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Objectives: This study aimed to determine the frequency of blood group types among COVID-19 patients and to investigate its potential association with disease severity and patient outcomes. Methods: this prospective cross-sectional study was conducted from February to July 2022 in three different healthcare facilities in the Duhok region. All confirmed PCR confirmed COVID-19 patients were classified into: mild, moderate, severe, and critical cases. Information on demographic, clinical, and laboratory characteristics were collected using a standardized questionnaire. All patients were subjected to ABO blood grouping. The statistical calculations were performed by JMP Pro 14.3.0. A p value of < 0.05 was considered significant. Results: the study comprised of 404 patients. The age range of the patients varied from 16 to 100 years with a male predominance (204, 50.5%). Out of the total patients, 250 (61.88%) had mild-moderate course, while 154 (38.12%) had severe-critical course. The most frequent blood group was O (164, 41.58%), followed by blood group A (121, 29.95%). There was no significant difference in the distribution of the Rh factor among the studied subjects (p=0.426). There was a significant increase in disease severity and worse outcome with increasing age (p=

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first identified in people in the city of Wuhan at the end of December 2019, and it has since spread to all continents. Global interest has been focused on discovering a treatment and developing a successful coronavirus vaccine as a result of the emergence of this new coronavirus. In this research, we sequenced the whole genome of the SARS-COV-2 virus that were isolated from 40 patients in Duhok, Iraq. 95 different mutations were identified in our isolation when such the whole genome sequence of the SARS-COV-2 isolated from the city of Wuhan, China (Accession number: NC 045512.2) was matched to the virus's sequence using Sequencing technology (Illumina , USA ) and Assembly method (iVar 1.3.1). Sequence analysis revealed that 38 mutations were found at spike glycoprotein (S), 30 of which were found in the ORF1b , 11 mutations were found in ORF1b ,7,3,2,1 mutations were found in ( N,M,ORF6 ,ORF9 /E ) genes which had been linked to structural changes at various places. The conclusion that the cases in Iraq were of different origins of infections and had a close relationship with the isolates from different country and state were further confirmed by phylogenetic analysis and transmission. The whole genome sequence of the SARS-CoV-2 , which were identified from the Iraqi Kurdistan region, and reported as a first study in Kurdistan region.

Objectives: study aims to provide a descriptive overview about the magnitude and frequency of dispensing the unprescribed antibiotics UABs. It furthermore aims, to specify the most dispensed UAB types, the most common infections, signs and symptoms that require dispensing the UABs in community pharmacies of Duhok city and its districts. Methods: A cross sectional cohort study had been conducted from September to October 2022, private community pharmacies of Duhok province were included in this study. A standardized questionnaire platform was utilized to complete the survey, it included 2 sections, the first of which was related to demographic data and the second part included details of the dispensing unprescribed antibiotics UABs like: what are the most common dispensed UABs, what are the most common illness and symptoms of patients who require dispensing UABs. Results: One hundred fifty pharmacies have been included in this study. The majorities were from Duhok city 46%, and Zakho 28.7%. The prevalence of dispensing UABs was 100%, the three most common dispensed UABs were Amoxicillin 77%, followed by azithromycin 16% and cefixime 7%. The most infections and conditions requiring dispensing UABs were tonsilitis (69.3%), followed by flu and common cold (58.7%), and lower respiratory tract infection (48.7%). Conclusion: This study concluded that dispensing UABs is a frequent practice in Duhok community pharmacies. Viruses are the most common cause of upper respiratory tract infections; hence, antibiotics must be avoided and OTC medicines should be encouraged to alleviate the symptoms. Continuing medical education through training pharmacists on dispensing antibiotics by adhering to the regulations of antibiotic stewardship is crucial.

The aim of this study is to demonstrate the prevalence of the long-term side effects of Covid19, namely memory impairment among recovered patients, and obtaining the associated factors that link with memory impairment. It is a cross sectional retrospective cohort study, that has been conducted from September to November 2022 in Iraq. People who were previously infected with COVID-19 were included. The study was performed by asking people to complete a questionnaire platform by either online or face to face interview. The Memory Assessment Clinic-Q (MAC-Q) test were utilized, scores that are equal or higher than 25 are indicative of memory decline. 1287 participated in this study. However only 1157 were included for the final analysis. Three hundred ninety-nine (34.49%) have memory impairment after Covid19 recovery. Female gender, older age group, repeated exposure to COVID-19 infections, severe diseases, and exposure to multiple SARS-CoV-2 variants were independent risk factors of memory deficit in post-COVID-19 survivors with a p value of 0.0001, 0.02, 0.0001, 0.001, 0.0001 respectively. It is crucial to pay particular attention to psychosocial rehabilitation of such risky groups. COVID-19 vaccine administrations with booster shots are necessary steps to decrease the disease incidence and avoid subsequent post-COVID-19 symptoms. This article is protected by copyright. All rights reserved.

