Background Staphylococcus aureus (SA) is an invasive bacterium that may lead to both hospital and community acquired infection. SA may reside in the nose and may act as an endogenous source of surgical site infection (SSI). The emergence of resistant strains of SA complicates infection. Objectives In this study we studied the relation between surgical site infection and nasal carriage of Staphylococcus Aureus. Methods This is a prospective study that was done in the surgical words in two surgical centers in Duhok city. A total number of 257 patients were included in this study. Nasal swabs were taken from patients who underwent various surgical procedures, and were sent for bacteriological examination to detect the staphylococcal carriage status for each patient. Results Clean surgeries were the commonest (61.1%) and elective surgeries comprised (92.2%). About 38% were nasal carriers for SA and 18.7 …

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.

Objectives The aim was to investigate methicillin-resistant Staphylococcus aureus (MRSA) carriage rates and to characterize the staphylococcal cassette chromosome mec (SCCmec) among Syrian refugees and the host community in Duhok, Iraq. Methods A total of 492 host community and 355 Syrian refugee subjects were recruited. Participant bio-information was collected using a study questionnaire. MRSA carriage was identified as recommended in the Clinical and Laboratory Standards Institute guidelines. PCR was performed for typing the mecA gene and SCCmec groups. Results In the host community, 76/492 (15.4%) carried MRSA, whereas 49/355 (13.8%) Syrian refugees carried MRSA (p = 0.505). Refugees were classified according to their arrival date; 36/278 (13%) existing refugees and 13/77 (16.9%) new refugee arrivals were identified as MRSA carriers (p = 0.375). Regarding the risk factors …

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

Cutaneous Leishmaniasis (CL) is caused by protozoan parasites called Leishmania. CL is endemic in Iraq and caused by L. tropica and L. major species. 1 Antimonial medications are the most commonly prescribed treatments for the infection. Other drugs, such as itraconazole and paromomycin, have been used with varying success. A Cochrane study, 2 analyzing the different regimens for the treatment of CL, concluded that they were difficult to evaluate due to the variability of the regimens used, the inconsistency of the duration of the studies, the diversity of clinical conditions and the difference of Leishmania species. 2 Besides, critical methodology-related issues, study design quality, and reporting weakness of these clinical trials were present in the reports published. Such issues made comparing the results and meta-analyzing the data difficult, and no conclusions could be drawn. 3 CL may lead

Helicobacter pylori infection is a predisposing factor for gastric cancer. This prospective, randomized clinical trial aimed to compare H. pylori eradication rates associated with a clarithromycin-based regimen and levofloxacin-based regimen. H. pylori infection was confirmed by a rapid urease test during endoscopy and its eradication by a urea breath test. In this study, 192 patients were recruited; 93 patients received a clarithromycin-based regimen and 99 a levofloxacin-based regimen. Sixty-four patients completed the clarithromycinbased regimen and 60 the levofloxacinbased regimen. The eradication success rate of the clarithromycin-based regimen was 52/64 (81.25%), while that of the levofloxacin-based regimen was 49/60 (81.6%)(P= 0.9524; odds ratio [OR]= 1.0280; confidence interval [CI]= 0.4153-2.5447). Investigation of the risk factors associated with treatment failure showed that the overall efficacy of the regimens was influenced by body mass index (BMI), with a high failure rate observed in patients with a high BMI (P= 0.0174; OR= 1.1116; CI= 1.0187-1.2129). Age, sex, endoscopic diagnosis and smoking did not influence treatment outcomes. Further studies are needed to monitor H. pylori antibiotic resistance rates.

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.

Cutaneous leishmaniasis (CL) is a major health problem worldwide. Although CL is a common disease among children, treatment regimens for the pediatric age group are based on extrapolation of efficacy data in adults. The present study aimed to evaluate the treatment outcome of CL in preschool-age children and the factors influencing the outcome. Two hundred ninety-four children were diagnosed with CL between December 2018 and March 2019 in Sinjar Province, Iraq. All patients were treated with intralesional injections of sodium stibogluconate and followed up for 3 months after the completion of treatment. The treatment success rate was 99% (291/294). A statistically significant association was found between the number of doses per lesion and the number of lesions (P = 0.002; CI = 0.066–0.2875). No association was found between the number of lesions, age, gender, or the presence of livestock and the …

