Alarming update on incidence of Crimean-Congo hemorrhagic fever in Iraq in 2023.

Objectives: In 2021, large outbreak of Crimean-Congo hemorrhagic fever (CCHF) was reported in Iraq and cases have increased without any significant control measures. To raise awareness about the increasing cases in different regions of Iraq, hence remind the necessity to tackle contributing factors and potential outbreak interventions. Methods: The study included 511 polymerase chain reaction-confirmed CCHF infection cases out of 1827 suspected cases from 18 Provinces from January to August 2023. Approval from the Ministry of Health for data analyzed. Results: Out of 1827 suspected cases, 511 were confirmed positive by polymerase chain reaction. The total case fatality rate (CFR) was 12.7 with varying severity levels among provinces. Erbil had the highest CFR, 38.5, while Sulaimaniya and Anbar report no deaths. Independent t-test showed a significant difference in CFR between provinces west and south of Baghdad compared to north (P <0.05). Trend showed significant surges after Iftar and Adha holidays. Conclusion: Differences in CFR among provinces around the religious ceremonies, highlight the need for one public health intervention strategy. Increased temperatures affected vector behavior. Uncontrolled animal movement with neighboring countries is an important factor. Virus or host determinants can shape the clinical case outcomes, which need clinical and extensive laboratory studies to unravel the reasons leading to death.

Evaluation of interleukin-38 levels in serum of patients with coronavirus disease 2019.

Interleukin-38 (IL-38) has recently been considered as a cytokine with anti-inflammatory properties in viral respiratory infections, particularly coronavirus disease 19 (COVID-19), but the evidence has not been well elucidated. Therefore, a case-control study was conducted to determine IL-38 serum levels in 148 patients with COVID-19 (45 moderate, 55 severe, and 48 critical) and 113 controls. Results demonstrated that IL-38 levels did not show significant differences between patients and controls (68.7 [interquartile range: 62.7-75.6] vs. 67.7 [58.0-82.6] pg/ml; probability = 0.457). Similarly, patients stratified by disease severity, age group, gender, or chronic disease showed no significant differences between IL-38 levels in each stratum. Whereas, overweight/obese patients had a significantly lower median of IL-38 compared to normal-weight patients. Further, IL-38 showed significantly higher levels in the age group ≥50 years of patients with critical illness than in the age group <50 years. Female patients with severe disease also showed significantly elevated levels of IL-38 compared to male patients. In conclusion, the study indicated that serum IL-38 levels were not affected by COVID-19 infection, but the distribution of patients according to disease severity, age, gender, and body mass index may better reveal the role of IL-38 in disease pathogenesis.

Serum Glial Fibrillary Acidic Protein: A Surrogate Marker of the Activity of Multiple Sclerosis.

OBJECTIVE: Multiple sclerosis (MS) is a neurodegenerative disorder with various clinical types. Glial fibrillary acidic protein (GFAP) is significantly elevated in the cerebrospinal fluid (CSF) of MS patients compared with that of healthy controls. The aim of this study is to evaluate serum levels of GFAP in relation to disease activity in relapsing-remitting MS patients and to compare them with those of healthy controls. METHOD: This study involved 58 MS patients of relapsing-remitting MS (RRMS) type, 22 in an active stage of the disease and 36 in remission, and 50 healthy individuals as age- and sex-matched controls. Blood samples were taken from the patients at the MS Clinic of the Baghdad Teaching Hospital, and the serum levels of GFAP were determined using the enzyme-linked immunosorbent assay (ELISA) technique. RESULTS: Mean GFAP serum levels in 22 patients presenting in the active state of the disease (6.47±3.39 ng/ml) and 36 cases in remission were (5.33±2.82 ng/ml) (p=0.074) were determined as indicated. When RRMS patients (n=58) were compared with the healthy controls (n=50, 1.89±1.21), the difference in serum levels of GFAP was statistically significant (p<0.001). The area under the curve of the serum measures of GFAP obtained through the receiver operating characteristics was 0.903, which was also statistically significant (p<0.001). CONCLUSION: GFAP biomarker is an indicator of disease activity in RRMS patients, and its serum level may correlate with the state of remission or exacerbation.