Objectives: First, to determine prevalence of vaccinated COVID-19 patients among hospitalized patients; Second, to determine the epidemiological, clinical, and laboratory characteristics of vaccinated and unvaccinated COVID-19 patients. Methods: The study was carried out on 300 adult COVID-19 hospitalized patients at Duhok COVID-19 health facilities. A prospective cross-sectional study was used as the study design. Between October 1, 2021, and March 31, 2022, all patients with PCR-confirmed COVID-19 were enrolled. Results: The majority of people in this study were unvaccinated. Pfizer was most popular among people who had received vaccination. The majority of hospitalized patients were old ages, the mean age was 60.73 ± 15.83 yr. In our study, the unvaccinated females had higher infection rates while vaccinated males had higher hospital admission rates. In our study, vaccinated patients had shorter hospital duration stays. In both vaccinated and unvaccinated patients, predominated cases were severe cases. D dimer was significantly higher among vaccinated patients. The mortality rate was relatively high among both groups. Patients who had received vaccinations tended to experience vomiting and flu-like symptoms more frequently than those who had not. In terms of comorbidities, smoking and malignancy were significant risk factors for COVID-19 infection in unvaccinated patients. Conclusion: We looked at 300 COVID-19 hospitalized patients. In this study, the majority of people were unvaccinated. Pfizer, had higher prevalence among vaccinated individuals. Majority were elderly. The unvaccinated cases had a higher rate of female hospital admissions than male. The D.Dimer level was significantly different between the two groups. Vomiting and flu-like illness showed higher prevalence in vaccinated cases with significant difference. Smoking and malignancy were significant risk factors for COVID-19 infection in unvaccinated patients. In the fight against a public health disaster like a COVID-19 pandemic, the availability of a COVID-19 vaccines campaign are crucial.

The aims of this study were: to determine the incidence of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection among vaccinated healthcare workers (HCWs), assess risk factors associated with the vaccine breakthrough (BT), and compare the effectiveness of vaccine manufacturers against SARS-CoV-2 variant of concern among HCWs in Duhok governorate. It is a multicenter retrospective cohort study, which enrolled 944 HCWs through March 2022. COVID-19 vaccinated HCWs aging 18 and above were included. A random sampling process was performed by asking the participants to fill out a standardized questionnaire by means of interviews or participant-completed surveys. Fully vaccinated HCWs with positive polymerase chain reaction tests were considered to have vaccine BT infection. Two hundred and eighty-four (30.1%) out of 944 vaccinated HCWs had SARS-CoV-2 infection postvaccination, of whom 241 (84.9%) were fully vaccinated, concluding that the incidence of BT infection is 25.5%. There were 422 (44.7%) males and 522 (55.3%) females. Most vaccine BT infections had developed in SARS-CoV-2 Omicron variant (53.5%). The majority of BT infections were mild to moderate (95.5%). Occupation, namely dentist was a significant risk factor, with a p value of 0.001. HCWs with a history of SARS-CoV-2 infection prevaccination were more prone to a vaccine BT infection (p value =0.002). Pfizer vaccine manufacturers revealed the highest effectiveness against BT infection (p value =0.0001). Paramedics showed a significant association with the disease severity (p value =0.02). The three available vaccine manufacturers in the Duhok governorate are effective against COVID-19 BT infections. Dentists and paramedics were significantly associated with poor COVID-19 outcomes.

Background The objectives were to estimate the prevalence of latent tuberculosis infection (LTBI) among household contacts (HHCs) with active TB patients, and to identify their risk factors. Methods A prospective, cross sectional study was conducted from May to October 2018. All HHCs with active TB cases were included. The subjects underwent two tests: Quantiferon TB-Gold plus assay (QFT-Plus) and tuberculin skin test (TST). Data were analyzed using the Statistical Package for Social Sciences 25. Results Among 521 HHCs, 101 (24.05%) revealed positive TST and 80 (19.85%) positive QFT-Plus. The significant risk factors associated with positive TST individuals were ≥ 15 years, immunosuppressive therapy, and pulmonary TB (PTB) patients; whereas, those with QFT-Plus positive were ≥ 45 years, alcohol consumption, and immunosuppressive therapy. The concordance rate among 309 individuals who performed both tests was 0.88 %; the kappa value showed good agreement (k = 0.679) and significant correlation (P Conclusions The overall rate of LTBI was intermediate. Screening of LTBI should be routine among HHCs, regardless of the site of the disease. Age ≥ 15 years, alcoholics, immunosuppressive therapy, and PTB were potential risk factors. There was a good concordance between TST and QFT-Plus. A QFT-Plus can overcome the limitation of a BCG vaccinated individual, especially in early life.

Considering Iraqi Kurdistan geographical area, there was great concern with regard to Iran’s COVID-19 situation as it was alarming to the doors of Kurdistan. In response, a framework named as “support of public basic services for vulnerable persons in Duhok Governorate” was performed by Directorate General of Health in collaboration with the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) organization. The ultimate results were: Out-patient and in-patient management guidelines for COVID-19 cases in Duhok Governorates; Recommended types of personal protective equipment (PPE) in the context of COVID-19; The methods of using and disposing of mask, gloves, and PPE for the healthcare providers.

Thrombocytopenia is a relatively uncommon extra-hepatic manifestation of uncomplicated chronic hepatitis B virus (HBV) infection. This study has two aims: to assess the prevalence of thrombocytopenia in non-cirrhotic patients with chronic hepatitis B (CHB); and to determine the association of certain variables with thrombocytopenia in Duhok province. It is a case control study conducted in Azadi Teaching Hospital during June 2016 - May 2019. Chronic active hepatitis B was defined according to the following parameters: the presence of detectable hepatitis B surface antigen (HBsAg) in the blood longer than six months, positive or negative HBeAg, HBV-DNA level >2000 IU/ml, elevated ALT, and/or at least moderate histopathological fibrosis. Thrombocytopenia was defined as platelet counts below 150,000/μl. The obtained results were analyzed by entering data into Microsoft Excel 2010. A total of 379 CHB patients and 200 cases as control were enrolled in this study. Their mean ages were 33.62 ± 14.48 and 40.72 ± 18.56 for HBV and control cases, respectively. There were 236 (62.27%) males in the HBV patients and 109 (54.50%) males in the control group. Comparing both groups, significant association was found between HBV and younger age, cigarette smoking, and alcohol consumption. Chronic active hepatitis B without liver cirrhosis was strongly associated with an increased rate of thrombocytopenia. This finding is paramount as it is statistically significant (P = 0.042). Significant association with younger age and Syrian nationality was found more in CHB patients with thrombocytopenia compared to non-thrombocytopenic. In conclusion, chronic active hepatitis B is strongly associated with thrombocytopenia. As hypersplenism resulting from liver cirrhosis was excluded in our patients, the cause of thrombocytopenia is due to other mechanisms. Therefore, it is important to consider CHB in the differential diagnosis of patients presenting with isolated thrombocytopenia. Older age and Syrian nationality were predictors for developing thrombocytopenia in chronic active HBV infection. Asian J. Med. Biol. Res. June 2019, 5(3): 207-211

