Capsular specific typing of multidrug-resistant Klebsiella pneumoniae isolated from clinical cases in Ramadi city of Iraq

Aims@#The increasing incidence of Klebsiella pneumoniae infections in the community and hospitals is a considerable health problem. This is due to the rising resistance of the bacteria to antibiotics, biofilm formation and the presence of a capsule. The aim of this study was to survey the most common capsular types in local isolates for the first time in Iraq on a molecular level. @*Methodology and results@#Seventy isolates were screened for multidrug resistance (MDR) using a standard test. Genomic DNA was extracted from all isolates and PCR was performed using a multiplex PCR assay to detect the capsular type genes for K1, K2, K5, K20, K54 and K57. Forty-eight (68.5%) isolates demonstrated resistance to at least one agent of three or more antimicrobial categories and were therefore considered as MDR isolates. Multiplex PCR showed that 16/48 (33.3%) of MDR isolates belonged to the K2 capsular type and two isolates belonged to the K57 capsular type. The other four capsular types were not detected.@*Conclusion, significance and impact of study@#The K2 capsular type was the most common capsular type among MDR K. pneumoniae isolates from urinary tract infections (UTI) in Ramadi, Iraq. Monitoring capsular type is essential in addition to monitoring antibiotic resistance, as highly resistant strains with hypervirulent types can be particularly dangerous.

A Prospective Cohort Study Investigating Adverse Perinatal Outcomes in Mosul, Iraq, among Women with Grand Multiparity

@#Introduction: This prospective case-control study aimed to compare the incidence of fetomaternal complications between grand multiparous women under the age of 35 and pregnant women with low parity in the same age group. Methods: The study was conducted at Al-khansaa and Al-Batool Teaching Hospitals from October 1, 2020, to June 1, 2021. One hundred pregnant women with singleton pregnancies in all three trimesters, aged between 18 and 34 years, were selected from the outpatient clinic and the ward. The participants were divided into two groups: Group A consisted of 50 grand multiparous women (with five or more deliveries), and Group B comprised 50 pregnant women with low parity (2-4 pregnancies) in the same age group. Results: The study found that gestational diabetes, anemia, meconium-stained amniotic fluid, cesarean section rate, postpartum hemorrhage, and neonatal intensive care unit admissions were significantly higher in the grand multiparity group compared to the low parity group. The mean Apgar scores at 1 and 5 minutes were significantly lower in Group A compared to Group B. Conclusion: The findings suggest that grand multiparity among younger mothers poses additional risks to pregnancy outcomes, including increased rates of gestational diabetes, anemia, postpartum hemorrhage, cesarean section, and neonatal intensive care unit admissions, especially in cases with inadequate antenatal care. The findings of this study underscore the need for further research in this area. Understanding the underlying mechanisms and risk factors associated with grand multiparity among younger mothers can lead to more targeted interventions and improved outcomes.

Phenotypic and molecular detection of CTX-M β-lactamases in Salmonella enterica local isolates from different origins in Mosul

Aims@#Multiple drug-resistant Salmonella has become a worldwide threat in human and veterinary medicine, especially with the increasing emergence of extended-spectrum β-lactamases (ESBLs) producing strains. The present study was aimed to investigate the occurrence and prevalence of ESBLs and CTX-M enzymes as a potential antimicrobial resistance mechanism in Salmonella enterica from different origins in Mosul city, Iraq.@*Methodology and results@#Forty-six S. enterica local isolates were detected for the occurrence of multiple drug resistance (MDR) and extended-spectrum β-lactamases (ESBLs) using CLSI methodology. Phenotypically positive isolates for ESBLs detection test were molecularly investigated for the presence of blaCTX-M gene using PCR technique. The results showed that 41.3% of the isolates were phenotypically ESBLs-producers and 57.9% of them harbored blaCTX-M gene, which encodes for the enzyme CTX-M. The results indicated the occurrence of ESBLs and blaCTX-M gene in S. enterica strains from clinical, veterinary and environmental origins. @*Conclusion, significance and impact of study@#Research findings from this study shed light on the possible medical threat that ESBLs producing S. enterica could represent to human health as they could transmit through the food chain. The awareness level of antimicrobials utilization in all sectors should be elevated to reduce the global dissemination of multidrug resistance and blaCTX-M harboring Salmonella stains.