SARS-CoV-2: A Piece of Bad News.

A shocking third species emerged from a family of coronaviruses (CoV) in late 2019 following viruses causing SARS (Severe Acute Respiratory Syndrome-CoV) in 2003 and MERS (Middle East Respiratory Syndrome-CoV) in 2012; it's a novel coronavirus now called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; formerly called 2019-nCoV). First emerging in China, it has spread rapidly across the globe, giving rise to significant social and economic costs and imposing severe strain on healthcare systems. Since many attempts to control viral spread has been futile, the only old practice of containment including city lockdown and social distancing are working to some extent. Unfortunately, specific antiviral drugs and vaccines remain unavailable yet. Many factors are encountered to play essential roles in viral pathogenesis. These include a broad viral-host range with high receptor binding affinity to various human tissues, viral adaptation to humans, a high percentage of asymptomatic but infected carriers, prolonged incubation, and viral shedding periods. There are also a wide variety of pulmonary and extrapul-monary tissue damage mechanisms including direct cell injury or immune-mediated damages involving the immune cells, upregulation of proinflammatory cytokines, and antibody dependent enhancement that can result in multi-organ failure. In this article, we summarise some evidence on the various steps in SARS-CoV-2 pathogenesis and immune evasion strategies to assess their contribution to our understanding of unresolved problems related to SARS-CoV-2 prevention, control, and treatment protocols.

Serum Glutamate Is a Predictor for the Diagnosis of Multiple Sclerosis.

One neurotransmitter, glutamate, has been implicated in the autoimmune demyelination seen in multiple sclerosis (MS). Glutamate is present in many tissues in the body, so consideration should be given to whether the serum level of glutamate is likely well correlated with the activity of the disease. This research aimed to compare the serum glutamate levels from patients diagnosed with MS with those from an age-matched control population. A review of this data could shed light upon whether the serum testing of glutamate using Enzyme-Linked Immunosorbent Assay (ELISA) is a reliable indicator of MS activity. Serum samples were obtained from 55 patients with different patterns of MS and from 25 healthy adults as a control group. The ELISA technique was used to determine the glutamate levels in the serum samples. The mean serum glutamate level for patients with MS was 1.318 ± 0.543 nmol/ml and that of the controls was 0.873 ± 0.341 nmol/ml. The serum glutamate levels showed an area under the curve via the receiver operating characteristics (ROC) of 0.738, which was significant (p value = 0.001). The present study is the first to establish a strong connection between the serum glutamate levels and MS patients, where there was statistically significant elevation of serum glutamate in MS patients; hence this elevation might be used as a monitor to help in the diagnosis of MS patients.

An investigation into IgE-facilitated allergen recognition and presentation by human dendritic cells.

BACKGROUND: Allergen recognition by dendritic cells (DCs) is a key event in the allergic cascade leading to production of IgE antibodies. C-type lectins, such as the mannose receptor and DC-SIGN, were recently shown to play an important role in the uptake of the house dust mite glycoallergen Der p 1 by DCs. In addition to mannose receptor (MR) and DC-SIGN the high and low affinity IgE receptors, namely FcεRI and FcεRII (CD23), respectively, have been shown to be involved in allergen uptake and presentation by DCs. OBJECTIVES: This study aims at understanding the extent to which IgE- and IgG-facilitated Der p 1 uptake by DCs influence T cell polarisation and in particular potential bias in favour of Th2. We have addressed this issue by using two chimaeric monoclonal antibodies produced in our laboratory and directed against a previously defined epitope on Der p 1, namely human IgE 2C7 and IgG1 2C7. RESULTS: Flow cytometry was used to establish the expression patterns of IgE (FcεRI and FcεRII) and IgG (FcγRI) receptors in relation to MR on DCs. The impact of FcεRI, FcεRII, FcγRI and mannose receptor mediated allergen uptake on Th1/Th2 cell differentiation was investigated using DC/T cell co-culture experiments. Myeloid DCs showed high levels of FcεRI and FcγRI expression, but low levels of CD23 and MR, and this has therefore enabled us to assess the role of IgE and IgG-facilitated allergen presentation in T cell polarisation with minimal interference by CD23 and MR. Our data demonstrate that DCs that have taken up Der p 1 via surface IgE support a Th2 response. However, no such effect was demonstrable via surface IgG. CONCLUSIONS: IgE bound to its high affinity receptor plays an important role in Der p 1 uptake and processing by peripheral blood DCs and in Th2 polarisation of T cells.