Objectives: We aimed to determine a threshold cutoff for hepcidin, ferritin, and the hepcidin-to-ferritin ratio in the diagnosis of liver fibrosis in chronic hepatitis C virus (HCV)-free s-thalassemia major patients with iron overload. Methods: This 1:1-matched case-control study included 102 individuals (3–30 yr.); 51 patients with iron overload anemia, and 51 apparently healthy individuals. Results: The highest areas under the ROC (receiver operating characteristic) curves (AUC-ROCs) for the diagnosis of patients vs. controls had overlapping 95% confidence intervals (CIs): serum hepcidin (0.758; 0.64–0.87; P ˂ 0.001), serum ferritin (1.000; 1.00–1.00; P ˂ 0.001), and the hepcidin/ferritin ratio (1.000; 1.00–1.00; P ˂ 0.001). For differentiation of patients with liver fibrosis stages of F0–F1 vs. F2–F4 and F0–F1 vs. F3–F4, aspartate aminotransferase (AST) and alanine aminotransferase (ALT) with P-values ˂ 0.001 were the only statistically significant parameters, while the AUC-ROCs of the hepcidin/ferritin ratio (0.631, P = 0.188 and 0.684, P = 0.098) exhibited 90% and 89.5% sensitivity, respectively, in staging liver fibrosis. Conclusion: The hepcidin/ferritin ratio is suggested as an aspartate aminotransferase (AST)-to-platelet ratio index (APRI) to differentiate liver fibrosis patients. This ratio may have excellent sensitivity in the prediction of liver fibrosis.

Background:The objectives were to describe the demographic and clinical profile and treatment outcomes in the National Tuberculosis Program Center of Duhok governorate.Methods:This was a descriptive retrospective study of all forms of drug-susceptible tuberculosis cases in the National Tuberculosis Program Center of Duhok. The Electronic Nominal Recording Reporting System data of tuberculosis cases were reviewed during 2014–2018. Information on the demographic, clinical, and laboratory characteristics of the patients were analyzed. Tuberculosis trends and treatment outcomes were determined.Results:A total of 1063 tuberculosis patients visited the National Tuberculosis Program Center, of whom 905 were from Duhok. The estimated tuberculosis notification rate per 100,000 people in Duhok governorate was 14.06, 16.16, 10.43, 11.05, and 10.34 for the years 2014, 2015, 2016, 2017, and 2018, respectively. The most affected age group was 15–24 years. The male cases were predominant. Most patients (97.3%) were native Iraqi. There were 718 (67.5%) pulmonary tuberculosis cases and 345 (32.5%) extra-pulmonary tuberculosis cases; tuberculosis lymphadenitis was the most common presentation. The majority of extra-pulmonary tuberculosis patients were females aged 15–24 years (p = 0.019), and patients aged ⩾65 years were associated with pulmonary tuberculosis and extra-pulmonary tuberculosis in males (p ⩽ 0.001). The highest tuberculosis incidence occurred in winter (288 patients). The patient treatment outcomes were as follows: 90.7% successful treatment, 1.6% lost to follow-up, 6.7% death, 0.3 transferred out, and 0.8 treatment failure.Conclusion:There was a high frequency of extra-pulmonary tuberculosis, which may reflect overestimation in its diagnosis. Therefore, meticulous evaluations should be provided. The treatment outcome was satisfactory in the center. Hence, we should maintain the favorable work to attain tuberculosis control objectives. Performing GeneXpert for all tuberculosis cases and introducing culture and drug susceptibility testing should be an urgent plan to strengthen the diagnosis of susceptible and drug-resistant tuberculosis cases.

Introduction On March 11, 2020, the novel coronavirus was declared a global pandemic. The disease was named COVID-19 standing for coronavirus disease 2019. The objectives were to determine the epidemiological, clinical, laboratory, and radiological characteristics of COVID-19 patients. Methods In this prospective descriptive study, 15 confirmed hospitalized cases of COVID-19 between 18th March and April 7, 2020 were followed-up till discharge. Results There were 15 reported patients infected by 3 imported index cases from Europe. The mean age of the patients was 28.06 (SD: 16.42 years). The patients' age stratification was as follows: 0–5 (2, 13.3%); 6–18 (2, 13.3); 19–50 (10, 66.7%), and 51–64 years (1, 6.7%). The patients were male (9, 60.0%) and female (6, 40.0%). Most of the patients had mild disease severity (13, 86.7%), followed by mild-moderate (1, 6.7%) and moderate-severe (1, 6.7%). The study revealed that 6 patients were asymptomatic, and 9 patients were symptomatic. The most common symptoms were: fever (n = 8; 53.3%), cough (n = 7; 46.7%), shortness of breath (n = 3; 20.0%), fatigue (n = 3; 20.0%), and taste and smell disorders (n = 4; 26.7%). All patients were recovered and discharged over a median of 8 between 8 and 21 days. The mean and Std. deviation values of the hematological were: WBC: 6.57 (1.86); neutrophil count: 3.75 (1.26); lymphocyte count: 1.87 (0.41); Hb: 13.89 (1.26); platelet count: 207.67 (52.21). Conclusion All COVID-19 cases were linked to foreign visits with few local transmissions to close contacts without community transmission. The majority of cases were mild illnesses with full recovery., Highlights • All COVID-19 cases were linked to foreign visits with local transmissions to close contacts without community transmission. • The majority of COVID-19 cases were mild illnesses with full recovery.