Antibiotic prescription in the management of endodontic infections amongst Iraqi final-year undergraduate dental students

Aim This study aimed to examine the prescription of antibiotics for endodontic infections among undergraduate dental students. Methods Two government Iraqi dental schools [(the University of Baghdad (UOB) (n=99) and University of Babylon (UB) (n=70)], and one private dental school [Osouldeen University College (OUC) (n=103)] were included in this survey study. A paper-based questionnaire composed of seven questions was distributed to students, and collected. A chi-square test was used for data analysis, and the level of significance was set at 0.05 (P=0.05). Results A statistically significant difference (P<0.05) was identified between students' answers in the three dental schools regarding antibiotic selection for endodontic infections in which patients had no known allergies (P=0.001). In comparison to other dental schools, a statistically significantly higher proportion of respondents from UOB (32%) favored Azithromycin 500mg for treating patients with penicillin hypersensitivity (P=0.003). A high percentage of participants (62.1%) selected antibiotic prescription in cases with necrotic pulp and symptomatic apical periodontitis (with swelling and moderate/severe preoperative symptoms). However, there were no significant differences between the 3 dental schools (P>0.05). Conclusion In conclusion, a significantly greater percentage of UB chose amoxicillin for the treatment of endodontic infection in patients with no medical allergies. Azithromycin 500mg was selected by UOB as the preferred option in patients who were sensitive to penicillin. Our findings support the need for the implementation of strategies to raise awareness of good antibiotic prescribing practices among dentists in Iraq.

Exploring Women’s Challenge to Pap Smear Attendance and Colposcopy Referral: A Qualitative Study

@#Introduction: The greatest protection against cervical cancer can be achieved through the combination of cervical screening via repeated Pap tests and HPV vaccination before first sexual intercourse. This study aimed to explore women’s perceptions and experiences of Pap test and colposcopy examination to avoid advance stage of cervical cancer. Methods: An exploratory qualitative approach was carried out using face-to face semi-structured interviews with 22 women attending for their Pap test appointment or colposcopy examination in the main hospital in Kirkuk, Iraq. The study took place between October 2019 and March 2020. The collected data were analysed using inductive content analysis. Results: The findings revealed gap in knowledge regarding Pap test and colposcopy investigation among participants. Overall, three main categories emerged during data analyses namely, women’s awareness of Pap test; challenges to access cervical screening and colposcopy services; women’s views and suggestions to improve their access to cervical screening cervices. Conclusion: Currently, women living in Iraq have no access to regular cervical screening due to unavailability of the cervical screening programme in Iraq. This study provides evidence to develop strategies to enhance the existing cervical cancer prevention services. Health policy makers should consider the establishment of regular population based cervical screening. Health promotion efforts and interventions should focus on challenges and barriers influence the screening behavior among women living in Iraq

Implications of Health Care Providers by Physicians' and Pharmacists' Attitudes and Perceptive Barriers towards Interprofessional Collaborative Practices

Abstract The study was aimed at assessing and comparing physicians' and pharmacists' attitudes and experiences with collaborative practices, along with the extent of barriers toward interprofessional collaboration in Iraqi healthcare settings. A descriptive, cross-sectional study was conducted among physicians and pharmacists in different healthcare settings in Baghdad, Iraq through an interview using a structured 3-part questionnaire, assessing the demographic characteristics, attitudes and barriers to interprofessional collaborative practices. A total of 384 participants were enrolled in this study. The physicians and pharmacists reported a significant positive attitudes towards collaboration, such as ''pharmacists are qualified to assess and respond to patients' drug treatment needs'' (69.8%, vs. 89.6%,; P=0.001);''pharmacists have special expertise in counseling patients on drug treatment'' (59.9%, vs. 86%; P=0.001); ''physicians and pharmacists should be educated to establish collaborative relationships'' (80.7%, vs. 100%; P=0.001), respectively. However, 57.3% of the physicians agreed about ''lack or inadequate of pharmacists' time to provide direct and effective patient care because of medications dispensing duties'', while 56.8% of the pharmacists disagreed about this barrier (P=0.005). Both professions reported significant, positive attitudes and shared some barriers toward collaborative practices; however, there is a disagreement in some areas in which both professions would like more collaboration for better patient care.

