Vacuolating cytotoxin genotypes are strong markers of gastric cancer and duodenal ulcer-associated Helicobacter pylori strains: a matched case-control study.

The Helicobacter pylori virulence gene, cagA, and active forms of the vacuolating cytotoxin gene, vacA, are major determinants of pathogenesis. However, previous studies linking these factors to disease risk have often included patients using aspirin/nonsteroidal anti-inflammatory agents (NSAIDs) or acid-suppressing drugs, both of which may confound results. Also, particularly for gastric cancer (GC), controls have often been of quite different ages. Here, we performed a careful study in a "clean" Belgian population with gastric cancer cases age and sex matched to 4 controls and with a parallel duodenal ulcer (DU) group. As in other populations, there was a close association between the presence of cagA and the vacA s1 genotype. For GC, associations were found for vacA s1-positive (P = 0.01, odds ratio [OR], 9.37; 95% confidence interval [CI], 1.16 to 201.89), i1-positive (P = 0.003; OR, 12.08; 95% CI, 1.50 to 259.64), and cagA-positive status (P < 0.05; OR, infinity; 95% CI, 0.76 to infinity). For DU, associations were found with vacA s1 (P = 0.002; OR, 6.04; 95% CI, 1.52 to 27.87) and i1 (P = 0.004; OR, 4.35; 95% CI, 1.36 to 14.78) status but not with cagA status. Neither condition showed independent associations with the vacA m1 allele or with more biologically active forms of cagA with longer 3' variable regions. In this Belgian population, the best markers of gastric cancer- and duodenal ulcer-associated strains are the vacA s1 and i1 genotypes. This fits with experimental data showing that the s and i regions are the key determinants of vacuolating cytotoxin activity.

A study of long COVID-19 in Duhok, Kurdistan region, Iraq.

INTRODUCTION: Long COVID-19 refers to a range of symptoms and complications that persist after being infected with COVID-19 or develop some time after recovery. Our study aimed at assessing the prevalence of long COVID-19 in Duhok city, Iraq and its correlation with epidemiological and clinical variables. METHODOLOGY: This cross-sectional study was conducted between March and August 2022. A questionnaire was used for data collection from participants aged 18 and older. The questionnaire included demographic information and clinical data. RESULTS: Among the 1039 participants, (49.7%) were male with a mean age of 34.048 ± 13 years. Total infected volunteers were 492 (47.4%), out of which 20.7% did not have long COVID-19 and 26.7% had long COVID-19. The most common long COVID-19 manifestations were fatigue (57%), hair loss (39%) and loss/change in the sense of smell or taste (35%). Correlation between the variables gender, comorbidities, age, and duration of infection, and long COVID-19 were significant (p values = 0.016, 0.018, 0.001, and 0.001 respectively). CONCLUSIONS: There was a significant correlation between long COVID-19 cases and age, gender, comorbidities, and duration of infection. The data of this report can be used as a baseline for studies that may help further understand long COVID-19 sequelae.

Hepatitis B vaccination status and knowledge, attitude, and practice towards Hepatitis B virus among medical sciences students: A cross-sectional study.

BACKGROUND AND AIMS: Healthcare staff are at high risk of occupational exposure to Hepatitis B and other blood-borne diseases. Lack of education about the knowledge of Hepatitis B virus contributes to an increase in cases. This study aims to determine the knowledge of the Hepatitis B virus among the medical professionals in Duhok province, Kurdistan Region of Iraq, and to determine their knowledge of the importance of vaccination. MATERIALS AND METHODS: This cross-sectional study was conducted in Duhok province, Kurdistan Region of Iraq, among medical science students from November 2022 to February 2023 and a total of 511 students participated in the study. A Self-administered questionnaire comprising 22 items categorized into five sections was distributed to the students either electronically or by paper and pen method. The survey utilized a Five-point Likert scale when assessing respondents' opinions on knowledge, attitude, and practice (KAP). Microsoft Excel and GraphPad Prism 9 were used for statistical analysis. RESULTS: A total of 511 responses were collected from medical, dental, pharmacy, and laboratory students. The average age of the participants was 20.74 ±1.43 years. Among the respondents, only 96 (18.8%) were fully vaccinated against the Hepatitis B virus (received 3 or more doses of the vaccine), while 294 (57.5%) were not vaccinated. Lack of vaccination programs was the major reason for not receiving a vaccination (n = 182, 62%). About 286 (55.96%) of the participants had good knowledge, attitude, and practice on Hepatitis B, manifesting median scores of 26, 18, and 20, respectively. CONCLUSION: In our study, half of the students were found to be unvaccinated, mainly due to the absence of vaccination programs. Vaccinated students exhibited better knowledge, attitude, and practice toward the infection than non-vaccinated students. Therefore, we recommend the implementation of a vaccination program as well as training on infection prevention guidelines to increase awareness and encourage vaccination.