Diabetes can be linked with impaired host immunity that subsequently increases the rate of various infections including tuberculosis (TB), particularly in developing countries where TB is endemic. The objectives of this case control study were to determine the prevalence and the risk of LTBI among diabetic patients. It is a prospective case control study conducted in Azadi Teaching Hospital from September 2017 until May 2018. The diabetic patients included in this study were randomly selected. The diagnosis of diabetes mellitus (DM) was made according to the American Diabetes Association (ADA). Diabetes mellitus patients and the control participants were offered a voluntary tuberculin skin test (TST). The TST ≥10 mm was considered positive. The results were analyzed by entering the data in SPSS (statistical package for the social sciences, version 16; SPSS Inc., Chicago, Illinois, USA). Two hundred DM patients and 208 control individuals participated in this study. Collectively, 28 patients had positive TST results. Based on the sputum smear microscopy and CXR, none of these patients showed active TB disease. The differences between the DM patients and the control group had no statistical significance apart from previous hospitalization. The prevalence of LTBI was 23.53% in the diabetic group, whereas, it was 9.62% in the control group. The frequency of LTBI in diabetic patients was significantly higher than the control group. When the diabetic group was compared with the control group in terms of diabetic control and the duration of diabetes disease, there was a statistically significant association of diabetes duration ≥ 10 years and TST positivity. In conclusion, the previous hospitalization was a significant risk factor for diabetic patients to acquire TB bacilli. Latent TB infection was more common in diabetics than non diabetics and there was an increased likelihood of having LTBI with the duration of diabetes ≥ 10 years. To avoid the threatening of TB control program, prophylactic treatment of LTBI in diabetic patients is paramount.Asian J. Med. Biol. Res. June 2018, 4(2): 227-232

Aims the objectives of this study are to reveal the potential side effects after taking the covid19 vaccines, associated risk factors with severe side effects, and to compare the three COVID-19 vaccines available in Iraq (Sinopharm, AstraZeneca-Oxford and Pfizer- BioNTech). Methods a randomized cross-sectional study was conducted in April 2021. A standardized questionnaire platform was utilized to collect information about the Iraqi population. Results 1012 were enrolled in the study, 60.2% were male and 39.8% were female. 84% were symptomatic post vaccination. Young aged participants, females, participants with history of COVID19 infection, those with comorbid diseases and AstraZeneca vaccine receivers were statistically significant risk factors for having adverse reactions post vaccination, P value (0.03, 0.028, 0.007, 0.019 and 0.0001) respectively. Regarding severity of symptoms, most symptoms were mild and moderate. Residency in Kurdistan Region of Iraq and AstraZeneca vaccine were the statistically significant risk factors for getting severe symptoms P value

Background: Chronic hepatitis B virus (HBV) related to liver cirrhosis is an advanced liver fibrosis that is usually progressive, irreversible, and the only option for the treatment is liver transplantation in selected patients Objectives: to examine the demographic, clinical, and laboratory characteristics of patients with the chronic HBV related to cirrhosis. Methods: The viral hepatitis clinic in Azadi Teaching Hospital is dealing with all viral hepatitis cases. All patients with liver cirrhosis caused by chronic HBV infection were studied. Demographic, clinical and laboratory information of the patients were retrieved by interviewing and from the case notes of September in 2014 until December in 2016. Child–Turcotte–Pugh (CTP) classification was used to evaluate the prognosis of liver cirrhosis. The results obtained were analyzed by entering the data into a Microsoft Excel spreadsheet. A value of less than 0.05 was considered as statistically significant.

Context: Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are major public health issues as they may progress into chronic hepatitis, liver cirrhosis, and hepatocellular carcinoma (HCC). Aims: to identify the prevalence and risk factors of HBV and HCV among diabetic patients in Duhok province. Patients and Methods: It is a prospective study conducted in Shilan private hospital from June 2016 until December 2018. The serum of all diabetic patients was investigated by Enzyme-linked Immunosorbent Assay (ELISA) to detect HBsAg and anti-HCV. Diabetes mellitus (DM) was diagnosed according to American Diabetes Association (ADA). The results were analyzed by entering the data in Statistical Package for the Social Sciences (SPSS). Results: Three hundred seventy five DM patients were included in this study. The mean age of the patients was 54.38 ± 9.23, and the majority was female patients (65.87%). Out of 375 patients, 8 cases (2.13%) were HBV and 2 cases (0.53%) were HCV. Considering risk factors associated with HBV and HCV infections among diabetic patients, alcoholism was associated with both infections. Hemodialysis was a risk factor for HCV infection among diabetic patients but it was not associated with HBV. Conclusions: Although prevalence of HBV and HCV is higher among diabetic patients, its prevalence is low in comparison to other studies. It is recommended to screen HBsAg and anti-HCV in all alcoholic diabetic patients. Hemodialysis remains a significant risk factor for HCV transmission among diabetic patients with end stage renal disease (ESRD).

