The Effect of Vitamin D Deficiency on Immune-Related Hub Genes: A Network Analysis Associated With Type 1 Diabetes.

Background Type 1 diabetes (T1D) is an autoimmune disorder that results in the destruction of pancreatic beta cells, causing a shortage of insulin secretion. The development of T1D is influenced by both genetic predisposition and environmental factors, such as vitamin D. This vitamin is known for its ability to regulate the immune system and has been associated with a decreased risk of T1D. However, the specific ways in which vitamin D affects immune regulation and the preservation of beta cells in T1D are not yet fully understood. Gaining a better understanding of these interactions is essential for identifying potential targets for preventing and treating T1D. Methods The analysis focused on two Gene Expression Omnibus (GEO) datasets, namely, GSE55098 and GSE50012, to detect differentially expressed genes (DEGs). Enrichr (Ma'ayan Laboratory, New York, NY) was used to perform enrichment analysis for the Gene Ontology (GO) biological process and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways. The Search Tool for the Retrieval of Interacting Genes 12.0 (STRING) database was used to generate a protein-protein interaction (PPI) network. The Cytoscape 3.10.1 (Cytoscape Team, San Diego, CA) was used to analyze the PPI network and discover the hub genes. Results The DEGs in both datasets were identified using the GEO2R tool, with a particular focus on genes exhibiting contrasting regulations. Enrichment analysis unveiled the participation of these oppositely regulated DEGs in processes relevant to the immune system. Cytoscape analysis of the PPI network revealed five hub genes, MNDA, LILRB2, FPR2, HCK, and FCGR2A, suggesting their potential role in the pathogenesis of T1D and the response to vitamin D. Conclusion The study elucidates the complex interaction between vitamin D metabolism and immune regulation in T1D. The identified hub genes provide important knowledge on the molecular pathways that underlie T1D and have the potential to be targeted for therapeutic intervention. This research underscores the importance of vitamin D in the immune system's modulation and its impact on T1D development.

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.

The Increased Frequency of Type 1 Regulatory T (Tr1) Cells and the Altered Expression of Aryl Hydrocarbon Receptor (AHR) and Interferon Regulatory Factor-4 (IRF4) Genes in Type 1 Diabetes: A Case-Control Study.

Background and aim Type 1 diabetes is an autoimmune disorder characterized by the destruction of pancreatic beta cells, leading to insulin deficiency and hyperglycemia. Regulatory T cells (Tregs), particularly type 1 regulatory T (Tr1) cells, play a crucial role in modulating autoimmune responses. Therefore, this study aimed to evaluate the frequency of Tr1 cells and their association with aryl hydrocarbon receptor (AHR) and interferon regulatory factor-4 (IRF4) gene expression levels in type 1 diabetes mellitus (T1DM) compared to the healthy controls. Method A case-control study design was used. The case group included patients diagnosed with T1DM, while the control group consisted of healthy individuals, matched for age and sex. Blood samples were collected, and peripheral blood mononuclear cells (PBMCs) were isolated. Serum interleukin 10 (IL-10) and interleukin 21 (IL-21) levels were measured using enzyme-linked immunosorbent assay (ELISA). The gene expression of AHR and IRF4 was analyzed using quantitative real-time polymerase chain reaction (qPCR), and Tr1 cell populations were determined using flow cytometry. Data were summarized with mean and standard error of the mean (SEM) for quantitative variables. Independent sample t-test, chi-square test, and the Mann-Whitney U test were used to compare groups. Statistical analyses were performed using SPSS version 25 (IBM SPSS Statistics, Armonk, NY), with significance levels set at p < 0.05. Figures were created using GraphPad Prism (GraphPad Software, San Diego, CA). Results A total of 45 cases were enrolled in the study, with 30 T1DM patients and 15 healthy controls. The mean IL-10 concentration was significantly higher in the patients (10.4 ± 1.1 pg/mL) compared to the healthy controls (5.1 ± 0.7 pg/mL), with a p-value of 0.001. There was no significant difference in IL-21 levels between the patients (76.1 ± 9.0 pg/mL) and healthy controls (88.2 ± 17.5 pg/mL), indicated by a p-value of 0.480. AHR gene expression was significantly lower in patients, with a p-value of 0.037. Although IRF4 gene expression was higher in patients, the difference was not statistically significant (p = 0.449). Tr1 cell frequency was significantly higher in T1DM patients (1.45% of cluster of differentiation 4+ {CD4+} T cells) compared to the healthy controls (0.40% of CD4+ T cells), with a p-value of 0.045. Conclusions The study demonstrated that T1DM is associated with higher IL-10 levels, decreased AHR gene expression, and a higher frequency of Tr1 cells. Policymakers should focus on developing targeted immunomodulatory therapies to address these immunological abnormalities. Healthcare providers should prioritize monitoring cytokine levels and gene expression in T1DM patients to tailor treatment plans effectively. Further research is needed to explore the therapeutic potential of modulating Tr1 cells and their related pathways in T1DM management.

