Epidemiological profile of tuberculosis in Iraq during 2011-2018.

BACKGROUND: Tuberculosis (TB) is one of the most progressive infectious diseases caused by Mycobacterium tuberculosis. The pathogen is the first cause of mortality linked to a single pathogen worldwide, especially in poor and developing countries. METHODS: A cross-sectional descriptive study was conducted to estimate incidence rate (IR) of TB in Iraq during a period of eight years (2011-2018). TB data were extracted from the computer system of the National Specialized Center for Chest and Respiratory Diseases in Baghdad. RESULTS: During 2011-2018, 65,102 confirmed TB cases were reported in Iraq; 39,640 pulmonary TB (PTB) and 25,462 extra-pulmonary TB (EPTB). The average IR (case/100,000 inhabitants) of TB was 23.4 (14.2 for PTB and 9.1 for EPTB). Annual rate of TB cases showed a gradual decline over years (from 29.2 in 2011 to 18.6 in 2018). The decline in IR was more pronounced in PTB than EPTB. However PTB/EPTB ratio showed a gradual decreasing over years (from 2.04 in 2011 to 1.56 in 2018). GIS-mapping revealed that PTB and EPTB IRs show variations between the 18 governorates of Iraq. Most of the recorded PTB cases were new (average: 90.5%), followed by relapse cases (average: 7.9%). Among the reported PTB cases, percentage of males was greater than females (average: 52.1 vs. 47.9%), whereas an opposite trend was observed in EPTB (42.9 vs. 57.1%). The frequency distribution of PTB and EPTB varied between age groups, and lowest average frequency was recorded in age groups 1-4 and 5-14 year. CONCLUSIONS: TB is still a public health threat, and although a declining trend in incidence was depicted over the years 2011-2018, the disease is still out of control in Iraq, and more investments of resource are necessitated to eliminate the disease. In this context, EPTB and PTB relapse need a recognized attention.

Helmet Non-Invasive Ventilation for COVID-19 Patients (Helmet-COVID): study protocol for a multicentre randomised controlled trial.

INTRODUCTION: Non-invasive ventilation (NIV) delivered by helmet has been used for respiratory support of patients with acute hypoxaemic respiratory failure due to COVID-19 pneumonia. The aim of this study was to compare helmet NIV with usual care versus usual care alone to reduce mortality. METHODS AND ANALYSIS: This is a multicentre, pragmatic, parallel randomised controlled trial that compares helmet NIV with usual care to usual care alone in a 1:1 ratio. A total of 320 patients will be enrolled in this study. The primary outcome is 28-day all-cause mortality. The primary outcome will be compared between the two study groups in the intention-to-treat and per-protocol cohorts. An interim analysis will be conducted for both safety and effectiveness. ETHICS AND DISSEMINATION: Approvals are obtained from the institutional review boards of each participating institution. Our findings will be published in peer-reviewed journals and presented at relevant conferences and meetings. TRIAL REGISTRATION NUMBER: NCT04477668.