A study of anti-SARS-CoV-2 antibody positivity in Duhok City, Iraq.

INTRODUCTION: The study aimed to investigate the positivity rate of anti-SARS-CoV-2 antibodies and associated factors. METHODOLOGY: Data and blood samples were collected between January 10th and December 30th, 2021 based on COVID-19 infection by using a designated questionnaire. The blood samples were used for the detection of total SARS-CoV-2 antibodies. RESULTS: 743 participants were recruited and 62.58% of them were positive for SARS-CoV-2 antibodies. Among these, 56.34% denied any symptoms of COVID-19. A higher positivity rate was found among females than men (OR = 1.5, CI = 1.1-2.0, p = 0.0073). Participants that had been diagnosed with COVID-19 in the past had a significantly higher prevalence of antibodies, and were nearly four times more likely to develop antibodies (OR = 4.0, CI = 2.4-6.8, p < 0.0001). Interestingly, only 3% of the participants with previous COVID-19 were seronegative while 46.54% were positive for antibodies without having a history of COVID-19 infection. Participants that reported symptoms were 2.6 times more likely to develop antibodies (OR = 2.6, CI = 1.9-3.6, p < 0.0001). Lastly, we found age to be significantly associated with the production of antibodies (CI = 13.3-14.7, p < 0.0001). CONCLUSIONS: The information from this study can be used to mitigate and develop tailored vaccination efforts and plan evidence-based strategies to better mitigate the ongoing COVID-19 pandemic in Kurdistan-Iraq.

Strict social distancing measures helped early control of SARS-CoV-2 spread in Duhok city, Iraq.

The aim of this letter is to discuss the pandemic management measures, including social distancing and community containment, taken in Duhok city in Northern Iraq, where a few patients were infected with COVID-19. During the first three months of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, 15 patients were diagnosed with SARS-CoV-2 in Duhok city. All the patients were asymptomatic and were discharged to their home within 10 ± 3.2 days after throat swabs indicated a negative SARS-CoV-2 Real Time Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) test. The social distancing and lockdown measures taken by the city were implemented in three stages. In the first stage, all educational institutions including schools, colleges and universities were closed. In the second stage, all gatherings were banned. Finally, state-imposed community-wide containment was declared. The social distancing measures helped control infections in the city. Gradual reopening is recommended to avoid the spread of infection.

Phylogenetic relatedness of methicillin-resistant Staphylococcus aureus isolates from the host community and Syrian refugees in Duhok Governorate based on 16S rRNA.

Objectives: The aim of the study was to investigate the genetic relatedness between methicillin-resistant Staphylococcus aureus (MRSA) strains isolated from the host community of Duhok City and Syrian refugees based on the partial sequences of the 16S rRNA gene, and to investigate the prevalence of SCCmec and vancomycin resistance. Methods: Thirty MRSA isolates that had previously been detected and characterized were included. PCR was used for SCCmec typing, vancomycin detection, and amplification of the 16S rRNA gene for sequencing. Results: The MRSA isolates were identical and highly similar to globally published S. aureus strains, especially human nasal cavity strains. The phylogenetic tree showed that the isolates were grouped into two major groups: groups 1 and 2. Group 2 was divergent from group 1 and included isolates from the host community and Syrian refugees (new arrivals). Group 1 included isolates from the three groups, and these were genetically closely related. Most strains in both study groups were SCCmec type IVa and clustered on the same lineage of the tree. The highest rate of vancomycin resistance was found among the isolates from refugees. Conclusions: The close relationship between MRSA strains in the two study groups could be due to the geographical location of neighboring countries, which enhances the spread of MRSA strains between them.