Oral carriage of staphylococcus aureus in people with different body mass index / Colonización oral por staphylococcus aureus en personas con diferente índice de masa corporal

Background: The association between obesity and the oral microbiome has received great attention. Objective: This study aimed to determine the association of oral Staphylococcus aureus with different body mass index people. Material and Methods: A total of 155 saliva samples were collected. The individuals were grouped into three categories according to their BMI, normal weight, overweight and obese individuals. A loopful of saliva sample was cultured and incubated at 37°C for 24. Staphylococcus aureus isolates were diagnosed by colony characteristics, morphology, and biochemical tests. Results: The oral carriage rate of Staphylococcus aureus was 61.3% (65.1% females and 56.5% males). The Staphylococcus aureus rate was 68% in married and 60% in single people. The differences of oral carriage rates of Staphylococcus aureus in obese (73.6%) and overweight (85.4%) populations was statistically significant (p<0.0001) compared to the rate in normal weight group (34%). Among males, the highest oral carriage rate of Staphylococcus aureus was in overweight individuals (82.6%). Likewise, in females, the highest rate of salivary Staphylococcus aureus was among the overweight group (88.9%). Regarding marital status, in single people, the differences of Staphylococcus aureus in obese (p=0.0003) and overweight (p<0.0001) people was significantly compared to normal weight people. But, in married people, the differences in Staphylococcus aureus rates among all groups were statistically not significant (p=0.0935). Conclusion: Staphylococcus aureus was significantly related to overweight and obese individuals. The human oral Staphylococcus aureus may play a key role in the manifestation of obesity. The oral microbiota could provide a new target for improving the physical well being of humans.

Antecedentes: la asociación entre la obesidad y el microbioma oral ha recibido gran atención. Objetivo: Este estudio tuvo como objetivo determinar la asociación de Staphylococcus aureus oral en personas con diferentes índices de masa corporal. Material y Métodos: Se recolectaron un total de 155 muestras de saliva. Los individuos fueron agrupados en tres categorías según su indice de masa corporal: normopeso, sobrepeso y obesos. Se cultivó un asa de muestra de saliva y se incubó a 37°C durante 24 horas. Los aislamientos de Staphylococcus aureus se identificaron mediante las características de la colonia, la morfología y las pruebas bioquímicas. Resultados:La tasa de colonización oral por Staphylococcus aureus fue del 61,3% (65,1% mujeres y 56,5% hombres). La tasa de colonización por Staphylococcus aureus fue del 68% en casados y del 60% en solteros. Las diferencias de las tasas de portación oral de Staphylococcus aureus en las poblaciones obesas (73,6%) y con sobrepeso (85,4%) fueron estadísticamente significativas (p<0,0001) en comparación con la tasa en el grupo de peso normal (34.0%). Entre los hombres, la tasa más alta de portadores orales de Staphylococcus aureus fue en individuos con sobrepeso (82,6%). En las mujeres, la tasa más alta de Staphylococcus aureus salival se también se presentó en el grupo con sobrepeso (88,9 %). En cuantal estado civil, en solteros, las diferencias de Staphylococcus aureus en obesos (p=0,0003) y con sobrepeso (p<0,0001) fueron significativas compararadas con normopeso. Pero, en personas casadas, las diferencias en las tasas de Staphylococcus aureus entre todos los grupos no fueron estadísticamente significativas (p=0,0935). Conclusion: Staphylococcus aureus salival se relacionó significativamente en individuos con sobrepeso y obesidad. El Staphylococcus aureus oral humano puede jugar un papel clave en la manifestación de la obesidad. La microbiota oral podría proporcionar una nueva diana para mejorar el estado físico de los humanos

Prevalence of Y chromosome microdeletion in azoospermic infertile males of Iraqi population

