Nonpharmaceutical interventions reduce the incidence and mortality of COVID-19: A study based on the survey from the International COVID-19 Research Network (ICRN).

The recently emerged novel coronavirus, "severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)," caused a highly contagious disease called coronavirus disease 2019 (COVID-19). It has severely damaged the world's most developed countries and has turned into a major threat for low- and middle-income countries. Since its emergence in late 2019, medical interventions have been substantial, and most countries relied on public health measures collectively known as nonpharmaceutical interventions (NPIs). We aimed to centralize the accumulative knowledge of NPIs against COVID-19 for each country under one worldwide consortium. International COVID-19 Research Network collaborators developed a cross-sectional online survey to assess the implications of NPIs and sanitary supply on the incidence and mortality of COVID-19. The survey was conducted between January 1 and February 1, 2021, and participants from 92 countries/territories completed it. The association between NPIs, sanitation supplies, and incidence and mortality were examined by multivariate regression, with the log-transformed value of population as an offset value. The majority of countries/territories applied several preventive strategies, including social distancing (100.0%), quarantine (100.0%), isolation (98.9%), and school closure (97.8%). Individual-level preventive measures such as personal hygiene (100.0%) and wearing facial masks (94.6% at hospitals; 93.5% at mass transportation; 91.3% in mass gathering facilities) were also frequently applied. Quarantine at a designated place was negatively associated with incidence and mortality compared to home quarantine. Isolation at a designated place was also associated with reduced mortality compared to home isolation. Recommendations to use sanitizer for personal hygiene reduced incidence compared to the recommendation to use soap. Deprivation of masks was associated with increased incidence. Higher incidence and mortality were found in countries/territories with higher economic levels. Mask deprivation was pervasive regardless of economic level. NPIs against COVID-19 such as using sanitizer, quarantine, and isolation can decrease the incidence and mortality of COVID-19.

Childhood asthma as a risk factor for adult chronic obstructive pulmonary disease: a systematic review and meta-analysis.

BACKGROUND: Due to the disagreement in studies, the present study performed a systematic review and meta-analysis to investigate the relationship between childhood asthma and the development of chronic obstructive pulmonary disease (COPD) in adulthood. METHODS: Literature search was performed in Medline and Embase databases until the end of 2019. Data were recorded as adjusted odds ratio (OR) and 95% confidence interval (95%CI). Analyses were performed on STATA 14.0 and an overall OR was reported. Subgroup analysis was performed to determine the source of heterogeneity. RESULTS: Data from 11 articles were included in the meta-analysis. Overall, the odds of developing adulthood COPD in children with asthma were 3.0 times higher than that in non-asthmatic children (OR = 3.00; 95%CI: 2.25-4.00; p < 0.001). The relationship between childhood asthma and COPD in adulthood was reported somewhat greater in random sampling method studies than consecutive sampling method studies (OR = 2.89; 95% CI: 1.72-4.86; p = 0.001). CONCLUSION: Asthma in childhood could be considered as an independent risk factor for COPD in adulthood. Since type of study, sampling method, sample size of study and COPD prevalence are the main sources of heterogeneity, further prospective high-quality studies assessing the relationship of childhood asthma and adulthood COPD are recommended to be performed.

Chondroitinase ABC Administration in Locomotion Recovery After Spinal Cord Injury: A Systematic Review and Meta-analysis.

Introduction: The present systematic review and meta-analysis aims to conduct a comprehensive and complete search of electronic resources to investigate the role of administrating Chondroitinase ABC (ChABC) in improving complications following Spinal Cord Injuries (SCI). Methods: MEDLINE, Embase, Scopus, and Web of Sciences databases were searched until the end of 2019. Two independent reviewers assessed the studies conducted on rats and mice and summarized the data. Using the STATA 14.0 software, the findings were reported as pooled standardized mean differences (SMD) with 95% confidence intervals (CI). Results: A total of 34 preclinical studies were included. ChABC administration improves locomotion recovery after SCI (SMD=0.90; 95% CI: 0.61 to 1.20; P<0.001). The subgroup analysis showed that the differences in the SCI model (P=0.732), the severity of the injury (P=0.821), the number of ChABC administrations (P=0.092), the blinding status (P=0.294), the use of different locomotor score (P=0.567), and the follow-up duration (P=0.750) have no effect on the efficacy of ChABC treatment. Conclusion: The findings of the present study showed that prescribing ChABC has a moderate effect in improving locomotion after SCI in mice and rats. However, this moderate effect introduces ChABC as adjuvant therapy and not as primary therapy.

