Assessment of Anxiety, Stress, and Depression Among COVID-19 Survivors After 40 Months in the Kurdistan Region of Iraq: An Online Cross-Sectional Study.

BACKGROUND AND AIMS: COVID-19 survivors often experience significant and pervasive psychological distress. This study aimed to investigate the prevalence and demographic factors affecting anxiety, stress, and depression levels among COVID-19 survivors in the Kurdistan region of Iraq. METHOD: This online cross-sectional study was conducted from August 1, 2023 to December 17, 2023, in the Kurdistan region of Iraq, including Erbil, Sulaymaniyah, and Duhok. Purposive sampling was used to collect data using an online survey. The survey included demographic information and the Depression, Anxiety, and Stress Scale - 21 Items (DASS-21). Statistical analysis was performed using Stata version 12 (StataCorp LLC, College Station, TX), with frequency and percentage used for categorical variables and mean and standard deviation for quantitative variables. Ordinal regression analyses were conducted to assess associations between demographic factors and mental health outcomes. A p-value of less than 0.05 was considered statistically significant. RESULTS: A total of 783 participants were enrolled in the study. The mean score for anxiety was 11.62 ± 4.71, indicating moderate levels. For depression, the mean score was 11.54 ± 5.21, indicating mild levels, and for stress, the mean score was 14.0 ± 5.78, indicating normal levels. Younger individuals (15-27) showed higher stress (Estimate: 18.96, P=0.001) and anxiety (Estimate: 2.79, P=0.001) levels compared to older age groups. Males reported significantly lower stress (Estimate: -1.01, P=0.001), anxiety (Estimate: -1.29, P=0.001), and depression (Estimate: -0.72, P=0.001) than females. Participants with a diploma had lower anxiety (Estimate: 0.65, P=0.004) and stress (Estimate: 0.77, P=0.002) levels compared to those with only elementary education. CONCLUSIONS: The study found moderate levels of anxiety among COVID-19 survivors, with mild depression and normal stress levels. To address these issues, it is recommended that policymakers develop targeted mental health interventions. Healthcare providers should focus on early identification and treatment, providing personalized counseling and support to enhance coping mechanisms and overall psychological well-being. By implementing these measures, mental health outcomes for COVID-19 survivors in Iraq can be significantly improved.

Assessment of Nursing Faculty Members' Knowledge Toward Research: A Cross-Sectional Study.

Background and aim In the context of contributing to healthcare and the well-being of a nation and its communities, nursing research plays a vital role in advancing the discipline of nursing science. Nursing research is essential for improving the quality of nursing care. This study aims to examine the research knowledge level of faculty members at the College of Nursing, University of Raparin, Kurdistan Region, Iraq. Methods We conducted a cross-sectional study involving 43 nursing faculty members at the University of Raparin. The survey was distributed using convenience sampling in April 2024. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 26.0 (released 2019, IBM Corp., Armonk, NY). Continuous variables were analyzed using mean and standard deviation, while categorical variables were analyzed using frequency and percentage distributions. The association between knowledge scores and demographics was tested using Mann-Whitney, Kruskal-Wallis, Chi-square, and post-hoc tests. Stepwise multiple regression analysis was used to determine the variables that influence the knowledge score. Significance was set at p < 0.05. Results A total of 43 participants were enrolled in this study. The mean age was 32.56 ± 4.75, with 69.8% of participants being male. In terms of educational attainment, 48.8% held master's degrees, 39.5% held bachelor's degrees, and only 11% possessed PhDs. The mean work experience was 5.40 ± 4.04 years, and the mean knowledge score toward research was 3.09 ± 1.97 out of 7. Demographic variables, such as age, marital status, and gender, showed no significant associations with knowledge levels (p > 0.05). However, significant associations were found for education level (p = 0.004) and years of experience (p = 0.011). In the stepwise regression analysis, we observed a significant positive correlation between the level of education and knowledge score (F =10.787, p = 0.002). However, variables, such as age, gender, marital status, years of experience, and participation in research courses, did not demonstrate statistical significance (p-values > 0.05). Conclusion This study highlights a significant lack of research expertise among nursing faculty members, emphasizing the urgent need for targeted interventions and instructional activities in nursing education programs. It is crucial to address this knowledge gap in order to support the professional growth of faculty members and promote the advancement of nursing research and evidence-based practice. Policymakers should also consider implementing mentorship programs that strategically pair less experienced faculty members with seasoned researchers. This initiative aims to cultivate a collaborative learning environment and enhance research skills.