A study of HBV infection and its risk factors in pregnant women in Zakho city, Iraq.

BACKGROUND: Despite vaccine and antiviral treatment availability, hepatitis B virus (HBV) continues to circulate among pregnant women in Iraq. HBV spread is due to many factors. This study evaluated HBV prevalence among pregnant women and Syrian refugees residing in Zakho city, Iraq, and identified risk factors associated with infection. MATERIALS AND METHODS: Demographic data were collected from 2,054 pregnant women via a questionnaire assessing risk factors associated with HBV infection. Blood samples were collected for hepatitis B surface antigen (HBsAg) and were screened using an enzyme-linked immunosorbent assay. RESULTS: Tests revealed that 1.1% of pregnant women in Zakho and 11.3% of Syrian refugees (p = 0.001) were positive for HBsAg. The average age of HBsAg-positive patients was 31.4286 ± 6.6746 years (p = 0.002). Average rates of parity and abortion in HBV-infected subjects were 3.5 ± 2.6874 and 0.1785 ± 0.5479, respectively (p = 0.044 and 0.012, respectively). The following were identified as associated risk factors for HBV infection: nationality, (Zakho versus the city centre), tattoos, and polygamy (p = 0.001, 0.03, 0.007, and 0.001, respectively). No significant associations between HBV prevalence and blood transfusion, prior injection history, dental procedures, or surgical procedures were found. CONCLUSION: The prevalence of HBV infection among Syrian refugees was higher than that of indigenous participants. Several risk factors were significantly associated with HBV positivity, which may facilitate effective preventive program implementation and decrease mother-to-child transmission risk. This will likely reduce infant and childhood HBV chronicity, and mortality rates.

A study of SARS-CoV-2 delta variant breakthrough infections and side effects of the Oxford-AstraZeneca vaccine.

Objective: This study aimed to investigate the breakthrough infection rate and safety profile of the AstraZeneca vaccine. Methods: The breakthrough COVID-19 infection rate was defined as a positive polymerase chain reaction test 14 days after the vaccine dose. Safety was assessed as local reactions and systemic events that occurred within 14 days of receiving vaccine doses. Results: The average age of the 265 participants was 43.85 years and 169 (63.77%) were male. . After the second dose, 18 (6.71%) participants contracted the infection. The SARS-CoV-2 delta variant was responsible for all infections but no participants required hospitalisation. We found significant correlations between post-vaccination IgG levels and post-vaccination infection (P = 0.001; odds ratio [OR] = 0.959; 95% Confidence interval [CI]: 0.944-0.974), and between a history of previous infection and post-vaccination infection rates (P = 0.005; OR = 0.1; 95%CI:0.009-0.6). IgG levels were significantly higher in women than in men (P = 0.006) and in patients who developed side effects after vaccination than in those without side effects (P = 0.04). A significant association was found between a history of COVID-19 infection prior to vaccination and IgG levels (P = 0.001). Conclusions: The vaccine is effective in preventing severe disease, with few side effects.

Human papillomavirus (HPV) genotype prevalence and impact of COVID-19 on the HPV prevention program in Duhok city.

Introduction and aims: Human papillomavirus (HPV) is a sexually transmitted virus that can cause cervical cancer. This study aimed to investigate the prevalence of HPV infection, the prevalent HPV genotypes in women and men with recurrent genital infections, and the impact of the coronavirus disease 2019 (COVID-19) pandemic on the HPV prevention program. Materials and methods: This cross-sectional study was conducted in Duhok city, in the Kurdistan Region of Iraq, between January 2018 and September 2020. We recruited patients from an infectious disease clinic, who were married, were older than 18 years, and agreed to participate in this study. A reverse hybridisation-based assay was used to identify the HPV genotypes prevalent in these patients. Results: Among the patients in the study, 20.9% (67/320) tested positive for HPV infection. The HPV prevalence in females was 18.8% (52/276), which was lower than that in males (34.1%,15/44) (p = 0.21). Thirty-six patients (11.3%) were infected with a single HPV genotype, seventeen (5.3%) with two HPV genotypes, eight (2.5%) with three HPV genotypes, and the remaining six (1.8%) with four or more HPV genotypes. The most common genotypes detected among the patients were HPV-6 (7.2%), -11 (3.8%), and -16 (3.4%). The prevalence of all HPV genotype infections was highest and lowest in the 18-25- and 36-45-year age groups, respectively (X 2 = 8.24; p = 0.041). The number of referred patients substantially reduced from 12 patients per month to 1 patient per month during the COVID-19 pandemic. Conclusion: HPV infection was common in the study population. The most common genotypes were HPV 6, 11, and 16, against which vaccines are available. Further population-based studies are needed to investigate the prevalence of such an infection.