Healthcare workers (HCWs) are at increased risk of infection with Mycobacterium tuberculosis (Mtb) and, hence, of developing tuberculosis (TB) disease. The aims of this study are to identify the prevalence and determinants of latent TB infection (LTBI) among HCWs in Duhok Province. This is a cross-sectional prospective study conducted during April–July 2018 in different health care facilities of Duhok province. HCWs at multiple levels were selected by a non-systematic random sampling method. Information on demographic and associated risk factors of LTBI were collected by using a standardized questionnaire. Thereafter, all HCWs underwent QuantiFERON Gold Plus (QFT-Plus) assay. HCWs with indeterminate QFT-Plus underwent a Tuberculin Skin Test. HCWs with positive results were further evaluated by smear microscopy investigation and chest X-ray examination. Three hundred ninety-five HCWs were enrolled, 49 (12%) tested positive for LTBI. The mean age of the HCWs was 33.4 ± 9.25 with a female predominance (51.1%). According to the univariate analysis, LTBI was significantly higher among HCWs with the following: age groups ≥ 30 years, alcohol intake, ≥ 11 years of employment, high risk stratification workplaces, and medical doctors. In the multivariate analysis, the age group of 30–39 years (OR = 0.288, 95% CI: 0.105–0.794, p value = 0.016) was the only risk factor associated with LTBI. Further medical investigations did not reveal active TB cases among HCWs with LTBI. With regards to prophylactic treatment, 31 (63.3%) LTBI HCWs accepted the treatment, whereas 18 (36.7%) declined the chemoprophylaxis. Of these 31 HCWs on chemoprophylaxis, 12 (38.7%) received isoniazid (INH) for six months, 17 (54.8%) received INH in combination with rifampicin (RMP) for three months, and two (6.5%) received alternative therapy because of anti-TB drug intolerance. In conclusions, although Iraq is a relatively high TB burden country, the prevalence of LTBI among Duhok HCWs is relatively low. It is important to screen HCWs in Duhok for LTBI, particularly medical doctors, young adults, alcoholics, and those whom had a long duration of employment in high-risk workplaces. The acceptance rate of HCWs with LTBI to chemoprophylaxis was low. Therefore, ensuring medical efforts to educate the healthcare staff particularly, non-professionals are a priority to encourage chemoprophylaxis acceptance.

Tuberculosis (TB) is a serious public health problem worldwide, particularly in developing countries. The most common presentation of TB is the pulmonary form; however, extrapulmonary manifestations are not uncommon, particularly in the immunocompromised patients. TB of the central nervous system is the most severe extrapulmonary presentation. We report a post-kidney transplant patient who had multiple ring-like lesions on contrast-enhanced magnetic resonance imaging (MRI). Based on the results of MRI and biopsy specimen, the patient was diagnosed with multiple intracranial tuberculomas. He was treated successfully with a standard quadruple therapy of rifampicin, isoniazid, ethambutol and pyrazinamide.

Objective/background: Viral hepatitis, particularly hepatitis B virus (HBV) and hepatitis C virus (HCV), infections and tuberculosis (TB) are a global public health concern. Co-infection with HBV or HCV among TB patients may potentiate the risk of hepatotoxicity induced by anti-TB drugs. Hence, the aim of this study was to identify the prevalence of HBV and HCV among TB patients included in the Duhok National Tuberculosis Program (NTP). Methods: The Duhok NTP Center is a specialized institution in Duhok City, Iraq, concerned with management and follow-up of TB patients. A cross-sectional study was conducted at the center between June 2015 and May 2016. All documented TB patients were analyzed on the basis of socio-demographic and other characteristics. Thereafter, all patients underwent screening for hepatitis B surface antigen (HBsAg), anti-HCV, and anti-HIV using enzyme-linked immunosorbent assay (ELISA). The results obtained were analyzed by entering the data in binary format into a Microsoft Excel spreadsheet. A p value of

Background and study aim Several genes of Helicobacter pylori , such as vacA , cagA , iceA and babA , have been reported to significantly increase the risk of gastrointestinal diseases. The aim of this study was to study the relationship between H. pylori virulence factors and clinical outcomes and identify the independent markers of peptic ulcer disease in Iraq. Patients and methods DNA was extracted from specimens taken from 154 unselected H . Pylori positive Iraqi patients. Genotyping was performed by the polymerase chain reaction (PCR), using specific primers for cagA , vacA (s, m), iceA and babA2 genes. Results A total of 56 (82%) peptic ulcer disease (PUD) patients carried cagA + strains, significantly more than the 56 (65%) non-ulcer disease (NUD) patients ( p = 0.017). The difference in the prevalence of babA2 positivity was significant between patients with NUD (33.7%) and PUD (58.8%) ( p = 0.002). In addition, babA2 was associated as an independent factor, with PUD ( p = 0.005; odds ratio (OR) = 0.4; confidence interval (CI) = 0.18–0.68) followed by cagA ( p = 0.05; OR = 0.4; CI = 0.18–0.85). Forty-five isolates (29%) were typed as ‘triple positive’ strains, and their presence was significantly associated with PUD ( p = 0.001). Conclusion The cagA and babA2 genotypes might be considered as useful markers for PUD patients. However, iceA1 and iceA2 seem not to be good markers for the disease. The presence of H. pylori strains with triple-positive status is of high clinical relevance to H. pylori -associated diseases.