Exploring Young Adults' Reluctance to Engage With Psychiatric Hospitals in Erbil, Iraq: Identifying Barriers to Psychiatric Care.

BACKGROUND AND AIM: In Erbil, Iraq, the reluctance of young adults to engage with psychiatric services is influenced by a complex array of barriers, including stigma-related, attitudinal, and instrumental factors that hinder effective mental healthcare access. This study aimed to identify these specific barriers to accessing psychiatric care among young adults in Erbil. MATERIALS AND METHODS: The study utilized a cross-sectional online survey conducted between April 5th and May 1st, 2024. Data collection was carried out through purposive sampling and involved a comprehensive questionnaire. Electronic informed consent was obtained from all participants before they started the survey, which collected demographic data and utilized the Barriers to Access to Care Evaluation (BACE v3) tool. Statistical analysis was conducted using SPSS version 27 (IBM Corp., Armonk, NY). Descriptive statistics (frequency and percentage) were used for categorical data, while the mean and standard deviation characterized continuous variables. Chi-square tests, including Fisher's exact test and odds ratio (OR), were used to analyze categorical data, with a significance level set at p < 0.05. RESULTS: A total of 407 participants were enrolled in the study. The study highlighted several barriers to mental health care. Stigma-related barriers were significant, with participants fearing being seen as weak (mean score = 2.14, SD = 0.96) and concerns about being labeled "crazy" (mean score = 1.80, SD = 1.19). Regarding attitudinal barriers, there was a notable preference for dealing with issues independently (mean score = 2.04, SD = 0.98) and a tendency toward resolving problems without professional help (mean score = 1.88, SD = 0.98). Additionally, instrumental barriers were identified, including the rare availability of culturally diverse mental health professionals (mean score = 1.78, SD = 1.09) and practical difficulties such as arranging transportation to appointments (mean score = 0.61, SD = 0.87). CONCLUSION: The study demonstrated that young adults in Erbil face significant stigma and attitudinal and instrumental barriers to accessing psychiatric care. In response to these findings, it is recommended for the government to prioritize mental health awareness, actively destigmatize mental health issues, and improve service accessibility to foster a supportive care environment. Additionally, mental health professionals and educational institutions should collaborate to provide targeted support programs and resources for young adults.

Antimicrobial Resistance: Stewardship and One Health in the Eastern Mediterranean Region.

Antimicrobial resistance (AMR) is a major threat in the Eastern Mediterranean region (EMR) due to factors such as the high prevalence of infectious diseases, weak health systems, and the misuse of antimicrobials. This paper aims to discuss how interdisciplinary action and collaboration, specifically through antimicrobial stewardship (AMS) and the One Health approach, can effectively address AMR in the EMR. The review focuses on successful AMS initiatives and the adoption of the One Health approach in countries within the EMR, including the Gulf Cooperation Countries (GCC), Egypt, Iran, Jordan, and Pakistan. The goal is to highlight the potential for progress in combating AMR and identify challenges and opportunities for strengthening interdisciplinary collaboration. The results showcase successful AMS programs and One Health initiatives in various EMR countries, demonstrating their potential to address AMR challenges. The paper also discusses the challenges faced by these nations, such as limited resources, fragmented health systems, and knowledge gaps. Additionally, opportunities for enhancing interdisciplinary action through regional cooperation, international partnerships, and research and innovation are outlined. In conclusion, this paper emphasizes the importance of a comprehensive and collaborative response to combat AMR in the EMR. It advocates for the One Health approach as a crucial framework to guide these efforts, promoting coordinated action, improved surveillance, responsible antimicrobial use, and enhanced interdisciplinary collaboration to effectively mitigate the threat of AMR.

Bridging the Gap: Nurses' Integral Role in Oral Cancer Prevention and Management.

This editorial explores the important role that nurses play in bridging the gap in the prevention and management of oral cancer. Despite advances in medical science, oral cancer remains a significant global public health challenge, with high mortality rates due to late diagnosis and inadequate treatment. Nurses, with their multifaceted contributions, are indispensable in addressing this challenge. The editorial emphasizes the key role of nurses in patient education and awareness, early detection and screening, comprehensive patient care, supportive services, and advocacy. Nurses are frontline educators, advocates, caregivers, and collaborators in the fight against oral cancer. Through their expertise, compassion, and dedication, nurses have a significant impact on patient outcomes, reducing mortality rates, and promoting a healthier future for those affected by oral cancer. Recognizing and supporting the crucial role of nurses in the management of oral cancer is essential for advancing prevention, detection, and treatment efforts.