Helicobacter pylori dupA is polymorphic, and its active form induces proinflammatory cytokine secretion by mononuclear cells.

BACKGROUND: Infection with Helicobacter pylori possessing a newly described virulence factor--duodenal ulcer-promoting gene A (dupA)--has been associated with duodenal ulceration and increased gastric inflammation. METHODS: The dupA locus of 34 strains was sequenced. A panel of dupA mutants was generated and cocultured with human gastric epithelial cells and peripheral blood mononuclear cells; proinflammatory cytokine release was measured. IL8 expression was measured in human gastric biopsy specimens and related to the dupA and cagA status of infecting strains. RESULTS: Most H. pylori strains had a dupA allele that was longer (1884 bp; dupA1) than previously described dupA alleles, although some had truncated versions (dupA2). Unlike the best-characterized H. pylori virulence determinant, the cag pathogenicity island (cag PaI), neither dupA type induced release of interleukin (IL)-8 from gastric epithelial cells. However, infections due to dupA-positive strains were associated with higher-level mucosal IL-8 messenger RNA expression in the human stomach than were infections due to dupA-negative strains. To explain this paradox, we found that dupA1 (but not dupA2 or the cag PaI) substantially increased H. pylori-induced IL-12p40 and IL-12p70 production from CD14(+) mononuclear cells. Other T helper 1-associated cytokines were also modestly induced. CONCLUSION: We suggest that virulent H. pylori strains cause inflammation by stimulating epithelial cells through cag-encoded proteins and mononuclear inflammatory cells through dupA1 products.

A rare case of absolute thrombocytopaenia in a COVID-19 patient: Case report.

INTRODUCTION: Thrombocytopaenia, one of the most common haematological disorders worldwide, is characterised by platelet counts <150,000/mm3. Patients with coronavirus disease (COVID-19) were found to commonly exhibit haematological abnormalities, often with mild forms of thrombocytopaenia. Absolute thrombocytopaenia tends to be rare among these patients and is believed to be secondary to immune-induced thrombocytopaenia. CASE PRESENTATION: A 53-y-old man presented with fever and generalised body ache that persisted for a few days. His polymerase chain reaction test was positive for COVID-19, for which he was treated with acetaminophen, levofloxacin, and favipiravir. On the third day of treatment, he noticed bruising and bleeding, mainly in the oral cavity, with clot formation. A complete blood picture (CBP) revealed severe thrombocytopaenia with an almost-zero count. Prednisone 1 mg/kg/d and frequent doses of intravenous platelet transfusion were administered as rescue therapy to prevent fatal bleeding. The patient was able to recover. CLINICAL DISCUSSION: Immune thrombocytopaenia should be considered in patients presenting with bleeding tendencies after severe acute respiratory syndrome coronavirus 2 infection. Serial CBP is recommended for vulnerable patients, especially during the second and third weeks of hospitalisation, for the early detection and prevention of life-threatening COVID-19 complications. CONCLUSIONS: Absolute thrombocytopaenia is a rare condition. Such a condition should be considered in patients presenting with bleeding tendencies with severe Covid-19 infection. With early diagnosis and appropriate treatment, patients' lives can be saved.

Possible COVID-19 reinfection case in Duhok City, Kurdistan: A case report.

