to the coronary branch involved, the most frequently affected was the left anterior descending artery followed by right coronary artery, left circumflex artery, and left main stem (60.7%, 46.3%, 43.7% and 6% respectively). Conclusion: This study showed that the coronary artery disease tends to occur earlier in our population. Although cardiovascular risk factors were clustered among women, older men showed more aggressive coronary angiographic lesions. Keywords: Coronary artery disease, cardiovascular risk factors, coronary angiography, Kurdistan, Iraq

Abstract Objectives: The aim of this study was to investigate the prevalence of poor glycemic control in Zakho city and to explore the modifiable risk factors that may help controlling the disease. Methods: We recruited patients with known history of diabetes receiving oral anti-diabetic medications. Those patients were registered in Zakho Diabetes center with regular visits. The measurement of anthropometric indices was conducted by trained personnel. Plasma glucose was determined using colorimetric enzymatic method with glucose oxidase. HbA1c concentrations were measured in whole blood samples using high performance liquid chromatography. Results: In this study, 520 patients were recruited. The average age of the patients was 56.92 ± 9.62. Among those, 190 were male. The blood sugar was controlled in 122 (23.4%) patients. We found a significant association between sex and HbA1C level (p = 0.000; OR = 0.4796; CI = 0.3175–0.7243). In addition, waist circumference was significantly associated with HbA1C levels (p = 0.018; OR = 1.02; CI = 1.0031–1.0373). Conclusions: The vast majority of the patients had uncontrolled diabetes. We found that sex and waist circumference were risk factors for uncontrolled diabetes. Any diabetes controlling program should focus on those two factors. Keywords: Risk factors, Diabetes mellitus, poor glycaemic control, Zakho city

Novel coronavirus disease (COVID-19) or SARS-CoV-2 was discovered in December 2019 in Wuhan City, China. The infection became a global pandemic over few months.1 Duhok is a big city in the Kurdistan Region of Iraq with a population of 1.3 million. The city experienced a large epidemic with one of the highest COVID-19 infection and case fatality rates in Iraq.2 The centralized COVID-19 database registration system and the intensity of infection spread in the city provided an excellent opportunity to evaluate the risk of reinfection in the city. It is worth mentioning that reinfection may be possible after recent reports showing recovered patients testing positive after a symptom-free period.3–5 This study aimed to evaluate the risk of reinfection in a cohort of 445,660 COVID-19 RT-PCR-tested cases

Abstract 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 article 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 12 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: 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. Keywords: HCV, Sustained virologic response, Recurrence rate