In human gamete development, the important period is spermatogenesis, which is organized by specific genes on Y chromosome. In some cases, the infertile men have shown microdeletions on Y chromosome, which seemed as if the structural chromosome variance is linked to the reduction of sperm count. This study aimed to determine the frequency and patterns of Y chromosome microdeletions in azoospermia factor (AZF) of Iraqi infertile males. Here, 90 azoospermic infertile males as a study group and 95 normal fertile males as control group were investigated for the microdeletion of AZF loci using numerous sequence-tagged sites. Of these 90 infertile male patients, 43 (47.8%) demonstrated Y chromosome microdeletions, in which AZFb region was the most deleted section in azoospermia patients (33.3%) followed by deletions in the AZFc region (23%), while there were no microdeletion in the AZFa region. The largest microdeletion involved in both AZFb and AZFc was detected in six azoospermic patients (6.7%). The present study demonstrated a high frequency of Y chromosome microdeletions in the infertile Iraqi patients which is not reported previously. The high frequency of deletions may be due to the association of ethnic and genetic factors. PCR-based Y chromosome screening for microdeletions has a potential to be used in infertility clinics for genetic counselling and assisted reproduction.

Seroprevalence of Toxoplasma gondii Infection in Children With Visual and/or Hearing Disability in Comparison With Healthy Children in Iraq

@#Introduction: Infection with Toxoplasma gondii is very prevalent in Iraq. The aim of this study was to determine the seroprevalence of T. gondii infection among children with visual, hearing or both disabilities (VHDC) and among healthy children (HC) living in Diyala and Baghdad provinces in Iraq. Methods: For this study, 100 VHDC children (attending the Al-Amal Centers for Blind, Dumb and Deaf Children) and 100 age-matched healthy children were recruited. Blood was obtained from all disabled and healthy children and the sera were examined for the presence of the specific antibodies (IgG and IgM) of T. gondii. Results: Among VHDC children, the seropositivity of IgG antibodies (24.0%) was significantly higher (OR= 7.6; 95% CI= 2.5-22.8; P= 0.0003) than that in HC children (4.0%). Disabled boys (OR= 5.7; P= 0.009) and disabled girls (OR= 12.7; P= 0.0183) showed significantly higher seropositivity than healthy children. The greatest risk was in disabled children who are their mothers had one or more abortion (OR= 6.89; P= 0.0005), followed by children who have brother or sister with visual and/or hearing disabilities (OR= 5.6; P= 0.0039), children whose their mothers got infection during pregnancy (OR= 2.9; P= 0.0256), and then children whose their mothers have taken treatment (OR= 2.9; P= 0.0256). The presence of stray cats in the houses was identified as a risk factor (OR= 4.05; P= 0.0186). Conclusion: In children with visual and/or hearing disabilities, the seropositivity of IgG antibodies was significantly higher than that in healthy children.

Assessing the Period between Diagnosis of Breast Cancer and Surgical Treatment among Mastectomized Female Patients in Iraq

Introduction: Breast cancer is the most common cancer and the major cause of cancer related deaths among Iraqi women. Due to the relatively late detection of breast cancer, the majority of the patients are still treated by modified radicle mastectomy. Aim: To assess the time lag between diagnosis of breast cancer and mastectomy among Iraqi patients; correlating the findings with other clinicopathological characteristics of the disease. Patients and methods: This retrospective study enrolled 226 Iraqi female patients who were diagnosed with breast cancer. Data were registered on the exact time period between signing the histopathological report and the surgical treatment. Other recorded variables included the age of the patients, their level of education, number of parity, age at first child birth, family history and the stage at breast cancer presentation. Results: In general, 51% of the patients were under the age of 50 years, 93.8% were married, 10.6% were illiterate, only 1.8% were nulliparous while positive family history of cancer was noted in 25.6%. Overall 67.7%, 87.6%, and 92% underwent mastectomy during the first month, two months and three months after diagnosis respectively. Only 3.1% were operated upon after one year. With the exception of the age at first childbirth, there was no significant correlation between the waiting times to surgery and the patients’ age, education, number of parity, family history and the stage at breast cancer detection. Conclusions: The percentage of the patients who had surgical treatment during the first month following diagnosis seems rather satisfactory when compared to the corresponding findings reported in similar surveys from developing and some developed countries. Strengthening public education and adopting multimodality evidenced-based management protocols are crucial steps to control the waiting times among those who have delayed mastectomies.

