COVID-19 Vaccination Among Diverse Population Groups in the Northern Governorates of Iraq.

Objectives: The present study was carried out to investigate COVID-19 vaccination coverage among populations of internally displaced persons (IDPs), refugees, and host communities in northern Iraq and the related underlying factors. Methods: Through a cross-sectional study conducted in five governorates in April-May 2022, 4,564 individuals were surveyed. Data were collected through an adapted questionnaire designed to gather data on participants. Results: 4,564 subjects were included (59.55% were 19-45 years old; 54.51% male). 50.48% of the participants (51.49% of host communities, 48.83% of IDPs, and 45.87% of refugees) had been vaccinated with at least one dose of COVID-19 vaccine. 40.84% of participants (42.28% of host communities, 35.75% of IDPs, and 36.14% of refugees) had been vaccinated by two doses, and 1.56% (1.65% of host communities, 0.93% of IDPs, and 1.46% of refugees) were vaccinated with three doses. Conclusion: Sociodemographic factors including age, gender, education, occupation, and nationality could affect vaccination coverage. Moreover, higher acceptance rate of vaccination is associated with belief in vaccine safety and effectiveness and trust in the ability of the vaccine to prevent complications.

Transnasal Endoscopic Treatment of Tension Pneumocephalus Caused by Posttraumatic or Iatrogenic Ethmoidal Damage.

Background: Tension pneumocephalus is a neurosurgical emergency caused by progressive accumulation of air in the intracranial spaces mediated by a valve mechanism. Tension pneumocephalus usually presents with headaches, reduced consciousness, and even death. One of the most common causes is an ethmoidal defect resulted by nasal surgery or facial traumas. Methods: A literature review about tension pneumocephalus resulting from ethmoidal damages was performed. Surgery strategies included decompression by frontal burr holes and multilayer repair of the ethmoidal defect. In this paper, an endoscopic technique that exploits the ethmoidal defect to decompress the intracranial spaces and to resolve tension pneumocephalus with fewer complications and shorter hospitalization in comparison to frontal craniotomy is proposed. Conclusion: The proposed endonasal endoscopic technique could be effectively used as a first-line treatment for symptomatic tension pneumocephalus caused by posttraumatic or iatrogenic ethmoidal defect.

Epidermoid cyst of the posterior fossa: A case report of a combined microscopic and endoscopic transcranial approach.

AIM: To show a case of a giant epidermoid cyst of the posterior fossa treated with a combined microscopic and endoscopic transcranial approach. MATERIAL OF STUDY: A 13-years-old girl presented recurrent episodes of convulsions and vision impairment for years. CT scan and MRI revealed a suprasellar cystic lesion. The patient was operated with a combined microscopic and endoscopic transcranial approach. RESULTS: Postoperative MRI demonstrated complete resection of the mass and pathology confirmed the preoperative suspicion of epidermoid cyst. Post procedure, the patient recovered well and was discharged. At the 4 week follow up her symptoms had resolved completely. DISCUSSION: Epidermoid tumors are congenital lesions with a benign nature. They are the most frequent congenital intracranial lesions. Surgical treatment of epidermoid and dermoid cysts may be challenging. In the recent decades endoscopic endonasal approach (EEA) has been commonly used for the treatment of cranial base lesions because it has several advantages compared to open transcranial approach. We decided to do a transcranial approach combining the use of the microscope with the endoscope because EEA was not possible due to the location of the tumor. CONCLUSIONS: Despite the development of innovative techniques such as the EEA, the transcranial approach remains a viable option, especially when more techniques are combined. In fact, the combination of microscope and endoscope grants the advantages of both tools being very useful to assure a complete excision of intracranial tumors. KEY WORDS: Combined Transcranial Approach, Epidermoid Cyst, Posterior Fossa.

Inverted papilloma with bilateral origin. A case report and review of the literature.