Mesenchymal Stromal Cells Derived Conditioned Medium in Pulmonary Fibrosis: A Systematic Review and Meta-analysis.

BACKGROUND: A definitive conclusion on the efficacy of mesenchymal stromal cells-derived conditioned medium (MSCs-CM) in pulmonary fibrosis has not yet been reached. Therefore, the present meta-analysis intends to investigate the efficacy of MSCs-CM administration on improvement of pulmonary fibrosis. METHODS: An extensive search was performed on the Medline, Embase, Scopus and Web of Science databases by the end of August 2019. Outcomes in the present study included pulmonary fibrosis score, lung collagen deposition, lung collagen expression, transforming growth factor ß1 (TGF-ß1) expression and interleukin-6 expression. Finally, the data were pooled and an overall standardized mean difference (SMD) with a 95% confidence interval (CI) was reported. RESULTS: Data from seven studies were included. Analyses showed that administration of MSCs-CM significantly improved pulmonary fibrosis (SMD = -2.36; 95% CI: -3.21, -1.51). MSCs-CM administration also attenuated lung collagen deposition (SMD = -1.70; 95% CI: -2.18, -1.23) and decreased expression of type I collagen (SMD = -6.27; 95% CI: -11.00, -1.55), type III collagen (SMD = -5.16; 95% CI: -9.86, -0.47), TGF- ß1 (SMD = -3.36; 95% CI: - 5.62, -1.09) and interleukin-6 (SMD = -1.69; 95% CI: - 3.14, -0.24). CONCLUSION: The present meta-analysis showed that administration of MSCs-CM improves pulmonary fibrosis. It seems that the effect of MSCs-CM was mediated by reducing collagen deposition as well as inhibiting the production of inflammatory chemokines such as TGF-ß1 and interleukin 6 (IL-6). Since there is no evidence on the efficacy of MSCs-CM in large animals, further studies are needed to translate the finding to clinical studies.

Molecular Characterization and Disease-Related Morbidities of ß-Thalassemia Patients from the Northeastern Part of Iraq.

BACKGROUND: ß-thalassemia is a significant problem in the northeastern part of Iraq, and has imposed a huge burden on the health authorities. OBJECTIVE: To identify the molecular characterization and morbidity prevalence in transfusion-dependent thalassemia (TDT) and non-transfusion dependent thalassemia (NTDT) phenotypes in northeastern Iraq. PATIENTS AND METHODS: This is a cross-sectional study conducted on 242 ß-thalassemia patients from 162 families. Reverse hybridization technique and direct gene sequencing were used to characterize ß-thalassemia mutations, and medical records of the patients were reviewed with a well-designed questionnaire. RESULTS: A total of 22 ß-globin mutations arranged in 53 different genotypes were identified: IVS-II-1 (G> A) (35.7%), followed by IVS-I-6 (T> C) (18.0%), and codon 8/9 (+G) (8.5%) were the most frequent. Among disease-related morbidities, bone disease amounted to (66.9%), followed by endocrinopathies (32.2%), hepatobiliary complications (28.9%), and pulmonary hypertension (9.9%), whereas thrombosis, extramedullary hemopoiesis, and leg ulcers were less frequent. CONCLUSION: The overall complications rate was 78.9%, with a growing probability of complications with advanced age, with evidently higher rates in patients with ß0ß0 and ß0ß+ genotypes that explain the role of underlying genetic defects in the pathophysiology of disease complications.

Central Nervous System Complications in COVID-19 Patients; a Systematic Review and Meta-Analysis based on Current Evidence.