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.

Clustered Regularly Interspaced Short Palindromic Repeat-1 (CRISPR-1) Locus as a Tool for Tracing the Zoonotic History of Salmonella enterica Strains.

Background Salmonella enterica is a significant foodborne pathogen that causes considerable illness and death in humans and animals. The clustered regularly interspaced short palindromic repeat (CRISPR)-CRISPR-associated protein (Cas) system in bacteria acts as an adaptive immune defense against invasive genetic elements by incorporating short intergenic spacers (IGSs) into CRISPR loci. These loci serve as molecular records of past interactions with phages and plasmids, providing insights into the transmission and evolution of bacterial strains across different hosts. Aim This study aimed to investigate the diversity of IGSs in the CRISPR-1 locus of S. enterica isolates from humans and camels. The objective was to assess the potential of IGSs to distinguish strains, track sources, and understand patterns of zoonotic transmission. Materials and methods Genomic DNA was extracted from multiple strains of S. enterica, and the CRISPR-1 locus was polymerase chain reaction (PCR) amplified and sequenced. The sequences were compared to identify distinct patterns of IGSs and potential host-specific characteristics. Sanger sequencing and bioinformatics tools were used to classify the IGSs and determine their similarity to known sequences in the National Center for Biotechnology Information (NCBI) database. Results Sequence analysis revealed five distinct CRISPR-1 types among S. enterica isolates from humans and three among camel isolates. The presence of shared IGSs between human and camel S. enterica isolates suggested zoonotic or reverse-zoonotic transmission events. Additionally, host-specific unknown IGSs (UIGS) were identified. Importantly, camel isolates initially identified as S. enterica subspecies enterica serovar Enteritidis based on rrnH gene sequencing were reclassified as S. enterica serovar Enteritidis based on CRISPR-1 profiling, demonstrating the higher resolution of CRISPR-based genotyping. Conclusion The diversity of IGSs in the CRISPR-1 locus effectively differentiated S. enterica strains and provided insights into their evolutionary origins and transmission dynamics. CRISPR-based genotyping proves to be a promising tool to complement traditional serotyping methods, enhancing the molecular epidemiology of salmonellosis and potentially leading to better management and control strategies for this pathogen.

Knowledge and Attitudes Regarding Depression Among a Sample of Iraqi Non-Psychiatric Nurses: A Cross-Sectional Study.

Introduction: Nurses, comprising the largest profession in healthcare, play a significant role in the identification and management of mental health disorders in hospitals. Objectives: The study assessed the knowledge and attitudes of non-psychiatric nurses and their encounters with depressive patients throughout their careers. Methods: This was a cross-sectional descriptive study with 400 non-psychiatric nurses from different hospitals in the Kurdistan Region of Iraq during October and November 2022. The independent Student's t-test, one-way analysis of variance, and binary logistic regression were used to assess possible factors associated with knowledge and attitude toward depression. Results: In this study, 400 non-psychiatric nurses were examined, revealing a mean age of 31.57 ± 8.59 years. Their mean scores for knowledge and attitude toward depression were 5.41 out of a maximum of 11 (standard deviation 1.15) and 5.15 out of 18 (standard deviation 1.83), respectively. Notably, differences in mean knowledge scores were observed concerning participant marital status (P = .044), while disparities in mean attitude scores are related to participant gender (P = .010). Upon binary logistic regression analysis, none of the independent variables exhibited an association with good knowledge. Nevertheless, gender emerged as a significant factor influencing attitude toward depression (odds ratio: 0.51; 95% confidence interval: 0.30-0.86; P = .012). Subsequently, in the multivariate binary logistic regression analysis, gender sustained significance (adjusted odds ratio: 0.573; 95% confidence interval: 0.348-0.942; P = .028) as the key variable impacting attitudes toward depression among non-psychiatric nurses. Conclusion: Based on the results of this study, nurses have insufficient awareness and management skills for depression. It has been experienced and reported that nurses lack knowledge and an attitude toward depression management. The study highlights a significant gap in nurses' skills for managing depression, urging the immediate improvement of training programs. Customizing these programs to enhance nurses' abilities in identifying and managing depression is crucial.

The role of digital health in revolutionizing healthcare delivery and improving health outcomes in conflict zones.