Congenital abnormalities and arthrogryposis in newly born lambs in Al Muthanna province Iraq. Suspicion of Akabane virus infection / Anormalidades congênitas e artrogripose em cordeiros recém-nascidos na província de Al Muthanna, Iraque. Suspeita de infecção pelo vírus Akabane

Akabane virus, a member of the Orthobunyavirus genus in the family Bunyaviridae, causes congenital abnormalities and arthrogryposis with hydrocephalus or hydroencephaly in ruminants. This study intends to describe the clinical signs, gross and histopathological features seen in 25 affected lambs in an outbreak of congenital arthrogryposis with hydrocephalus or hydranencephaly in Al-Muthanna governorate, Iraq after a large number of stillbirths and musculoskeletal deformities from October 2017 to May 2018. Skeletal muscle hypoplasia was seen in the limbs of the affected lambs accompanied with severe arthrogryposis and gross visible brain malformations. In addition, fetal mummifications, stillbirths, and dead lambs were also seen. The most histopathological features in muscle fibers were degenerative lesions and absences of cross-striation accompanied with mild infiltration of neutrophils and mononuclear cells in severely affected lambs. The meninges of affected lambs revealed fused membranes with focal areas of fibrous thickenings and necrotic debris. In conclusion, according to clinical signs, gross and histopathological investigations, Akabane virus, a member of the Orthobunyavirus genus in the family Bunyaviridae, causes congenital abnormalities and arthrogryposis with hydrocephalus or hydroencephaly in ruminants and could be the cause of this outbreak, although future studies must be performed to confirm the etiology of this outbreak. Moreover, other causes of hydrocephalus or cerebellar malformation, such as Schmallenberg virus, bluetongue virus and border disease virus and teratogenic plants that lead to arthrogryposis, have to be investigated. Also, the authorities should take prevention and control measurements to stop the replication of arthropod vectors.(AU)

O presente trabalho descreve os sinais clínicos, as lesões macroscópicas e os aspectos histológicos observados em 25 cordeiros acometidos em um surto de artrogripose congênita com hidrocéfalo ou hidrocefalia registrado no Iraque, governadoria Al-Muthama após a ocorrência de nascimentos prematuros e deformidades músculo-esqueléticas no período compreendido entre outubro de 2017 e maio de 2018. A hipoplasia músculo-esquelética foi observada nos membros dos cordeiros afetados, acompanhada de severa artrogripose e malformações cerebrais, grosseiras visíveis, além de mumificações fetais, nascimentos prematuros e morte de cordeiros. Os principais aspectos histopatológicos nas fibras musculares foram lesões degenerativas e ausências da estriação cruzada acompanhada de leve infiltração de neutrófilos e células mononucleares dos cordeiros severamente afetados. As meninges dos cordeiros afetados apresentaram fusão de membranas com áreas focais de espessamento fibroso e debris necróticos. O vírus Akabane, um membro do gênero Orthobunyavirus, da família Bunyaviridae, causa anormalidades congênitas e artrogripose com hidrocéfalo e hidrocefalia em ruminantes e poderá vir a ser a causa do presente surto. Os autores recomendam a realização de novos estudos com investigações epidemiológicas e isolamento do agente causal. Contudo, outras causas de hidrocéfalo ou malformações cerebrais como as determinadas pelo vírus Schmallenberg, vírus da língua azul e vírus da doença de border, bem como de plantas teratogênicas que determinam a artrogripose, também deverão ser investigadas. As autoridades sanitárias deverão tomar medidas de prevenção e controle para bloquear a replicação do vírus em artrópodes vetores.(AU)

Dirofilaria immitis infestation in imported police (K-9) dogs in Iraq: clinicopathological and molecular investigations study / Infecção por Dirofilaria immitis em cães policiais importados no Iraque: estudo clínico-patológico e de investigações moleculares