Since the discovery of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the coronavirus disease (COVID-19) pandemic has become the most important health-care crisis globally, having spread to millions of people worldwide. Patients who recover from COVID-19 are still susceptible to reinfection. In this report, we present the case of a patient who had recovered from COVID-19. Recovery was defined as the resolution of symptoms accompanied by two consecutive SARS-CoV-2-negative real-time reverse transcriptase-polymerase chain reaction (RT-PCR) test results. Two months after the first infection, the patient tested positive for anti-SARS-CoV-2 antibodies. Three months after this test, the patient presented with mild COVID-19 symptoms that was confirmed by RT-PCR. These findings indicate a possible reinfection case. If the occurrence of reinfections is demonstrated to be true, then it may change the strategy of community-based disease prevention. More research is needed to confirm the concept of reinfection.

Home management scheme for patients with severe covid-19 in Duhok city, Kurdistan region of Iraq: a possible role for family physicians.

AIM: This study investigated the clinical characteristics and outcomes of patients with severe coronavirus disease 2019 (COVID-19) who were involved in the home management scheme in Duhok city. MATERIALS AND METHODS: This prospective descriptive study enrolled Kurdish patients diagnosed with severe COVID-19 between June 1 and November 1, 2020, and were treated at home. RESULTS: The average age of the patients was 59.77 ± 14 years and 51 (56.04%) of them were males. Seven of these patients (7.69%) were smokers. Most patients (72.52%) had one or more comorbidities. Fever (87.1%) was the most commonly presented symptom in older patients. The case fatality rate was 3/91 (3.29%). This rate was not found to be associated with sex, history of smoking, or comorbidities. The age of deceased patients (40 ± 25 years) was significantly lower than that of cured patients (60 ± 13 years) (p = -0.025). CONCLUSIONS: The case fatality rate of patients enrolled in this scheme was comparable to those who received treatment in hospitals. Therefore, this scheme could provide a good alternative for treating patients with severe COVID-19 and family physicians could lead the scheme through the primary care network.

Characterization of different virulent factors in methicillin-resistant Staphylococcus aureus isolates recovered from Iraqis and Syrian refugees in Duhok city, Iraq.

Methicillin-resistant Staphylococcus aureus (MRSA) is a serious public health problem. There is limited information regarding the genetics of MRSA strains among the native Iraqi and incoming Syrian refugee communities. We aimed to characterize the genotypes and different virulence factors of MRSA in strains isolated from these two communities. Frozen MRSA strains (125) isolated from the native Iraqi and Syrian refugee communities were used in this study. PCR (singleplex and multiplex) and agr typing was used for the genotypic analysis of different virulence genes. We tested for the presence of virulence genes including pvl, arcA, tst, lukE/lukD, hla, hlb, eta, etb and agr. Prevalence of arcA MRSA in the Iraqi community (56.58%) was significantly higher (p = 0.008) than that in the Syrian refugee community (32.66%). Prevalence of lukE-lukD was also significantly higher (p = 0.001) in the Iraqi (82.89%) compared to that in the Syrian refugee community (57.14%). Further, prevalence of hla MRSA in the Iraqi community was (93.4%) and in the Syrian refugee community was (71.4%); (p = 0.0008). No significant differences were observed in the prevalence of pvl, tst, eta, etb and hlb. The most dominant agr types in both Iraqi (76.1% and 10.5%) and Syrian refugee (44.9% and 18.37%) communities were I and III. To sum up, no significant differences were observed between the groups for a majority of virulence factors. This is the first investigation of MRSA genotypes and virulence in both these communities. These results could be useful for further studies that assess the genetic relatedness of strains in the region for epidemiological and monitoring purposes, which would be crucial to limiting the spread of MRSA.

Methicillin-resistant Staphylococcus aureus carriage rate and molecular characterization of the staphylococcal cassette chromosome mec among Syrian refugees in Iraq.

OBJECTIVES: The aim was to investigate methicillin-resistant Staphylococcus aureus (MRSA) carriage rates and to characterize the staphylococcal cassette chromosome mec (SCCmec) among Syrian refugees and the host community in Duhok, Iraq. METHODS: A total of 492 host community and 355 Syrian refugee subjects were recruited. Participant bio-information was collected using a study questionnaire. MRSA carriage was identified as recommended in the Clinical and Laboratory Standards Institute guidelines. PCR was performed for typing the mecA gene and SCCmec groups. RESULTS: In the host community, 76/492 (15.4%) carried MRSA, whereas 49/355 (13.8%) Syrian refugees carried MRSA (p = 0.505). Refugees were classified according to their arrival date; 36/278 (13%) existing refugees and 13/77 (16.9%) new refugee arrivals were identified as MRSA carriers (p = 0.375). Regarding the risk factors influencing MRSA spread, no association was found between MRSA prevalence and risk factors. The most common types of SCCmec in both communities were types IVa and V: 67.1% and 5.26%, and 49% and 2.04%, respectively. CONCLUSIONS: It is inferred that the effect of MRSA in refugees on the host community will be negligible. However, the refugee carriage rate is higher than that found in Western countries, the final destination of refugees. Therefore, screening for MRSA is mandated and the rapid detection of carriers would prevent its spread.