Background: The objective of this study was to characterize patients with HBeAg-negative chronic hepatitis B in Duhok province.Methods: We recruited all patients with HBeAg negative chronic hepatitis B virus infections who visited viral hepatitis clinic in Azadi Teaching Hospital between September 2015-December 2017. The main evaluation parameters were: serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels, serum albumin, total serum bilirubin (TSB), viral load. Few patients were subjected to Fibro-test, Fibroscan, or liver biopsy.Results: There were 251 patients. The mean age of the patients was 35.75±14.40 years. One hundred fifty-seven cases were male and 94 cases were female. The baseline mean of ALT, AST and viral load was 42.09±2.71U/L, 30.26±19.65U/L, and 1421197.08±14436692.04IU/ml, respectively. Compared with women, men have significantly higher values of ALT and AST, serum albumin, and TSB. There were 217 chronic inactive carrier (IC) patients and 34 chronic active hepatitis (AH) patients. ALT, AST, and viral load levels were significantly higher among AH patients.Conclusions: The majority of patients showed nil to mild liver injury. The higher level of ALT in males is a supporting guide to follow the American Association for the Study of Liver Diseases (AASLD) considering 30U/L and 19U/L levels for males and females, respectively. There was preponderance of males in AH, which indicates greater frequency of advanced fibrosis in such patients. There was a greater probability of AH in old aged people. Serum albumin and TSB were not good markers for differentiation between AH and IC state. Twenty-four patients had ALT above twice upper limit of normal level, but 34 patients showed AH based on liver biopsy, firboscan or fibrotest.

Background: The aim of this study was to identify prevalent spoligopatterns of Mycobacterium tuberculosis (MTB) strains within Iran and its neighboring countries. Methods: The spacer oligonucleotide typing (spoligotyping) was performed on 1,742 MTB strains isolated from Iranian and Afghan patients. Subsequently, these results were compared with published results of Pakistan and Turkey. Results: Based on the international spoligotyping database T, Central Asian Strain (CAS), East African-Indian and Latin American and Mediterranean families were prevalent in the region. T was dominant amongIranian (32.3%) and Turkish (36.5%), whereas CAS was more prevalent among Pakistani (61.3%) and Afghan-immigrant (27.4%) TB patients. Conclusion: The majority of strains isolated from Pakistan and Afghanistan belonged to ancient MTB genotypes (principal genetic group, PGG, I). In contrast, in Turkey there was prevalence of modern TB (PGG II and III), whereas in Iran, the prevalence of ancient and modern TB was almost equal. Therefore, Iran may be considered as the connecting geographical location between ancient and modern TB.

INTRODUCTION: The aim of this study was to determine hepatitis B surface antigen (HBsAg) seroclearance rate among patients treated with lamivudine at a specialized tertiary care referral hospital in Tehran, Iran. METHODS: All patients on lamivudine (biovudin®) therapy at a dose of 100 mg/day, who showed seroclearnace between March 2001 and September 2011 were recruited. The main evaluation parameters were duration of HBsAg seroclearance and duration of HBsAg seroconversion. Serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were evaluated using standard methods. HBsAg seroclearance was defined as two consecutive negative serums HBsAg at least 6 months apart, whereas HBsAg seroconversion was defined as the disappearance of serum HBsAg and the presence of anti-HBs for >6 months. RESULTS: A total of 203 chronic HBV patients treated with lamivudine at a dose of 100 mg/day were included in the study. HBsAg seroclearance and seroconversion were observed in 11 patients after the initiation of the lamivudine therapy. Overall, in lamivudine responder patients, the mean time to HBsAg seroclearance was 26.90±10.93 months (range: 12-48 months). Furthermore, the responders showed seroconversion after a mean time of 26.90±11.08 months from the initiation of lamivudine therapy. When comparing the characteristics of those who have responded to lamivudine and those who have not responded, baseline HBV-DNA levels was significantly lower in responder than non responder patients (p

Dear Editor, Occupational exposure to blood-borne viruses (BBVs) is a major concern in the health care setting. The BBVs of primary concern are the human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV). Health care workers (HCWs) can be exposed to these viruses through needle-stick and other injuries through contaminated material with blood and other infectious body fluids. Nurses, health technicians, cleaning personnel and physicians are potentially targets for such accidents. The Center for Disease Control and Prevention (CDC) estimates that hospital-based healthcare personnel sustain an estimated 385,000 percutaneous injuries (needle-sticks and other sharp-devices) (1) annually. In Iran, the annual incidence of occupational exposure to BBVs is unknown due to the limited data in this area. The World Health Organization (WHO) estimates that more than two million injuries causes about 66,000 HBV, 16,000 HCV and about 1,000 HIV infections among 35 million HCWs each year (2). The key in reducing accidental exposure to BBVs is through promoting educational awareness of health care staff on suitability of HBV vaccination, in house training courses concerning preventive measures of such accidents and implementing proper postexposure prophylaxis (PEP) and following-up. Here, we reviewed case notes of 193 HCWs accidently exposed to BBVs over four-years, from January 2009 to January 2013. The data were reviewed in Labbafinejad hospital, which is a specialized 231 bed public tertiary care referral hospital with a total number of 915 HCWs who are potentially at accidental risk of acquiring BBVs. The study was approved by the ethics committee in the hospital. The reviewed HCWs cases (193) were classified into 75 nurses, 39 medical doctors, 35 cleaning personnel, 30 medical technicians (17 surgical operation technicians, 10 lab technicians and 3 radiology technicians), 13 nursing students and 1 medical student. In this study, the nurses were in top list of accidental exposure, which is in line with other studies (3, 4). Injuries were categorized as follows; 150 had needle-stick injuries, 22 cases had sharp cuts like scalpel and broken glasses and 21 cases had blood splashes on their eyes. Among these 193 cases, 132 HCWs were exposed to known serologically tested HIV, HBV and HCV negative patients, 24 had exposure to HBsAg positive patient, 5 had exposure to anti-HCV positive patients and two were exposed to HIV seropositive patient (one was co-infected with HCV infection). A total of 30 HCWs had occupational exposures to unknown sero-status patients. Anti-HBs antibody titer of the 24 HCWs, who had HBV exposure, was higher than 200 mIU/mL. Therefore, no intervention was done for them expect one who, despite being vaccinated had low anti-HBs titer. Thus, he was treated with hepatitis B immunoglobulin (HBIG) with another full course of hepatitis B vaccine, as routine schedule. Six patients were exposed to HCV seropositive patients; they underwent lab investigations, the result of that was normal for everyone. In these patients, follow up 2 weeks RT-PCR was negative. Thereafter, 1, 3, 6 months lab investigations were repeated and results were negative. One HCW was exposed to seropositive HIV patient, as the result of which he received PEP for HIV infection and underwent follow up and the result was negative. Another HCW was exposed to seropositive HIV coinfected with HCV. He also received PEP for HIV and underwent follow up lab investigation for HCV infection and lab results were negative. Hence, no further action was advised. PEP therapy has been shown to reduce the risk of transmission of HIV following accidental exposure by 80% (5). In conclusion, avoiding accidental occupational exposure to BBVs is an important safety issue, which can be achieved to some extent by health awareness of the problem and further by strengthening health control measures and providing a safe hospital work environment.