The glycosylation pattern of common allergens: the recognition and uptake of Der p 1 by epithelial and dendritic cells is carbohydrate dependent.

Allergens are initiators of both innate and adaptive immune responses. They are recognised at the site of entry by epithelial and dendritic cells (DCs), both of which activate innate inflammatory circuits that can collectively induce Th2 immune responses. In an attempt to have a better understanding of the role of carbohydrates in the recognition and uptake of allergens by the innate immune system, we defined common glycosylation patterns in major allergens. This was done using labelled lectins and showed that allergens like Der p 1 (Dermatophagoides pteronyssinus group 1), Fel d 1 (Felis domisticus), Ara h 1 (Arachis hypogaea), Der p 2 (Dermatophagoides pteronyssinus group 2), Bla g 2 (Blattella germanica) and Can f 1 (Canis familiaris) are glycosylated and that the main dominant sugars on these allergens are 1-2, 1-3 and 1-6 mannose. These observations are in line with recent reports implicating the mannose receptor (MR) in allergen recognition and uptake by DCs and suggesting a major link between glycosylation and allergen recognition. We then looked at TSLP (Thymic Stromal Lymphopoietin) cytokine secretion by lung epithelia upon encountering natural Der p 1 allergen. TSLP is suggested to drive DC maturation in support of allergic hypersensitivity reactions. Our data showed an increase in TSLP secretion by lung epithelia upon stimulation with natural Der p 1 which was carbohydrate dependent. The deglycosylated preparation of Der p 1 exhibited minimal uptake by DCs compared to the natural and hyperglycosylated recombinant counterparts, with the latter being taken up more readily than the other preparations. Collectively, our data indicate that carbohydrate moieties on allergens play a vital role in their recognition by innate immune cells, implicating them in downstream deleterious Th2 cell activation and IgE production.

Housewife onycholysis.

OBJECTIVE: The aim of this study was to evaluate the clinical and microbiological aspects of onycholysis in Iraqi housewives. METHODS: One hundred housewives with onycholysis of the finger nails were evaluated clinically in the Department of Dermatology and Venereology, Baghdad Teaching Hospital, Baghdad, Iraq between October 2002 to March 2003. Swabs were taken from those patients for microbiological evaluation in the Department of Microbiology, College of Medicine, University of Baghdad, Baghdad, Iraq. All cases with skin disorder related systemic diseases like anemia, hypothyroidism and drug intake like minocycline, oral contraceptives were excluded from the study. RESULTS: One hundred housewives with onycholysis were enrolled in the study. Their ages ranged between 17-70 years with a mean of 41.96 +/- 12.57 years. Married females were 89 (89%), while unmarried females were 11 (11%). The site of involvement was mainly the thumb (76%) followed by the ring finger (12%), the index (7%), little (6%) and middle (5%) fingers. The pattern of onycholysis was distal in 47 (47%), lateral in 30 (30%) and both distal and lateral in 23 (23%) of the patients. CONCLUSION: Onycholysis is a major problem among Iraqi housewives, most probably caused by repetitive mechanical, chemical and physical trauma; therefore, special preventive measures should be undertaken to minimize the incidence of the disease. Housewives should be encouraged to use preventive measures like using gloves and washing machines.