Assessment of knowledge, attitudes, and practices toward COVID-19 virus among university students in Kurdistan region, Iraq: Online cross-sectional study.

BACKGROUND AND AIM: The World Health Organization (WHO) declared the novel coronavirus infection COVID-19 as a pandemic on March 11, 2020. Adherence to infection control measures is potentially influenced by people's knowledge, attitudes, and practices (KAP) about the infection. This project was performed to assess the KAP toward COVID-19 of university students in Kurdistan Region, Iraq. MATERIALS AND METHODS: An online cross-sectional study was performed in April 2020 to evaluate KAP about coronavirus infection among university students in Kurdistan Region, Iraq. A total of 1959 students were recruited in this study and ages ranged from 18 to 55 years old. RESULTS: Among the respondents, 55.03% were female, 93.8% were from Duhok province, and the majority of participants (93.4%) were undergraduate students. The overall correct answer rate of the knowledge questions toward COVID-19 was 75.8% with an average score of 9.1 ± 2.1 SD out of 12. Participants showed better knowledge of infection prevention with around 86.2% correct answers, while the lowermost subscale scores were (67.7%) for questions toward the mode of the transmission of the infection. We found a significant difference in knowledge scores across genders, marital status, program of study, and among different colleges/institutes (P < 0.001). The majority of participants agreed that the local authority will control the infection successfully (69.8%) and showed confidence that the battle against the virus will be won by Kurdistan Regional Government (86.7%). The majority of the recruited sample (93.0%) had not been in any area with crowd and 57.3% used facemasks when leaving out, recently. CONCLUSION: Students demonstrated good knowledge, appropriate practice, and positive attitude about the infection. These findings indicated that local health education plans to improve people's knowledge about the infection are valuable in protecting the community. The results may be helpful in tailoring an educational program for better containment of the infection and halting the spread of the virus.

The impact of COVID-19 pandemic on the care of patients with kidney diseases in Duhok City, Kurdistan Region of Iraq.

BACKGROUND AND AIMS: The coronavirus disease-2019 (COVID-19) pandemic impacted healthcare services for kidney disease patients. Lockdown and social distancing were mandated in Kurdistan, Iraq to combat the transmission of the infection. The report analyzed the impact of the COVID-19 pandemic on kidney disease patient care in Duhok City, Kurdistan Region of Iraq. METHODS: This study took place in the Duhok Kidney Disease and Transplant Center and compared data from February-April 2019 and 2020. RESULTS: The average number of patients visiting the consultation unit per week was reduced from 68.67 ± 13.6, to 33.42 ± 29.36 (P = 0.001) during the pandemic. In the dialysis unit, weekly hemodialysis sessions were reduced from 341.5 to 306.42 sessions (P = 0.002). The number of patients visiting the kidney transplant consultation unit was significantly reduced (135.7 ± 37.7 versus 102.5 ± 26.3; P = 0.005). The number of kidney transplant operations per week was reduced from 1.167 to 0.5 (P = 0.025). CONCLUSIONS: The COVID-19 pandemic interrupted healthcare services and may continue to impart long-term negative consequences for kidney disease patients.

Impact of Covid-19 pandemic on surgical practice in Kurdistan, Iraq: An online cross-sectional survey.