Actinomycosis is an infectious disease caused by a gram-positive anaerobic or microaerophilic Actinomyces species that causes both chronic suppurative and granulomatous inflammation. The following study reports a 48-year-old Iranian woman presenting with a spontaneous discharging sinus on the hard palate for 8months. The patient has no past medical history of note. Laboratory findings were unremarkable. The diagnosis was based on history and clinical evidence of the lesion confirmed by histopathological examination. The patient was treated with a regimen of oral ampicillin 500mg four times a day. She had a marked response to the treatment after 4weeks, and it was planned to continue the treatment for at least 6months with regular follow-up. To the best of the researchers’ knowledge, this is the first report of actinomycotic sinus tract of the hard palate in Iran.

A 22-year-old Iraqi male presented with a case of intestinal obstruction secondary to primary ileocecal tuberculosis (TB). The presumptive diagnosis of either Crohn’s disease or neoplasm was expected. A right hemicolectomy was performed. Histopathology revealed an inflammatory mass of TB origin; a polymerase chain reaction (PCR) confirmed the diagnosis. The patient was treated with standard anti-TB drugs for 6months. Following the treatment, the systemic symptoms disappeared and the laboratory investigations returned to normal. Follow-up period showed no recurrence of the disease.

The ultra-structure of Mycobacterium tuberculosis (MTB) was examined by transmission electronic (TEM)) and atomic force microscopy (AFM). The study was performed to describe the morphology of susceptible, multidrug-resistant (MDR), extensively drug-resistant (XDR) and extremely drug-resistant tuberculosis isolates (XXDR-TB) during their exponential growth phase. Four types of cell division were observed and described. While three of them (symmetrical, asymmetrical and branching type) occurred in all isolates studied, the fourth one (adapted type) was seen only in XDR and XXDR-TB bacilli. In the fourth type of cell division, a rod shaped mother cell produced a small round shape bacillus (0.3-0.5 μm). These round cells were different from buds or polar division, but similar to terminal endospores without showing the typing heat resistance. Based on the present observation, we suggest that XDR-and XXDR-TB bacilli accommodate changes helping them to overcome the hostile environment. Viewed under AFM, the other frequently detected shapes in MTB isolates were oval, V, Y and multi-branching filaments. These shape variation confirmed pleomorphic phenomena in MTB populations and the specific features of pan-resistant strains.

Introduction: This study aimed to determine first-line anti-tuberculosis drug resistance rates in new and previously treated cases and to identify risk factors associated with multidrug resistant tuberculosis (MDR-TB) at the National Reference Tuberculosis Laboratory of Iran. Methodology: This was a retrospective analysis of all confirmed TB patients from December 2000 to June 2005. Drug susceptibility testing to isoniazid, rifampicin, streptomycin, ethambutol and pyrazinamide was performed on Löwenstein-Jensen (LJ) medium according to the proportion method. Results: Mycobacterium tuberculosis strains were isolated from 1,742 patients with TB, of whom 935 (53.7%) were male. The mean age of patients was 44.2 ± 17.4 years (SD). A total of 1,074 patients were native Iranians while 668 (38.3%) were immigrant patients. Out of 1,139 (65.4%) new cases, 340 (29.9%) had at least one drug resistance. Of 603 (34.6%) previously treated cases, 416 (69.0%) had resistant strains. There were 263 patients (15.1%) with MDR-TB, 72 of whom were new (6.3% of all new cases) and 191 were previously treated (31.7% of all previously treated cases). Factors associated with MDR-TB included age under 45 years, male sex, previous TB treatment, immigration, poor living conditions, and unemployment. Conclusions: The high rate of initial resistance in MDR-TB cases and the high rate of MDR-TB in a young age group were indicators of recent transmission. Therefore, closer monitoring of transmission trends of drug resistant strains should be considered as priority, to ensure a successful TB control programme.