Charting the Future: The Role of AI in Transforming Nursing Documentation.

This editorial delves into the integration of artificial intelligence (AI) into nursing documentation, emphasizing its potential to streamline workflows, reduce human error, and enhance patient care. AI technologies, notably natural language processing and decision support systems, present opportunities to automate tedious documentation tasks and enhance record accuracy. However, their adoption raises ethical considerations, such as privacy, bias, and accountability. Striking a balance between technological advancements and ethical imperatives is pivotal to harnessing the benefits of AI while safeguarding patient safety and upholding professional integrity in nursing practice. Advocating for ongoing evaluation, regulation, and education is crucial to ensure the responsible integration of AI into nursing documentation. This approach aims to improve patient outcomes and maintain the high standards of the nursing profession.

Assessment of health-related behaviors among medical students: A cross-sectional study.

Background and Aim: Students sometimes participate in harmful activities that adversely influence their behaviors and well-being throughout college, which is one of the sensitive phases in an individual's life. Aim: To assess the health-related behaviors of university students. Methods: A cross-sectional study that includes systematic randomly selected 383 students from various colleges of Ras Al Khaimah Medical and Health Sciences University (RAKMHSU), Ras Al Khaimah Emirate, United Arab Emirates. A self-reported questionnaire included students' demographic traits and behaviors, including safety, medication intake, cigarette smoking, nutrition, physical activity, and health-related topics. Results: Most participants were females (69.7%), 13.3% were obese while 28.2% were overweight. The data revealed a significant difference between male and female students regarding medication intake without prescription, nutrition, physical activity, and health-related topics. The data also revealed that the majority of the students were attempting to lose weight, and the former male smokers had fewer trials to quit the use of all tobacco products than females. Conclusion: More than a quarter of participants were overweight, and the majority of students did not adhere to the guidelines for safety and nutritious eating. This study recognized significant health promotion opportunities for university students that can be carried out to establish a healthier youth for society.

Road traffic accidental injuries and deaths: A neglected global health issue.

Across the world, traffic accidents cause major health problems and are of concern to health institutions; nearly 1.35 million people are killed or disabled in traffic accidents every year. In 2019, 93% of road traffic injury-related mortality occurred in low- and middle-income countries with an estimated burden of 1.3 million deaths. This issue is growing; by 2030, road traffic injuries will be the seventh leading cause of death globally. The present report highlights an overview of road traffic accidents, accidental injuries, and deaths, associated risk factors, important precautions, safety rules, and counteracting management strategies. In modern cultures, road accidents are a major source of death and serious injuries. Road traffic injuries are a substantial yet underserved public health issue around the world that requires immediate attention. To prevent accidents in the long term, it is essential to adopt conservative preventive measures that can minimize collisions and promote a safe road environment.

The efficacy of intranasal oxytocin in patients with Prader-Willi syndrome: A systematic review and meta-analysis.

BACKGROUND AND AIMS: Prader-Willi Syndrome (PWS) is a rare genetic disease. Oxytocin is a neuropeptide hormone that impacts fear, and social recognition. Intranasal administration of oxytocin can be utilized to treat PWS patients. The results of published trials assessing the effects of intranasal oxytocin in PWS are variable. The current systematic review aims to investigate the efficacy of oxytocin in Prader-Willi patients. METHODS: We conducted a systematic literature search on Pubmed, Web of Science, and Scopus from inception to March 2022 for relevant interventional randomized controlled trials (RCTs) reporting the effect of oxytocin in patients with Prader-Willi syndrome. We assessed the quality of included trials using the Cochrane tool risk of bias 1. We performed the meta-analysis with Revman software version 5.4. In addition, we visualized our results using forest plots. We assessed the heterogeneity by using the Chi-square test. RESULTS: Relevant to hyperphagia, the data extracted in three studies comprising 92 patients did not show positive outcomes of oxytocin compared to placebo (MD = 0.18; 95% CI: -0.44, 0.80; P = 0.56). Three studies that included 94 patients revealed no significant effects regarding weight between oxytocin and placebo (MD = 0.30; 95% CI: -0.22, 0.83; P = 0.25). The Aberrant Behaviour Checklist found that group-administered oxytocin improved behaviour compared to their counterpart who received a placebo. CONCLUSION: Oxytocin didn't have significant effects on hyperphagia or weight. To establish the impact of oxytocin in Prader-Willi patients, additional prospective, large-sample randomized controlled trials (RCTs) are needed to avoid controversy.