INTRODUCTION: Several studies have confirmed neurological involvements, such as acute cerebrovascular disease and impaired consciousness in COVID-19. In the present study, our aim is to investigate the current evidence regarding central nervous system (CNS) complications in patients with confirmed COVID-19. METHODS: An extensive search was conducted in electronic databases including Medline (using PubMed), Embase, Scopus, and Web of Science, in addition to the manual search in Google and Google scholar search engines, for articles published from 2019 until April 21st, 2020. Inclusion criteria was articles that were reviewed and reported the incidence of neurological outcomes in patients with confirmed COVID-19 disease. RESULTS: The initial search yielded 638 records, from which 7 articles were included. Overall, the incidence of CNS complications was calculated to be 6.27% (95% CI: 3.32 to 9.98). The incidence of the most common CNS complications, encephalopathy and acute cerebrovascular disease, were 9.14% (95%CI: 2.20 to 19.81) and 2.59% (95% CI: 1.31 to 4.25), respectively. CONCLUSION: CNS complications do exist in COVID-19 patients, encephalopathy being the most concerning one. The heterogeneity in the existing literature causes an uncertainty in reporting the definite prevalence rate for each complication. Thus, further studies are needed for scientists to reach a more accurate estimate of the prevalence of these complications in COVID-19 patients. However, healthcare providers should consider the possibility of CNS involvements in patients with SARS-CoV-2 infection.

Value of chest computed tomography scan in diagnosis of COVID-19; a systematic review and meta-analysis.

PURPOSE: Real-time polymerase chain reaction (RT-PCR) and chest computed tomography (CT) scan are main diagnostic modalities of coronavirus disease 2019 (COVID-19). However, there is still no consensus on which of these methods is superior to the other. Therefore, the present meta-analysis was designed to answer to the question whether CT scan can be used in diagnosis of COVID-19 or not. METHODS: Searches were performed in Medline, Embase, Scopus, and Web of Science databases until the end of April 2020. Two researchers gathered the data of diagnostic accuracy studies that had attempted to evaluate sensitivity and specificity of CT scan in diagnosis of COVID-19. RESULTS: Data of 9 studies were included. Area under the curve of ground glass opacity (GGO), consolidation, pleural effusion, other CT features, and simultaneous observation of GGO with other CT features was 0.64 (95% CI 0.60-0.69), 0.30 (95% CI 0.26-0.34), 0.60 (95% CI 0.56-0.64), 0.61 (95% CI 0.56-0.65), and 0.90 (95% CI 0.87-0.92), respectively. Sensitivity and specificity of simultaneous observation of GGO with other CT scan features was higher than all of the other signs. Sensitivity, specificity, and diagnostic odds ratio of this sign was calculated to be 0.90, 0.89, and 20, respectively. CONCLUSION: Simultaneous observation of GGO and other features of viral pneumonia in CT scan had optimum performance in detection of COVID-19. However, it is suggested to make the final diagnosis based on both CT scan and RT-PCR, as none of the two diagnostic modalities are reliable alone.

Corticosteroids on the Management of Coronavirus Disease 2019 (COVID-19): A Systemic Review and Meta-Analysis.

BACKGROUND: We aimed to examine the available evidence regarding the efficacy and safety of corticosteroids on the management of coronavirus disease 2019 (COVID-19), severe acute respiratory syndrome (SARS-CoV) and Middle East respiratory syndrome (MERS-CoV). METHOD: An extensive search was conducted in Medline, Embase, and Central databases until the end of March 2020, using keywords related to corticosteroids, COVID-19, SARS-CoV and MERS-CoV. The main outcome was considered to be the mortality rate, length of stay, virus clearance time, symptom improvement, and lung function improvement. The findings are presented as odds ratio (OR) with 95% confidence interval (95% CI). RESULTS: Fifteen paper compromising 5 studies on COVID-19, 8 studies on SARS-CoV and 2 studies on MERS-CoV were included. One study was clinical trial and the rest were cohort. The analyses showed that corticosteroids were not reduce the mortality rate of COVID-19 (OR=1.08; 95% CI: 0.34 to 3.50) and SARS-CoV (OR=0.77; 95% CI: 0.34 to 1.3) patients, while they were associated with higher mortality rate of patients with MERS-CoV (OR = 2.52; 95% CI: 1.41 to 4.50). Moreover, it appears that corticosteroids administration would not be effective in shortening viral clearance time, length of hospitalization, and duration of relief symptoms following viral severe acute respiratory infections. CONCLUSION: There is no evidences that corticosteroids are safe and effective on the treatment of severe acute respiratory infection when COVID-19 disease is suspected. Therefore, corticosteroids prescription in COVID-19 patients should be avoided.

A severe refractory COVID-19 patient responding to convalescent plasma; A case series.