Dirofilaria immitis, the cause of heartworm infestation (HWI) or dirofilariasis, affects members of the Canidae and remains a worldwide clinical problem. In Iraq, dirofilariasis was believed absent until 2009, when the Karbala Governorate was reported as an endemic area for canine dirofilariasis. Consequently, this study intended to investigate the occurrence of Dirofilaria immitis in police dogs in one police academy in Iraq and to study the gross and histopathological changes in 5 dead dogs, as well as to identify the species of the causative parasite using PCR technique. Thirty-nine police dogs, aged between 6 months and 12 years were included in this study. For the microfilariae investigation, 5 ml blood samples were collected from all dogs in EDTA tubes and examined by Knott's method. The systemic necropsy performed in five dead dogs showed severe clinical signs of dirofilariasis and tissue specimens were sent for routine histopathological processing. For the molecular analysis, adult worms of the detected Dirofilaria spp. were used for DNA extraction and amplification of the cox1 gene. Fifteen of 39 (38.46%) dogs were diagnosed with moderate to severe microfilariasis. The dead dogs revealed typical severe clinical signs of dirofilariasis. Moreover, typical gross and histopathological changes were also seen, accompanied by generalized thromboembolic lesions, suggesting the occurrence of the caval syndrome. The PCR investigation confirmed that D. immitis was the species present in Iraq. In conclusion, this study establishes that Iraq is a newly reported endemic area for dirofilariasis. Moreover, the infestation occurring in these cases most probably happened inside Iraq. The authors recommend doing further epidemiological studies concerning the occurrence of D. immitis in local dogs as well as in the imported dogs in all Iraqi governorates to better understand the epidemiological map of this disease and to introduce an active treatment and preventive program. Awareness and education regarding this disease should be provided to the veterinarians, dog guiders and people in direct contact with dogs, as this disease is one of the important zoonotic diseases.(AU)

A Dirofilaria immitis, causadora da infestação pelo verme do coração (IVC) ou dirofilariose afeta os membros da família Canidae e ainda é um problema clínico mundial. Até o ano de 2009, acreditava-se que o Iraque fosse livre da dirofilariose, porém nessa ocasião a governadoria de Kerbala foi relatada como uma área endêmica de dirofilariose. Assim, o presente trabalho foi realizado para investigar a ocorrência da Dirofilaria immitis em cães policiais em uma academia de polícia do Iraque, estudar as alterações macroscópicas e histopatológicas em cinco cães mortos, bem como, identificar as espécies do parasita causador com o emprego da técnida de PCR. Trinta e nove cães policiais com 6 meses a 12 anos de idade foram incluídos no estudo. Amostras de sangue de cinco mililitros foram colhidas por animal, em tubos com EDTA e foram examinadas pelo método de Knott. A necropsia sistêmica foi realizada em cinco cães que haviam apresentado sinais clínicos severos de dirofilariose e espécimens dos seus tecidos foram enviados para o processamento histopatológico de rotina. Para a análise molecular dos vermes adultos de Dirofilaria spp, foi empregada a extração do DNA e a amplificação do gene cox1. Quinze de 39(38,46%) cães foram diagnosticados com uma microfilariase variável de moderada para severa. As alterações macroscópicas e histopatológicas foram acompanhadas por lesões generalizadas tromboembólicas sugestivas da ocorrência da síndrome da veia cava. A investigação de PCR confirmou que a D.immitisera a espécie presente no Iraque. A conclusão do estudo estabeleceu que o Iraque deve passar a ser considerado como uma nova área endêmica da dirofilariose. Além da infestação registrada nos casos descritos é provável que ela também esteja presente em outras regiões do Iraque. Os autores recomendam a realização de estudos epidemiológicos para investigar a ocorrência de D.immitis tanto nos cães locais bem como em cães importados em todas as governadorias do Iraque, para ser construído o mapa epidemiológico da distribuição da doença e implantadas as ações de tratamento e de um progrma preventivo. Ações de educação em saúde sobre a doença deverão ser dirigidas para os veterinários, tratadores de cães e para pessoas em geral que tenham contato com os cães, pois esta doença é uma importante zoonose.(AU)

Genetic Characterisation of Honey Bees (Apis mellifera) Populations from Kurdistan Region of Iraq via ISSR Markers