INTRODUCTION: The COVID-19 pandemic is a major challenge to healthcare services in the world. It has negatively impacted surgical practice, and health workers. We aimed to assess the impact of the COVID-19 pandemic on surgical practice in the Kurdistan Region, Iraq. METHODS: An online cross-sectional study using an online survey was performed between 13 April to 29 April, 2020 in the Kurdistan Region, Iraq. An online cross-sectional study using an online survey was performed between 13 April to 29 April, 2020 in the Kurdistan Region, Iraq. A total of 241 surgeons, aged 28-70 years (mean range 22.2 ± 7.9 SD), were recruited to this study. The questionnaire was designed to evaluate the impact of the COVID-19 pandemic on surgeons' practices. Participants completed a self-developed online questionnaire. RESULTS: The majority of participants (44.39%) were general surgeons, followed by urologists (17.01%). Approximately 82.57% of surgeons performed surgeries during the COVID-19 pandemic and 60.31% undertook emergency surgeries only. There was no significant difference between men and women (P = 0.41) and different age groups (P = 0.08). Only 28.22% of surgeons had access to full personal protective equipment (PPE), and 41.18% believed that wearing PPEs severely affected their skills. Results also found that surgeons aged between 28 and 34 years were more pledged to the use of PPEs, than other age groups (P = 0.001). The use of PPEs during surgeries was significantly higher in the Sulaymaniyah province (P = 0.001). The surgical services were also severely impacted in the Sulaymaniyah province than in the other provinces (p = 0.001). CONCLUSION: The COVID-19 pandemic severely affected surgical practice in the Kurdistan Region, particularly in the Sulaymaniyah province. Males, and young surgeons showed a higher commitment level for using PPE. Additional training and precautions are needed to increase awareness about COVID-19 among surgeons, and the importance of using PPE during surgery.

A sharp increase in the number of COVID-19 cases and case fatality rates after lifting the lockdown in Kurdistan region of Iraq.

With the appearance of first cases of Coronavirus disease (COVID-19), strict control measures were implemented in the Kurdistan Region of Iraq to combat the infection. These measures included the closure of schools and universities, the closure of borders and airports, cancellation of public and religious gatherings, and mandatory quarantine for persons returning from traveling abroad. Such measures have played a major role in the control of COVID-19 spread. However, due to social and economic pressures, the government relaxed the lockdown. After relaxing the measures, a sharp increase in the number of patients was noticed. Besides, there was a significant increase in the number of symptomatic patients and the case fatality rate was doubled. In addition, the outbreak and outbreak response led to the loss of trust and a breakdown in relations between the society and local authority. To minimize the consequences for population health, local authority should have a plan that balances between health imperatives and socioeconomic imperatives. Finally, to be successful in controlling the infection, the government must rebuild public trust in the handling of COVID-19 outbreak and compensate people for lost earnings.

Impact of the Covid-19 pandemic on the elimination of hepatitis C virus in Duhok, Kurdistan, Iraq: A retrospective cross-sectional study.

BACKGROUND AND AIM: Infection with hepatitis C virus (HCV) is a public health threat worldwide. The World Health Organization aims to eliminate HCV. However, the coronavirus disease (COVID-19) pandemic has led to a severe compromise in health services, and this has halted efforts to eliminate HCV. Herein, we report our experience with the initiative of HCV elimination in Duhok city, Kurdistan Region of Iraq, with a focus on the effect of the COVID-19 pandemic on the HCV elimination plan. MATERIALS AND METHODS: An anti-HCV antibody test was used to screen subjects. All positive results were then confirmed by reverse-transcription polymerase chain reaction (RT-PCR) testing. All patients with current HCV infection were treated with direct-acting antiviral regimens. RESULTS: During the study period, 459,015 subjects were tested for anti-HCV antibody positivity, with a monthly average of 9,562 tests for HCV. This number dropped to zero during the lockdown period between 1March and 31May 2020. Among the tested samples, 0.29% (1350/459015) tested positive for anti-HCV antibodies. RT-PCR testing of all positive samples revealed that 0.020% (93/459015) were positive. Of the 93 recruited subjects, 3 patients did not complete the treatment course due to the lockdown. All patients who finished the treatment course were cured as determined by sustained virologic response 12 (SVR12) weeks after finishing the treatment course. CONCLUSION: During the COVID-19 pandemic, reductions in health facility utilisation led to a significant decrease in services offered for HCV screening and treatment. Such a decrease in services has had a negative impact on HCV elimination. An urgent plan is needed to resume the services, and strict follow-up is needed for patients whose treatment was interrupted.