The provision and planning for healthcare delivery in conflict is a pressing imperative. Healthcare within these environments is naturally complex, given the entanglement of affected populations, militaries and oft-deteriorating public services. The field of digital health, placed at the intersection of healthcare and technology, has the power to revolutionize healthcare delivery and improve health outcomes worldwide. Its impact is particularly significant in conflict zones, where it can address the unique challenges faced by these regions. Violence, damaged infrastructure, restricted mobility, forced migration, and overstretched healthcare facilities are all hallmarks of conflict zones that demand novel approaches to addressing them. Health care delivery is being revolutionized by the introduction of digital health technology in conflict zones, which are improving access, emergency response capacities, health information management, and mental health assistance. Doctors and aid organizations can more easily overcome challenges and reach out to underserved populations in these regions because to digital technological improvements. Recent decades have seen a shift in the nature of conflict, and with it, a corresponding shift in the range of digital health solutions available to address geographical, epidemiological, and clinical gaps. The purpose of this letter is to inquire into the application of digital health in conflict zones and its potential to lessen the pressing healthcare needs of affected communities.

Knowledge, Attitudes, and Willingness of Healthcare Workers in Iraq's Kurdistan Region to Vaccinate against Human Monkeypox: A Nationwide Cross-Sectional Study.

Although human monkeypox infections had not been recorded in the Kurdistan region of Iraq as of August 2023, the rapid growth of cases worldwide and the detection of monkeypox in neighboring Middle Eastern nations call for careful planning and timely response measures. Educating and empowering frontline healthcare workers (HCWs) so that they can act to curb the spread of monkeypox infections are core elements of primary prevention and protecting public health. Therefore, this study aimed to assess HCWs' knowledge and attitudes about monkeypox and their willingness to vaccinate against monkeypox. By employing a convenience sampling method, an online survey was disseminated via Google Forms between 1 November 2022 and 15 January 2023. The researchers utilized regression analyses to ascertain the factors associated with the three parameters: knowledge, attitude, and the willingness to vaccinate. A total of 637 HCWs were included in the analysis (ages ranged between 21 and 51 years). The mean overall scores were 8.18 of a max score of 16 (SD 3.37), 3.4 of 5 (SD 1.37), and 2.41 of 5 (SD 1.25) for knowledge, attitude, and willingness to vaccinate, respectively. A multivariate logistic regression analysis demonstrated that HCWs who had heard about monkeypox before 2022 rather than later had a higher level of knowledge (AOR: 4.85; 95% CI: 2.81-8.36; p < 0.001). In addition, those who had newly joined the workforce or had less than 1 year experience in practice had more positive attitudes about curbing monkeypox (AOR: 0.35; 95% CI: 0.20-0.59; p < 0.01) than those who practiced for longer. No significant predictors of willingness to vaccinate against monkeypox were identified. The research revealed that HCWs exhibited a relatively low level of monkeypox knowledge. They also had poor attitudes towards monkeypox vaccination and were therefore reluctant to receive the vaccines. Imparting knowledge about the infectious disease can cultivate better awareness and attitudes among HCWs as to their roles in mitigating the spread of an epidemic in the foreseeable future.

Environmental Health Risks After the 2023 Turkey-Syria Earthquake and Salient Mitigating Strategies: A Critical Appraisal.

A 7.8-magnitude earthquake in Turkey and Syria, followed by a 7.6-magnitude earthquake, caused over 50 000 deaths and over 100 000 injuries. The immediate physical injuries were severe, but the health repercussions, including the strain on healthcare services and the possibility of disease outbreaks, were equally concerning. Infections due to multidrug resistant microbes were also a matter of concern. Earthquake has caused not only loss of property and physical damage but also has a great negative impact on the mental health of the people. It is associated with serious psychological trauma. Moreover, the risk of malnutrition also became evident. Food aid and nutritional supplements can reduce the risk of malnutrition, but they are not a long-term solution. Establishment of sustainable food systems and restoration of agricultural productions are essential. Other demanding issues like derth of access to essential services related to health care, chances of child birth related complications following earthquake also need to be addressed. Emerging crises and disasters (conflicts, pandemics, epidemics), in addition to pre-existing conditions (collapsed health facilities, cold winter conditions, destruction of lifeline infrastructures, overcrowding in emergency shelters, poor sanitation, and unfavorable socio-economic conditions), may further exacerbate the already precarious public health situation and significantly delay the recovery process. The early warning and protection against the development of infectious diseases in earthquake-affected areas depend on good disease surveillance at the local and regional levels, which has been proposed as one of several techniques for prevention and management of infectious diseases in these areas. Our article outlines high-level approaches to reduce the risk of health issues among victims of Turkey and Syria.

Synthesis of Silver Nanoparticles from Aeromonas caviae for Antibacterial Activity and In Vivo Effects in Rats.