Background: Helicobacter pylori (H. pylori) infection is associated with gastric and extra-gastric manifestations such as idiopathic urticaria. Objectives: The aim of this report was to investigate the relationship between H. pylori positivity and chronic urticaria. Methods: This case control study was carried out between June 2018 and March 2019. The study was conducted at the Dermatology Consultation Unit, Azadi Teaching Hospital, Duhok, Iraq. A total of 49 patients with chronic urticaria were recruited in the study. During the study period, 95 subjects were recruited as a control. Results: The overall H. pylori positivity was 106/144 (73.6%). A significant association was found between family members number and H. pylori positivity (P = 0.04; OR = 1.15; CI = 1 - 1.3). The positivity was 38/49 (77.6%) positive for the patients’ group versus 70/95 (73.7%) for the control group (P = 0.7; OR = 1.16; CI = 0.53 - 2.57). Conclusions: The prevalence of H. pylori infections was high in the region. No association was found between H. pylori positivity and chronic urticaria. Further study is needed to explore the effect of H. pylori eradication on urticaria treatment outcome.

Background:Methicillin-resistantStaphylococcus aureus(MRSA) is a serious concern of the global health sector and more recently,an escalating problem in the community.Objectives:This study was performed to investigate the incidence of MRSA in hospital staff and community students in Duhok,Kurdistan, Iraq, and make a molecular comparison between the strains based on the detection ofmecA gene and Panton-ValentineLeukocidin (PVL) gene.Methods:We obtained 109 and 103 samples from the nares of hospital staff and community students, respectively. Conventionallaboratory tests were performed for the detection ofStaphylococcus aureus(S. aureus) and antibiotic sensitivity testing to identifyMRSA isolates. Besides, PCR was utilized for molecular analysis.Results:All isolates from hospital staff were identified asS. aureus. Out of the 109 isolates, 55 (50.4%) were MRSA carrying themecAgene, among which 4/55 (3.7%) were MRSA-PVL positive. Additionally, 54/109 (49.5%) isolates were methicillin-sensitiveS. aureus(MSSA) but four isolates (3.7%) were MSSA-PVL positive. Furthermore, 23/103 (22.3%) samples from community students were iden-tified asS. aureus, among which 5/23 (21.7%) and 17/23 (73.9%) isolates were MSSA-PVL positive and MSSA-PVL negative, respectively.Moreover, 1/23 (4.3%) was found as MRSA and was PVL gene-positive.Conclusions:The results showed that MRSA is swarming in hospitals and community in Duhok, Iraq. The highest rate of PVL wasassociated with community-acquired-MSSA (CA- MRSA). With further genotypic study, immediate action is needed to control andreduce the spread of MRSA clones, determine their clonal relations, and conduct epidemiological investigations (24) (PDF) Prevalence of Methicillin-Resistant Staphylococcus aureus in Hospitals and Community in Duhok, Kurdistan Region of Iraq. Available from: https://www.researchgate.net/publication/334328658_Prevalence_of_Methicillin-Resistant_Staphylococcus_aureus_in_Hospitals_and_Community_in_Duhok_Kurdistan_Region_of_Iraq [accessed Dec 02 2019].

Hepatitis B virus infection (HBV) is a leading cause of increased mortality and morbidity in renal transplant subjects. The purpose of this project was to investigate the prevalence of HBV in patients with renal transplant and compare it with the general population in Duhok city, Iraq. Then, the impact of HBV infection on graft function was evaluated. A total of 560 renal transplant subjects and 2975 volunteers were recruited in this study. All subjects were examined for HB surface antigen (HBsAg) positivity. Then, all HBsAg positive subjects were tested for viral load, alanine transaminase (ALT), aspartate aminotransferase (AST), serum creatinine and HBV profile. All HBsAg positive renal transplant subjects received treatment and were followed up for 24 months. It was found that 6/560 (1.1%) of the renal transplant subjects were HBsAg positive while 30/2975 (1.09%) of the volunteers were positive for HBsAg (P> 0.05). After initiation of medications, viral load became undetected within 6 months of treatment. Serum creatinine levels were normal at the end of the study. No major side effects were recorded. The prevalence of HBV in renal transplant subjects was similar to the prevalence in general population. HBV infection did not show any negative effect on the graft function. Further study is needed with a larger sample size to explore the long term effect of the infection on graft functionality.