INTRODUCTION: Although some medicines are under research, currently, no specific antiviral drug has been approved to target 2019 novel coronavirus. In this report two severe cases of 2019 novel coronavirus disease (COVID-19) patients have been described who received convalescent plasma (CP). CASE REPORT: Two male cases (a 46-year-old and a 56-year-old) after being diagnosed with severe COVID-19, they deteriorated despite supportive care and antiviral therapy. They started to improve with CP infusion both clinically and radiologically. Finally they were discharged in a very well condition with negative virology tests. CONCLUSION: CP might be an effective therapy for severe COVID-19 patients.

Corrigendum to "Beta-Thalassemia Intermedia: A Single Thalassemia Center Experience from Northeastern Iraq".

[This corrects the article DOI: 10.1155/2020/2807120.].

Discriminatory Precision of Neutrophil Gelatinase-Associated Lipocalin in Detection of Urinary Tract Infection in Children: a Systematic Review and Meta-Analysis.

INTRODUCTION: There is a significant discrepancy between studies on diagnostic precision of neutrophil gelatinase-associated lipocalin (NGAL) in diagnosis of urinary tract infection (UTI). Therefore, the present systematic review and meta-analysis was designed to assess the diagnostic value of NGAL in diagnosis of UTI in children and adolescents. METHODS: An extensive search was performed on Medline, Embase, Scopus and Web of Science databases by the end of 2019. Two independent researchers screened and summarized the data. Discriminatory precision of urinary and serum NGAL was assessed by reporting area under the curve, sensitivity, specificity and diagnostic odds ratio with 95% confidence interval (95% CI). RESULTS: Data from 12 studies were included. The area under the curve of urinary and serum NGAL for diagnosis of UTI in children and adolescents at the best cut-off point (between 30-39.9 ng/ml) was 0.95 (95% CI: 0.93 to 0.97) and 0.83 (95% CI: 0.80 to 0.86), respectively. Sensitivity, specificity and diagnostic odds ratio on urinary NGAL at these cut-off points were 0.89 (95% CI: 0.64 to 0.97), 0.89 (95% CI: 0.71 to 0.97) and 67 (95% CI: 5 to 891), respectively. Sensitivity, specificity and diagnostic odds ratio of serum NGAL in UTI detection were 0.85 (95% CI: 0.70 to 0.90), 0.81 (95% CI: 0.69 to 0.88) and 9.53 (95% CI: 1.52 to 59.65), respectively. CONCLUSION: The present meta-analysis showed that urinary NGAL had a high diagnostic value in detection of UTI in children and adolescents with an optimum cut-off point in the range of 30-39.9 ng/ml.

Evidence for eosinophil and IL-17 mediated inflammation in allergic rhinitis.

BACKGROUND: The aim was to determine the level of inflammatory cytokines, eosinophil cationic protein and IgE in allergic rhinitis (AR) patients. SUBJECTS AND METHODS: Blood samples were taken from 88 AR patients and 88 healthy controls (HC). Each sample was analysed for eosinophil counts by flow cytometry, IgE by ECLIA, ECP, IL-17, and IL-33 by using ELISA test. RESULTS: There was no significant difference between AR patients and the control group in age and gender. Levels of eosinophils, IgE, ECP, IL-17, IL-33 and the total symptom scores were significantly higher in AR patients than the HC (P = 0.0001). Serum ECP correlated with IL-17 (P = 0.041, r = 0.42), IL-33 (P = 0.0001, r = 080), and IgE levels (P = 0.017, r = 0.45) in the R patients. There was no correlation between IL-17 and IL-33. There was a correlation between symptom scores and eosinophils (P = 0.026, r = 0.52), and IgE (P = 0.001, r = 0.60) in the patients. No correlation was observed between symptom scores and ECP, IL-17, and IL-33 in the AR patient. CONCLUSIONS: Patients with AR have significant higher serum levels of ECP, IL-17, and IL-33 than healthy controls. This indicates that these markers could be used to in order to diagnose AR and to monitor disease. Inhibitory molecules to IL-17 and IL-33 may be considered as novel treatment strategies.

Accuracy of Urine Kidney Injury Molecule-1 in Predicting Acute Kidney Injury in Children; a Systematic Review and Meta-Analysis.