In the present study, to investigate genetic diversity and phylogenetic relationships among honey bee populations of Iraq ISSR markers were used. Sampling was carried out during summer 2017 from 5 cities of Iraq (Dahuk, Arbil, Sulaymaniyah, Kirkuk, and Kafri). Total DNA was extracted from the head and thorax sections of each worker honey bee, using salting out method with minor modifications. PCR amplification of genomic DNA was performed using 10 ISSR marker primers (A1, A2, A3, A4, A5, A6, A7, A8, A9 and A10). The primers yielded 50 polymorphic bands and number of bands were variable from 8-12 (average 9.62), and percentage of polymorphic loci was 73.6. The estimated genetic diversity for the populations ranged from 0.39 in Kafri population to 0.47 in Arbil population, and total genetic diversity among loci was calculated as 0.47 while average within population genetic diversity was 0.44. GST value was 0.085. The Phylogenetic tree showed two main clusters; the first one comprised of three populations (Dahuk, Arbil, and Sulaymaniyah), and the second one included two communities (Kirkuk and Kafri). Heterozygosity values, Shannon index and the number of alleles of honey bee populations were minimal that could be caused by low definite geographic structure of honey bee populations. This research provided new information regarding genetic diversity in selected local honeybee in Kurdistan region of Iraq and will be useful for selection, future local biodiversity conservation and controlled breeding programs.

Experiences of civilian nurses in triage during the Iran-Iraq War: An oral history / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>Nurses played a critical role in performing triage during the Iran-Iraq War. However, their experiences in triage have not been discussed. Therefore, the current study aimed to investigate the triage experiences of civilian nurses during the Iran-Iraq War.</p><p><b>METHODS</b>Oral history method and in-depth interviews were used to collect data to gain the nurses' experiences in triage.</p><p><b>RESULTS</b>Four themes were extracted from the data, which were the development of triage, challenging environment to perform triage, development of mobile triage teams, and challenges of triage chemical victims for nurses.</p><p><b>CONCLUSION</b>Triage is an important skill for nurses to manage critical situations such as disasters and wars. Nurses have to be competent in performing triage. Involvement in critical situations helps the nurses learn and gain more experience on how to manage unexpected events.</p>

Paraclinical findings in Iranian veterans exposed to sulfur mustard gas: A literature review / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>Sulfur mustard (SM) causes various systemic disturbances in human beings. This study aimed to assess paraclinical changes caused by exposure to SM gas in Iranian veterans during the war between Iraq and Iran.</p><p><b>METHODS</b>A literature review was carried out in international and national medical databases including ISI, Medline, Scopus, Iranmedex and Irandoc. Both Farsi and English literature were searched.</p><p><b>RESULTS</b>Search of the literature yielded 422 medical articles related to SM poisoning. Among them, 30 relevant articles were thoroughly reviewed. The most important reported complications were leukopenia, neutropenia, lymphopenia, eosinophilia, thrombocytopenia, increased bleeding time, positive C-reactive protein (CRP), rheumatoid factor (RF), antinuclear antibody (ANA), decreased T helper cells, natural killer cells, IL6, and IL8 levels, elevation of serum immunoglobulins, decreased levels of T3, T4 and cortisol, increased level of adrenocorticotropic hormone (ACTH), proteinuria, hematuria, and elevated liver enzymes. Also, there were some changes in chest assessments.</p><p><b>CONCLUSIONS</b>SM causes profound systemic complications in victims, even years after exposure. The paraclinical changes can be observed in hematology, immune system, biochemistry, hormonal profile and some imaging studies.</p>

Impact of maternal HBsAg carrier status on pregnancy outcomes in Duhok city, Iraq

Objective To investigate the relationship between hepatitis B virus (HBV) positivity and pregnancy outcomes. Also, the association between HBV-related risk factors and HBV status was studied. Methods A total of 100 HBV positive pregnant women were recruited and the pregnancy outcomes were compared with 301 HBV negative women. Blood samples were collected and tested for HBV by HBsAg ELISA. Data were collected for recruited subjects using interview questionnaire. Results Data analysis showed that 51/100 (51%) of the HBV-positive subjects gave a history of HBV in the family which was significantly higher than that of HBV-negative patients [41/301 (13.6%) P = 0.001]. A significant association was found between positive history of surgery and HBsAg positivity (P = 0.009). Then, pregnancy outcomes were stratified according to the HBV positivity. No significant association was found between HBV status and pregnancy outcomes (P > 0.05 for all). Conclusions Positive family history of HBV and previous surgical procedures are associated with higher rate of HBV positivity. No association is found between HBV positivity and pregnancy outcomes.