Background: Human Papillomavirus infection is sexually transmitted and associated with several cancers, such as cancer of the cervix, vagina, vulva, head and neck, anal, and penile carcinoma. Health education plays a pivotal role in building knowledge and positive attitude about health issues. Objectives: The current study aimed at assessing the knowledge of final and pre-final students of colleges of medicine and nursing. Methods: This cross-sectional study was performed between September 2017 and December 2017. The project was carried out in the College of Nursing and Azadi Teaching Hospital of Duhok, Iraq. An HPV knowledge questionnaire was used covering three HPV-related subjects, including cervical cancer-HPV association, HPV features, and HPV vaccines. All final and pre-final students of the college of medicine and nursing were recruited. Results: In cervical cancer-HPV association knowledge dimension, which composed of four questions, there were significant differences in knowledge regarding HPV-cancer association (77.6% for medical students versus 51.6% for nursing students, P< 0.001) and cancer prevention (81.9% versus 38.7%, P< 0.001), when the correct answers were stratified according to college. When the answers were stratified according to the study years, significant differences were found in awareness about the detection of HPV in cervical cancer between pre-final and final year students in college of medicine (68.3% for pre-final versus 87.5% for final P= 0.02) and college of nursing (33.3% versus 72.4%, P< 0.001). Then, the researchers tested awareness of HPV features and there were significant …

Background: Tuberculosis (TB) is a major public health problem. Close household-contacts are at high risk of infections, particularly latent TB (LTBI). Objectives: The study aimed to investigate the prevalence of LTBI in household-contacts of active TB patients. Methods: A total of 150 household contacts with active TB patients were recruited. Blood samples were collected and tested for the presence of LTBI by QuantiFERON-TB-Gold-Plus assay. Results: Amongst those recruited in this study, 62/150 (41.3%) were positive. Amongst the positive subjects, 33/62 (53%) were male. Four samples gave indeterminate results including two males and two females. Conclusions: The prevalence of LTBI was high in household-contacts. For successful TB control, close screening of contacts should be considered.

Leishmaniasis is caused by protozoan parasites of the genus Leishmania and is a major health problem in various parts of the world. Cutaneous leishmaniasis (CL) occurs, among others, in unpredictable outbreaks after wars and disasters. After the last war in Iraq, the collapse of the health system led to the spread of infectious diseases, including CL. Between September 2016 and November 2017, all patients with confirmed CL having one or more skin lesion(s) were referred to a regional health center in Musol City within the Rabeea District. During this period, 1539 patients visited the clinic. A total of 190 patients were excluded from the study because of poor follow-up. The treatment success rate was 97.7% (1319/1349). Statistically significant associations were found between number of lesions and treatment failure (p = 0.0018; OR = 1.4430; CI = 1.1466–1.8161), number of doses and number of lesions (Pearson’s correlation coefficient = 0.095; p = 0.001), and the lack of municipality services and number of doses used for the treatment (p = 0.008; OR = 1.0629; CI = 1.0158–1.1122). To conclude, the highest number of patients with CL in the city of Musol was recorded after the war in Iraq. The treatment success rate was high, which reflected the strict treatment and follow-up program. An urgent plan is needed to stop the spread of infection.

Background Hepatitis C virus (HCV) infection is a public health problem. Such an infection is prevalent and aggressive in patients with end-stage kidney disease (ESKD). The efficacy and the safety of direct-acting antivirus (DAA) in patients with acute HCV and ESKD are under investigation. The aim of this study was to assess the safety and efficacy of sofosbuvir-containing regimens in this difficult-to-treat population. Methods A prospective and observational study was conducted to evaluate the efficacy and the safety of sofosbuvir containing regimen in patients with ESKD who were undergoing haemodialysis and were acutely infected with HCV. Subjects either received sofosbuvir 200 mg and daclatasvir 60 mg daily or sofosbuvir 400mg/ledipasvir 60mg daily for 12 weeks. Results 19 Patients were recruited in this study who were infected with HCV genotype 1a. All subjects achieved a sustained virologic response …