INTRODUCTION: There is considerable controversy on the accuracy of Kidney Injury Molecule-1 (KIM-1) in prediction of acute kidney injury (AKI) in children. Therefore, the present study intends to provide a systematic review and meta-analysis of the value of this biomarker in predicting AKI in children. METHODS: An extensive search was performed on the Medline, Embase, Scopus and Web of Science databases by the end of 2019. Cohort and case-control studies on children were included. Urinary KIM-1 levels were compared between AKI and non-AKI groups. Findings were reported as an overall standardized mean difference (SMD) with a 95% confidence interval (CI). Also, the overall area under the receiver operating characteristic (ROC) curve (AUC) of KIM-1 in predicting AKI in children was calculated. RESULTS: Data from 13 articles were included. Urinary KIM-1 levels in children with stage 1 AKI were higher than the non-AKI group only when assessed within the first 12 hours after admission (SMD = 0.95; 95% CI: 0.07 to 1.84; p = 0.034). However, urinary KIM-1 levels in children with stage 2-3 AKI were significantly higher than non-AKI children (p <0.01) at all times. The AUC of urinary KIM-1 in predicting AKI in children was 0.69 (95% CI: 0.62 to 0.77). CONCLUSION: Based on the available evidence, KIM-1 seems to have moderate value in predicting AKI in children. Since previous meta-analyses have provided other urinary and serum biomarkers that have better discriminatory accuracy than KIM-1, so it had better not to use KIM-1 in predicting AKI in children.

Antiviral therapy in management of COVID-19: a systematic review on current evidence.

BACKGROUND: The purpose of the current systematic review is to evaluate the efficacy of antiviral therapies in treatment of COVID-19. In addition, clinical trials on the efficacy of antiviral therapies in the management of Severe Acute Respiratory Syndrome coronavirus (SARS-Cov) or Middle East Respiratory Syndrome coronavirus (MERS-CoV) have also been reviewed, in order to identify potential treatment options for COVID-19. METHOD: An extensive search was performed in Medline, Embase, Scopus, Web of Science and CENTRAL databases until the end of March 15, 2020. Two independent researchers performed the screening, and finally the related studies were included. RESULTS: Only one clinical trial on the efficacy of antiviral therapy in management of COVID-19 was found. The results depicted that adding Lopinavir-Ritonavir to the standard treatment regimen of patients with severe COVID-19 has no benefits. Moreover, 21 case-series and case-report studies reported the prescription of antiviral agents in COVID-19, none of which can be used to determine the efficacy of antiviral therapies in confronting COVID-19. In addition, no clinical trials were found to be performed on the efficacy of antiviral agents in the management of SARS-CoV and MERS-CoV. CONCLUSION: The current evidence impede researchers from proposing an appropriate antiviral therapy against COVID-19, making the current situation a serious concern for international organizations such as World Health Organization (WHO). In the time of the current pandemic and future epidemics, organizations such as WHO should pursue more proactive actions and plan well-designed clinical trials so that their results can be used in managing future epidemics.

Discriminatory Precision of Renal Angina Index in Predicting Acute Kidney Injury in Children; a Systematic Review and Meta-Analysis.

INTRODUCTION: There is still controversy over the value of renal angina index (RAI) in predicting acute renal failure (AKI) in children. Therefore, the present study aims to provide evidence by conducting a systematic review and meta-analysis on the value of RAI in this regard. METHODS: An extensive search of Medline, Embase, Scopus and Web of Science databases was conducted by the end of January 2020 using words related to RAI and AKI. Two independent reviewers screened and summarized the related studies. Data were analysed using STATA 14.0 statistical program and discriminatory precision of RAI was assessed. RESULTS: Data from 11 studies were included. These studies included data from 3701 children (60.41% boys). There were 752 children with AKI and 2949 non-AKI children. Pooled analysis showed that the area under the ROC curve of RAI in prediction of AKI was 0.88 [95% confidence interval (CI): 0.85 to 0.91]. Sensitivity and specificity of this tool in predicting AKI were 0.85% (95% CI: 0.74% to 0.92%) and 0.79% (95% CI: 0.69% to 0.89%), respectively. The diagnostic odds ratio of RAI was 20.40 (95% CI: 9.62 to 43.25). CONCLUSION: The findings of the present meta-analysis showed that RAI is a reliable tool in predicting AKI in children.

Beta-Thalassemia Intermedia: A Single Thalassemia Center Experience from Northeastern Iraq.