Silver nanoparticles (AgNPs) have excellent antimicrobial properties, as they can inhibit multidrug-resistant (MDR) pathogens. Furthermore, bio-AgNPs have potential applications in medicine due to their low toxicity and high stability. Here, AgNPs were synthesized from the biomass of Aeromonas caviae isolated from a sediment sample and subsequently characterized. The UV-Vis spectra of AgNPs in aqueous medium peaked at 417 nm, matching their plasmon absorption. The X-ray diffraction analysis (XRD) pattern of AgNPs showed four peaks at 2θ values, corresponding to Ag diffraction faces. Absorption band peaks at 3420.16, 1635.54, and 1399.43 cm-1 were identified by Fourier-transform infrared spectroscopy (FTIR) analysis as belonging to functional groups of AgNP-associated biomolecules. Transmission electron microscopy (TEM) and scanning electron microscopy (SEM) showed that the nanoparticles are spherical and pseudospherical, with sizes of 15-25 nm. Agar well diffusion minimal inhibitory concentration (MIC) assays were used to assess the antibacterial activity of the nanoparticles against MDR pathogens. AgNPs exhibited antibacterial activity against MDR bacteria. Two groups of albino rats received intraperitoneal injections of AgNPs at 15 mg/kg or 30 mg/kg for 7 days. Blood, kidney, and liver samples were collected to investigate hematological, biochemical, and histopathological alterations. Administered AgNPs in rats fluctuated in liver and kidney function parameters. The ultrastructural impacts of AgNPs were more prominent at higher doses. The results proved the easy, fast, and efficient synthesis of AgNPs using A. caviae isolates and demonstrated the remarkable potential of these AgNPs as antibacterial agents. Nanotoxicological studies are required to identify the specific dose that balances optimal antibacterial activity with minimal toxicity to human health.

Knowledge, Attitude and Worry in the Kurdistan Region of Iraq during the Mpox (Monkeypox) Outbreak in 2022: An Online Cross-Sectional Study.

The rapid spread of monkeypox (mpox) has been declared as a public health emergency of international concern (PHEIC). The present study aimed to assess the knowledge, attitude, and worry levels of the general population in the Kurdistan region of Iraq regarding the ongoing mpox multi-country outbreak. An online cross-sectional survey was conducted between 27-30 July 2022, using a convenience sampling method. The questionnaire was adapted from previous studies addressing the same topic. The independent Student's t-test, one-way ANOVA, and logistic regression were used to assess possible factors associated with knowledge, attitude, and worry toward mpox. A total of 510 respondents were included in the final analysis. The participants showed a moderate level of mpox knowledge, a neutral attitude towards mpox, and a relatively moderate worry level. The logistic regression analysis showed that age, gender, marital status, religion, level of education, and place of residence were associated with mpox knowledge; however, the significant variables in the multivariate regression analysis were gender, religion, level of education, and residential area. Gender and residential area were associated with attitudes toward mpox; however, the significant variables in the multivariate regression analysis were gender and residential areas. The worry toward mpox was influenced by gender, marital status, religion, and place of residence, yet the significant variables in the multivariate regression analysis were gender, religion, educational level, and residential area. In conclusion, the Kurdish population had moderate knowledge, a neutral attitude, and a moderate level of worry about mpox. Considering the continuous rapid rise in mpox cases in several countries, and its possible risk as pandemic amid the ongoing COVID-19 pandemic, proactive control measures, adequate disease prevention strategies, and preparedness plans need to be formulated and immediately implemented to tackle the appearance of fears among people, and to safeguard the mental health of the public.

Aeromonas sobria as a potential candidate for bioremediation of heavy metal from contaminated environments.

The uncontrolled discharge of industrial wastes causes the accumulation of high heavy metal concentrations in soil and water, leading to many health issues. In the present study, a Gram-negative Aeromonas sobria was isolated from heavily contaminated soil in the Tanjaro area, southwest of Sulaymaniyah city in the Kurdistan Region of Iraq; then, we assessed its ability to uptake heavy metals. A. sobria was molecularly identified based on the partial amplification of 16S rRNA using novel primers. The sequence was aligned with 33 strains to analyze phylogenetic relationships by maximum likelihood. Based on maximum tolerance concentration (MTC), A. sobria could withstand Zn, Cu, and Ni at concentrations of 5, 6, and 8 mM, respectively. ICP-OES data confirmed that A. sobria reduced 54.89% (0.549 mM) of the Cu, 62.33% (0.623 mM) of the Ni, and 36.41% (0.364 mM) of the Zn after 72 h in the culture medium. Transmission electron microscopy (TEM) showed that A. sobria accumulated both Cu and Ni, whereas biosorption was suggested for the Zn. These findings suggest that metal-resistant A. sobria could be a promising candidate for heavy metal bioremediation in polluted areas. However, more broadly, research is required to assess the feasibility of exploiting A. sobria in situ.