The natural resistance-associated macrophage protein (NRAMP1), Vitamin-D receptor (VDR) and Tumor necrosis factor (TNF-alpha) have been associated in susceptibility to tuberculosis, but the results have been inconsistent. This study aimed to determine the association of NRAMP1, VDR, and TNF-á variant with development of pulmonary tuberculosis (PTB) among Iranian patients. The single nucleotide polymorphisms (SNPs) at INT4, D543, 3'UTR of NRAMP1 gene, SNPs in restriction sites of BsmI, and FokI of the VDR gene and SNPs of TNF-alpha at -238,-308, -244,857,-863 positions were analyzed by PCR-RFLP among two groups of individual; patients with PTB (n=117) and healthy controls (n=60). Thereafter, the frequencies of extended haplotypes and diplotypes were estimated. No statistically significant differences were observed in allele frequencies of INT4, D543, 3'UTR of NRAMPI, FokI of VDR and TNF-alpha at -238, -244,-863 and -857 position. Although, the frequency of b allele of BsmI [ORs: 0.24 CI95% (0.07-0.67 (p=0.001)] and -308 A variant in TNF-alpha promoter region [ORs:0.26 CI95%( 0.07-0.77) (p=0.006)] were significantly more in PTB patients than healthy controls. The frequency of extended diplotypes of NRAMP [GG TGTG++GA; 0.02(0.001-0.0035)], VDR [FFBB; 0.2(0.6-0.6] and TNF-alpha [CCCCGGGGGG; 0.49(0.25-0.97)] were statistically different in patients and control subjects (p0.05). This study confirmed the association of SNPs in BsmI (B/b + b/b) of VDR and SNPs in -308A (G/A +G/G) of TNF-alpha genes with susceptibility to tuberculosis in Iranian PTB patients. Furthermore, the extended haplotypes and diplotypes analysis can be considered as an alternative way to determine the host susceptibility to TB.

A 17-year-old girl presented with a 3-day history of epistaxis, vaginal bleeding and petechiae over the lower extremities. The patient had been feeling unwell with productive cough, fever, chills, poor appetite and weight loss for 2 months. Laboratory findings revealed anemia and thrombocytopenia, whereas bone marrow examination was unremarkable. She was diagnosed as having idiopathic thrombocytopenic purpura (ITP) in association with active tuberculosis (TB). The patient was treated with intravenous immunoglobulin (IVIg) and corticosteroid along with anti-TB drugs. During the follow-up period there was no recurrence of thrombocytopenia or TB. It is important to consider TB in the differential diagnosis of ITP, particularly in high TB-burden areas. Keywords: idiopathic thrombocytopenic purpura, tuberculosis

Background Drug resistance in Mycobacterium tuberculosis is associated with chromosomal mutations in selected genes. These mutations can be screened for an early warning system for drug-resistant tuberculosis. The prevalence of individual mutations differs geographically, which must be considered in developing globally applicable screening tests. Methods In order to analyse the geographical distribution and frequency of mutations conferring resistance to rifampicin, isoniazid and fluoroquinolones, the researchers investigated the presence of mutations in the rpoB gene, the katG gene, the mabA-inhA promoter region and the gyrA gene in clinical isolates of multidrug-resistant tuberculosis (MDR-TB) from Belarus, China, Iran/Iraq, Honduras, Romania and Uganda. For each study site, the researchers described the distribution of specific mutations in 20 clinical MDR-isolates. Results The distribution of resistance-related mutations varied significantly between the study sites. Settings with a high incidence of MDR-TB, such as Belarus, showed a narrower spectrum of mutations related to rifampicin and isoniazid resistance and also a higher prevalence of fluoroquinolone resistance than study sites with a lower MDR-TB prevalence. Conclusion This study confirms that there are significant geographical differences in the distribution of resistance-related mutations and suggests that an increased understanding of such differences in the specific distribution of resistance conferring mutations is crucial for development of new, generally applicable, molecular tools for rapid diagnosis of drug-resistant TB. The fact that a narrower distribution of mutations in high MDR-TB prevalence settings was seen suggests that much of the problems in these settings can be a result of an ongoing transmission of certain MDR-TB strains.

Background The aim of this study was to evaluate the genotypic diversity of Mycobacterium tuberculosis strains using IS 6110 RFLP, spoligotyping and MIRU-VNTR typing. Materials and methods Between June 2008 and June 2009, all smear positive pulmonary specimens were collected prospectively at the national tuberculosis program (NTP) center of Duhok province. The specimens were processed for culture by modified Petroff’s method and were inoculated into two tubes of Lowenstein-Jensen (LJ) media. The isolates were identified as M. tuberculosis by using biochemical tests and growth rate. Molecular fingerprinting of all M. tuberculosis strains was performed by IS 6110 RFLP, spoligotyping and MIRU-VNTR. Results M. tuberculosis strains were isolated from 53 Iraqi patients with pulmonary TB. Spoligotyping of M. tuberculosis isolates showed T family (30%) as the predominant genotype. By using the three molecular techniques, there were four spoligotyping clusters of strains (“3540 & 3516”, “3565 & 3563”, “3605 & 3618” and “865, 877 & 13811”). Complete concordance with RFLP was observed in one cluster of spoligotyping, but no concordance with MIRU-VNTR profile (234426153433 and 236424183433). Conclusions Molecular fingerprinting methods are vital for differentiating a reactivation of latent infection from a recent transmission; however, it should be coupled with clinical epidemiological investigation. The low clustering rate in this study suggests that either reactivation of latent infections may be the main driving force for the endemic situation of the disease in Duhok, or it may indicate that a big circle of TB transmission is missed in the community, which means effective control measures have not been achieved yet in Duhok.