OBJECTIVE: To determine the molecular characterization and disease-associated complications of beta-thalassemia intermedia (ß-TI) patients in Sulaymaniyah province, northeastern Iraq. METHODS: A total of 159 ß-TI) patients in Sulaymaniyah province, northeastern Iraq. ß-TI) patients in Sulaymaniyah province, northeastern Iraq. RESULTS: Nineteen different ß-globin gene mutations arranged in 37 various genotypes were determined. The most frequent were IVS-II-I (G>A) (47.2%), followed by IVS-I-6 (T>C) (23.3%) and IVS-I-110 (G>A) (5%). Among disease-related morbidities documented, bone disease amounted to 53% (facial deformity and osteoporosis), followed by endocrinopathies 17.6% (growth retardation and subclinical hypothyroidism), cholelithiasis 13.8%, pulmonary hypertension 11.3%, and abnormal liver function test 7.5%, whereas venous thrombosis, extramedullary hemopoiesis, and leg ulcer were less frequently observed. Age ≥ 35 and female sex were risk factors for cholelithiasis, while age was an independent risk for hypothyroidism and female sex was associated with increased risk for osteoporosis. Mean serum ferritin of ≥1000 µg/L was associated with an increased risk of osteoporosis, whereas chelation therapy was protective for a multitude of other complications. Transfusion, on the other hand, increased the risk of osteoporosis, yet it was protective for cholelithiasis and hypothyroidism. Moreover, splenectomy was protective for cholelithiasis, although it was an independent risk for hypothyroidism. Finally, hydroxyurea was associated with an increased risk of osteoporosis, while it was protective for cholelithiasis. Discussion and Conclusion. ß +-thalassemia mutation had contributed to 41.25 of families with a less severe ß-thalassemia phenotype in the northeastern part of Iraq, justifying the need to investigate the contribution of genetic modifiers in ameliorating disease severity. In addition, the substantial number of ß-TI patients developed disease-related morbidities, which necessitates the need for more appropriate clinical management with earlier intervention.ß-TI) patients in Sulaymaniyah province, northeastern Iraq. µg/L was associated with an increased risk of osteoporosis, whereas chelation therapy was protective for a multitude of other complications. Transfusion, on the other hand, increased the risk of osteoporosis, yet it was protective for cholelithiasis and hypothyroidism. Moreover, splenectomy was protective for cholelithiasis, although it was an independent risk for hypothyroidism. Finally, hydroxyurea was associated with an increased risk of osteoporosis, while it was protective for cholelithiasis. Discussion and Conclusion. ß +-thalassemia mutation had contributed to 41.25 of families with a less severe ß-thalassemia phenotype in the northeastern part of Iraq, justifying the need to investigate the contribution of genetic modifiers in ameliorating disease severity. In addition, the substantial number of ß-TI patients developed disease-related morbidities, which necessitates the need for more appropriate clinical management with earlier intervention.Discussion and Conclusion. ß +-thalassemia mutation had contributed to 41.25 of families with a less severe ß-thalassemia phenotype in the northeastern part of Iraq, justifying the need to investigate the contribution of genetic modifiers in ameliorating disease severity. In addition, the substantial number of ß-TI patients developed disease-related morbidities, which necessitates the need for more appropriate clinical management with earlier intervention.ß-TI) patients in Sulaymaniyah province, northeastern Iraq. ß-TI) patients in Sulaymaniyah province, northeastern Iraq.

Levels of cytokines and GADA in type I and II diabetic patients.