AIM: To show a rare case of inverted papilloma with bilateral origin treated with endoscopic approach MATERIAL OF STUDY: The authors reported the unusual case of a 71-year-old male patient with a growing mass occupying both nasal cavities. The patient complained bilateral nasal obstruction associated with thick nasal secretions, anterior and posterior nasal drip, snoring and diffuse nasal pain. The biopsy revealed inverted papilloma. RESULTS: CT Scan and RMI of paranasal sinuses showed a bilateral origin of the tumor with a triple involvement on the left side: middle turbinate axilla, frontal recess posterior wall and ethmoidal sinus roof. Nasal endoscopic surgery approach was performed and the tumoral mass was removed completely. DISCUSSION: Inverted papilloma is an uncommon primary nasal tumor that presents three typical characteristics: a high rate of recurrence, local aggressive behaviour and association with malignancy. Although bilaterality is very rare, in this case the neoplasia occupied both nasal cavities with extension to left frontal, sphenoid and ethmoid sinuses. CONCLUSION: The authors, in line with the literature, showed that endoscopic approach represents once again a safe and efficient technique, even for larger tumors. KEY WORDS: Bilateral origin, Inverted papilloma, Paranasal sinuses.

Association between dietary total antioxidant capacity and hypertension in Iranian Kurdish women.

BACKGROUND: Antioxidants intake from diet has been identified as one of the effective factors in the development of hypertension (HTN). The present study aimed to investigate the association between total antioxidant capacity (TAC) and HTN in women. METHODS: This cross-sectional study was performed using the baseline phase data of the ravansar non-communicable disease cohort study. The TAC was calculated using food items of the food frequency questionnaire. TAC scores were classified into four groups (quartile). The first and fourth quartiles had the lowest and highest TAC scores, respectively. Logistic regression analysis was utilized to estimate the odds ratio. RESULTS: A total of 5067 women were included in the study. Women with the highest socioeconomic status (SES) had a significantly higher TAC intake compared to those with the lowest SES (P < 0.001). The participants in the third and fourth quartiles of the TAC had significantly lower odds of HTN, respectively by 21% (OR = 0.79; 95% CI: 0.64, 0.972) and 26% (OR = 0.74; 95% CI: 0.60, 0.91), compared to the first quartile. After adjusting for confounding variables was found to significantly reduce the odds of developing HTN in the fourth quartile of TAC by 22% compared to the first quartile (OR = 0.78; 95% CI: 0.62, 0.97). CONCLUSION: A high dietary TAC was associated to a decreased odd of HTN in women. We could suggest a diet rich in natural antioxidants as it may help prevent development of HTN.

Burden of Transport-Related Injuries in the Eastern Mediterranean Region: A Systematic Analysis for the Global Burden of Disease Study 2017.

BACKGROUND: Transport-related injuries (TIs) are a substantial public health concern for all regions of the world. The present study quantified the burden of TIs and deaths in the Eastern Mediterranean region (EMR) in 2017 by sex and age. METHODS: TIs and deaths were estimated by age, sex, country, and year using Cause of Death Ensemble modelling (CODEm) and DisMod-MR 2.1. Disability-adjusted life years (DALYs), which quantify the total burden of years lost due to premature death or disability, were also estimated per 100000 population. All estimates were reported along with their corresponding 95% uncertainty intervals (UIs). RESULTS: In 2017, there were 5.5 million (UI 4.9-6.2) transport-related incident cases in the EMR - a substantial increase from 1990 (2.8 million; UI 2.5-3.1). The age-standardized incidence rate for the EMR in 2017 was 787 (UI 705.5-876.2) per 100000, which has not changed significantly since 1990 (-0.9%; UI -4.7 to 3). These rates differed remarkably between countries, such that Oman (1303.9; UI 1167.3-1441.5) and Palestine (486.5; UI 434.5-545.9) had the highest and lowest age-standardized incidence rates per 100000, respectively. In 2017, there were 185.3 thousand (UI 170.8-200.6) transport-related fatalities in the EMR - a substantial increase since 1990 (140.4 thousand; UI 118.7-156.9). The age-standardized death rate for the EMR in 2017 was 29.5 (UI 27.1-31.9) per 100000, which was 30.5% lower than that found in 1990 (42.5; UI 36.8-47.3). In 2017, Somalia (54; UI 30-77.4) and Lebanon (7.1; UI 4.8-8.6) had the highest and lowest age-standardized death rates per 100,000, respectively. The age-standardised DALY rate for the EMR in 2017 was 1,528.8 (UI 1412.5-1651.3) per 100000, which was 34.4% lower than that found in 1990 (2,331.3; UI 1,993.1-2,589.9). In 2017, the highest DALY rate was found in Pakistan (3454121; UI 2297890- 4342908) and the lowest was found in Bahrain (8616; UI 7670-9751). CONCLUSION: The present study shows that while road traffic has become relatively safer (measured by deaths and DALYs per 100000 population), the number of transport-related fatalities in the EMR is growing and needs to be addressed urgently.