The distribution of HCV in subjects attending hospitals in Duhok City, Iraq

Objective To investigate the prevalence of hepatitis C virus (HCV) and its genotypes in Duhok City, Kurdistan Region, Iraq. Methods A cross sectional study was conducted to investigate the prevalence of HCV and its genotype. A total of 2 109 subjects, who attended the hospital for complaints other than hepatitis, were recruited in this study. Results First, anti-HCV antibody positivity was examined by ELISA. About 5.2% (111/2 109) of our samples were tested positive for anti-HCV antibodies. To confirm the positivity, RT-PCR was performed. Amongst all samples, 2.8% (60/2 109) was positive by RT-PCR. Then, we genotyped all the RT-PCR positive samples, and it was found that 50.0% (30/60) of our samples were typed as HCV genotype 4, 43.3% (26/60) as genotype 1 and 6.7% (4/60) as genotype 3. Conclusions The prevalence of HCV was higher than that was reported previously and genotype 4 was the most prevalent. Further population based study is required to investigate the prevalence of HCV.

Impact of maternal HBsAg carrier status on pregnancy outcomes in Duhok city, Iraq

Objective:To investigate the relationship between hepatitis B virus (HBV) positivity and pregnancy outcomes.Also,the association between HBV-related risk factors and HBV status was studied.Methods:A total of 100 HBV positive pregnant women were recruited and the pregnancy outcomes were compared with 301 HBV negative women.Blood samples were collected and tested for HBV by HBsAg ELISA.Data were collected for recruited subjects using interview questionnaire.Results:Data analysis showed that 51/100 (51％) of the HBV-positive subjects gave a history of HBV in the family which was significantly higher than that of HBV-negative patients [41/301 (13.6％) P =0.001].A significant association was found between positive history of surgery and HBsAg positivity (P =0.009).Then,pregnancy outcomes were stratified according to the HBV positivity.No significant association was found between HBV status and pregnancy outcomes (P ＞ 0.05 for all).Conclusions:Positive family history of HBV and previous surgical procedures are associated with higher rate of HBV positivity.No association is found between HBV positivity and pregnancy outcomes.

The distribution of HCV in subjects attending hospitals in Duhok City, Iraq

Objective: To investigate the prevalence of hepatitis C virus (HCV) and its genotypes in Duhok City, Kurdistan Region, Iraq. Methods: A cross sectional study was conducted to investigate the prevalence of HCV and its genotype. A total of 2109 subjects, who attended the hospital for complaints other than hepatitis, were recruited in this study. Results: First, anti-HCV antibody positivity was examined by ELISA. About 5.2%(111/2109) of our samples were tested positive for anti-HCV antibodies. To confirm the positivity, RT-PCR was performed. Amongst all samples, 2.8%(60/2109) was positive by RT-PCR. Then, we genotyped all the RT-PCR positive samples, and it was found that 50.0%(30/60) of our samples were typed as HCV genotype 4, 43.3%(26/60) as genotype 1 and 6.7%(4/60) as genotype 3. Conclusions: The prevalence of HCV was higher than that was reported previously and genotype 4 was the most prevalent. Further population based study is required to investigate the prevalence of HCV.

Expression of TIMP-2 in HPV-16 infected oral squamous cell carcinoma in patients in Iraq

Aim: To determine the expression of tissue inhibitors of metalloproteinases (TIMP-2) in oralsquamous cell carcinoma (OSCC) and the difference in its expression level between positiveand negative HPV-16 (human papilloma virus- 16) OSCC patients. Methods: This study wasconducted on 33 biopsies obtained from patients with OSCC and 10 normal oral mucosa ascontrols. In situ hybridization (ISH) was used to investigate the presence of HPV-16, whileimmunohistochemistry (IHC) was used to estimate the expression level of TIMP-2. Results: TheTIMP-2 was expressed in 27 (81.8%) of OSCC sections with no significant difference betweenits expression level in HPV-16 positive and HPV-16 negative OSCC cases (p=0.058). TIMP-2was found to be highly expressed in OSCC sections, and the presence of HPV was not relatedto its overexpression. Conclusions: The percentage of samples that appeared to accommodatedetectable HPV-16 was high, but no significant difference was observed in relation to TIMP-2expression level. Future studies with a larger number of patients are highly recommended toaddress the possible association between TIMp-2 and OSCC positive HPV-16.