BACKGROUND: Diabetes Mellitus is described as a group of metabolic diseases in which the patient has higher blood glucose levels due to many causes. These include a defect in insulin secretion and failure of the body's cells to respond to the hormone. Cytokines and autoantibodies have a critical role in the pathogenesis of diabetes, especially type I. AIM OF THE STUDY: The aim of this study was to measure the serum levels of interleukin-1 beta (IL-1 ß), interleukin-3 (IL-3), interferon-gamma (INF- γ), and glutamic acid decarboxylase autoantibody (GADA) in patients with type I and type II diabetes mellitus. MATERIAL AND METHODS: In this cross-sectional study, serum samples were taken from 250 individuals, including 100 samples from patients with type II diabetes mellitus, 100 samples from healthy controls, and 50 samples from patients with type I diabetes mellitus. Five milliliters of venous blood were taken from each individual and the samples were analyzed for cytokines (IL-1 ß, IL-3, and INF- γ) and GABA using ELISA. RESULTS: In the study, we found that the serum levels of IL-1 ß were significantly higher in the healthy control group compared to the patients with type I and type II diabetes mellitus. The levels of IL-3 and INF- γ were significantly higher in type II diabetes mellitus, while GABA serum levels were higher in type I diabetes mellitus. CONCLUSION: Our data showed that GADA is an important autoantibody, not only in type I but also in type II diabetes mellitus and can probably be used in the future for diagnosis of this disease. There was also a close association of GADA with systemic immunoregulation in type I and II diabetes mellitus. The relation of cytokines (IL-1 ß, IL-3, and INF- γ) and GADA in patients with diabetes will also increase our understanding for the immunology of diabetes mellitus and to propose specific treatment on the basis of our findings. Our data also include correlation between age and the level of cytokines and GADA with different conclusion for each parameter.

Initial Results of Peripheral-Blood Stem-Cell Mobilization, Collection, Cryopreservation, and Engraftment After Autologous Transplantation Confirm That the Capacity-Building Approach Offers Good Chances of Success in Critical Contexts: A Kurdish-Italian Cooperative Project at the Hiwa Cancer Hospital, Sulaymaniyah.

INTRODUCTION: At Hiwa Cancer Hospital (Sulaymaniyah, Iraqi Kurdistan) after the center was started by a cooperative project in June 2016, autologous transplantation was developed. PATIENTS AND METHODS: To develop the project, the capacity-building approach was adopted, with on-site training and coaching of personnel, educational meetings, lectures, on-the-job training, and the implementation of quality management planning. RESULTS: Here, we report initial results of peripheral-blood stem-cell mobilization and collection of the first 27 patients (age 12 to 61 years; 19 males and 8 females; multiple myeloma, n = 10; plasma cell leukemia, n = 1; Hodgkin lymphoma, n = 12; non-Hodgkin lymphoma, n = 3; and acute myeloid leukemia, n = 1). Only three (11.5%) of 26 patients experienced a failure of mobilization. A median of 6.1 × 106/kg CD34-positive cells per patient were collected (range, 2.4 to 20.8), with two apheretic runs. Twenty-four patients underwent autologous transplantation. All but one transplantation engrafted fully and steadily, with 0.5 and 1.0 × 109/L polymorphonucleates on day 10.5 (range, 8 to 12) and day 11 (range, 9 to 15), respectively, and with 20 and 50 × 109/L platelets on day 13 (range, 10 to 17) and day 17 (range, 2 to 44), respectively. More than 95% of patients are projected to survive 1 year after autograft. CONCLUSION: These data are the result of an Italian effort to establish in Iraqi Kurdistan a leading center for hemopoietic stem-cell transplantation. The capacity building approach was used, with on-site training and coaching as instruments for the development of provider ability and problem solving. With future limitations for immigration, this method will be helpful, especially in the field of high-technology medicine.

The Start-Up of the first Hematopoietic Stem Cell Transplantation Center in the Iraqi Kurdistan: a Capacity-Building Cooperative Project by the Hiwa Cancer Hospital, Sulaymaniyah, and the Italian Agency for Development Cooperation: an Innovative Approach.

We describe the entire process leading to the start-up of a hematopoietic stem cell transplantation center at the Hiwa Cancer Hospital, in the city of Sulaymaniyah, Kurdistan Iraqi Region. This capacity building project was funded by the Italian Development Cooperation Agency and implemented with the support of the volunteer work of Italian professionals, either physicians, nurses, biologists and technicians. The intervention started in April 2016, was based exclusively on training and coaching on site, that represent a significant innovative approach, and led to a first autologous transplant in June 2016 and to the first allogeneic transplant in October. At the time of reporting, 9 months from the initiation of the project, 18 patients have been transplanted, 15 with an autologous and 3 with an allogeneic graft. The center at the HCH represents the first transplantation center in Kurdistan and the second in wide Iraq. We conclude that international development cooperation may play an important role also in the field of high-technology medicine, and contribute to improved local centers capabilities through country to country scientific exchanges. The methodology to realize this project is innovative, since HSCT experts are brought as volunteers to the center(s) to be started, while traditionally it is the opposite, i.e. the local professionals to be trained are brought to the specialized center(s).