Hospital-based salient prevention and control measures to counteract the 2022 monkeypox outbreak.

Monkeypox (MPX) has been declared a public health emergency of international concern by the World Health Organization. As of November 4, 2022, 78,000 verified cases from 109 countries and territories, and 40 deaths have been reported due to MPX. The present article highlights salient hospital-based prevention and control measures to be adopted and their critical role to mitigate the ongoing MPX outbreaks and global public health emergency.

Monkeypox virus infection and myocarditis: A review of current evidence and possible pathogenesis.

The recent spread of the monkeypox virus (MPXV), causing monkeypox (mpox), to non-endemic areas, and the atypical and unusual clinical manifestations observed during its 2022 outbreak has focused international interest on the clinical features of the disease. Mpox is usually a self-limiting disease with mild symptoms with common manifestations, including fever and skin lesions; however, severe manifestations could occur in some vulnerable groups (children and those with impaired immune systems) and may present multisystem complications and fatal outcomes. In most cases, a fever is the first sign of disease, followed by the development of various inflammatory lesions on the skin, such as vesiculopustular rashes and ulcers. Pneumonitis, encephalitis, keratitis, secondary bacterial infections, acute kidney injury, and myocarditis are all possible outcomes of the infection. Myocarditis has been reported to be caused by orthopoxviruses, and it is a serious condition of which its pathophysiology is little understood. Recent reports have indicated myocarditis with cardiac involvement as a possible atypical and unusual consequence of the MPXV infection during present outbreak. This review provides an overview of the clinical manifestations of mpox with a special focus on its effects on the heart, including myocarditis. The evidence of the myocarditis in mpox patients and its possible pathogenesis are discussed.

Addressing the Effects of War on Gaza's Healthcare System.

The protracted conflict in Gaza, marked by extensive Israeli attacks, has devastatingly crippled the healthcare system. Hospitals, clinics, and essential facilities have been directly targeted or damaged, leading to critical shortages in beds, equipment, and medications. The strain on healthcare workers has resulted in burnout, trauma, and mental health disorders. Moreover, repeated conflicts have triggered widespread psychological trauma among residents, exacerbated by a lack of mental health professionals and the stigma surrounding seeking help. International cooperation and humanitarian aid are essential to rebuild healthcare infrastructure, ensure the availability of medical supplies, and support mental health services. Additionally, diplomatic efforts for lasting peace in the region are crucial to mitigate the frequency and severity of conflicts, ultimately contributing to the stability and development of Gaza's healthcare system.

The Impact of COVID-19 on Nursing Practice: Lessons Learned and Future Trends.

The coronavirus disease 2019 (COVID-19) pandemic significantly impacted healthcare givers, especially nurses, who were at the forefront of the crisis. It highlighted the importance of preparedness, adaptability, and technology in healthcare systems. Nurses faced challenges like personal protective equipment (PPE) shortages, high patient numbers, and evolving protocols, emphasizing the need for robust plans and flexible infrastructures. Telehealth became crucial, ensuring care continuity and access, particularly for underserved groups. Mental health support for nurses became vital due to extreme stress and pressure. The pandemic also emphasized ongoing education and upskilling in nursing and highlighted the role of AI in healthcare solutions. Interdisciplinary collaboration among healthcare professionals gained importance, shaping a more holistic approach to patient care. This editorial highlights the impact of the COVID-19 pandemic on the nursing profession, highlighting the crucial significance of being well-prepared, adaptable, technologically advanced, and collaborative in order to ensure a more robust healthcare system in the future.

Clinical features and laboratory findings first case of B. 1.617.2 (delta) variant concern (VOC) in Iraq.

Since the initial report of the severe acute respiratory syndrome (SARS CoV-2) in Wuhan, China, in 2019, the virus has constantly mutated, resulting in the appearance of novel variants. In December 2020, the B.1.617.2 (delta) variant concern (VOC) was first reported in India, and rapidly spread around the globe, is now the main brand in the United Kingdom, and it has grown dramatically. Here we present the clinical features and laboratory findings of the first case of B. 1.617.2 (delta) variant concern (VOC) in Iraq. A 6-year-old female child presented with severe abdominal pain, headache, severe vomiting, and diarrhea, runny nose, alerted mental status, loss of appetite, and fever. The patient was diagnosed with COVID-19 delta variant B.1.617.2 by RT-PCR. The patient was treated by administration of glucose saline 4% for 3 days, ceftriaxone vial 1 mg every 12 h for 6 days, and an acetaminophen bottle on a need to prevent fever followed by a Flagyl bottle every 24 h for 3 days. Vaccination and prevention the spread of the virus and against it are important preventive approaches for delta variant. Sore throat, runny nose, headache, and vomiting, diarrhea are the major clinical features of the delta variant. This was followed by an elevation of the leukocyte WBC, and blood platelets. To reduce the impact of new delta variant B.1.617.2 infection; handwashing, wearing a double mask, avoiding crowded and closed settings, social distancing, lockdown, and ensuring good ventilation are major significant options against this variant.

Thrombosed external jugular vein aneurysm mimics to a branchial cyst: A novel case from Iraq and review of the literature.

INTRODUCTION AND IMPORTANCE: Venous aneurysms are rare diseases, and according to their locations, history will change. They will be diagnosed based on the clinical history and imaging modalities. The exact incidence of external jugular vein aneurysm remains controversial. In the neck, venous aneurysm has been reported most commonly in the internal jugular vein. Frequently the venous aneurysm has a fusiform shape, and the saccular type is extremely rare. CASE PRESENTATION: Here we present a case of the external jugular vein aneurysm which was misdiagnosed as a branchial cyst presented with gradual swelling in the left supraclavicular region. The patient was diagnosed intraoperatively, and by histopathological examination. The patient successfully underwent surgery of Proximal and distal control of the external jugular vein without resection of the clavicle were performed, and trans-fixation of the external jugular vein was done without any complications. CLINICAL DISCUSSION: Idiopathic, spontaneous venous aneurysm of the external jugular vein thrombosis is extremely rare clinical findings. Computerized tomography was the gold standard test for the diagnosis of venous thrombosis, but nowadays neck ultrasound is the diagnostic test of choice. However, the mass was like a branchial cyst by ultrasound. CONCLUSION: External jugular vein aneurysm is rare, when it was a saccular type and thrombosed without any causes it will be extremely rare. When idiopathic thrombosis of external jugular vein aneurysm was confirmed by imaging modalities, then it was symptomatic, enlarged, ruptured or disfigured, the surgical excision will be mandatory without anticoagulant drugs preoperatively or postoperatively.

Subcutaneous emphysema and spontaneous pneumomediastinum in non-intubated COVID-19 patient: Presenting unusual case report.

INTRODUCTION AND IMPORTANCE: In non-intubated COVID-19 patients, subcutaneous emphysema and spontaneous pneumomediastinum (SPM) remain rarely, with incidence rates of 3.0 and 1.2 per 100,000, respectively; nevertheless, the occurrence of these conditions in COVID-19 patients is unclear. Up to date only few cases have been reported. The mechanism of pneumomediastinum in non-intubated COVID-19 patients remains unclear. CASE PRESENTATION: Here we present a 63-year-old male with subcutaneous emphysema, and spontaneous pneumomediastinum with a 1-day history of chest pain and productive cough, without chills and dyspnea. The patient was diagnosed by nasopharyngeal RT-PCR, Chest CT, and laboratory findings. The patient successfully treated by given double (mask and nasal) oxygen therapy, antibacterial (moxifloxacin tablet 400 mg) every 24 h for 7 days, followed by antiviral (lopinavir tablet 400 mg) twice daily for 6 days and corticosteroid treatments as well as steroid therapy (methylprednisolone 40 mg) daily for 8 days. Subcutaneous emphysema treated by supraclavicular slit-like incision (3 cm) bilaterally and milking of skin from face, neck, shoulders and chest done for three days for subcutaneous emphysema but regarding the pneumomediastinum we did only follow up of the patient. CLINICAL DISCUSSION: Spontaneous pneumomediastinum and subcutaneous emphysema are rare clinical finding in non-intubation of COVID-19 patients but frequently common in patients with coronavirus acute respiratory distress syndrome (COV-ARDS), or intubated COVID-19. In the present paper, subcutaneous emphysema and spontaneous pneumomediastinum occurred at the same time, with no past history of pulmonary diseases, and smoking of the patient. The only reason of this patient was high-pressure repetitive cough. CONCLUSION: The authors declared that COVID-19 infection leading to subcutaneous emphysema and spontaneous pneumomediastinum in non-intubated COVID-19 patients. Our case revealed that oxygen therapy, bed rest, analgesic, and supraclavicular slit-like incision best option for treat subcutaneous emphysema (SE) and spontaneous pneumomediastinum (SPM).