Assessment of Anxiety, Stress, and Depression Among COVID-19 Survivors After 40 Months in the Kurdistan Region of Iraq: An Online Cross-Sectional Study.

BACKGROUND AND AIMS: COVID-19 survivors often experience significant and pervasive psychological distress. This study aimed to investigate the prevalence and demographic factors affecting anxiety, stress, and depression levels among COVID-19 survivors in the Kurdistan region of Iraq. METHOD: This online cross-sectional study was conducted from August 1, 2023 to December 17, 2023, in the Kurdistan region of Iraq, including Erbil, Sulaymaniyah, and Duhok. Purposive sampling was used to collect data using an online survey. The survey included demographic information and the Depression, Anxiety, and Stress Scale - 21 Items (DASS-21). Statistical analysis was performed using Stata version 12 (StataCorp LLC, College Station, TX), with frequency and percentage used for categorical variables and mean and standard deviation for quantitative variables. Ordinal regression analyses were conducted to assess associations between demographic factors and mental health outcomes. A p-value of less than 0.05 was considered statistically significant. RESULTS: A total of 783 participants were enrolled in the study. The mean score for anxiety was 11.62 ± 4.71, indicating moderate levels. For depression, the mean score was 11.54 ± 5.21, indicating mild levels, and for stress, the mean score was 14.0 ± 5.78, indicating normal levels. Younger individuals (15-27) showed higher stress (Estimate: 18.96, P=0.001) and anxiety (Estimate: 2.79, P=0.001) levels compared to older age groups. Males reported significantly lower stress (Estimate: -1.01, P=0.001), anxiety (Estimate: -1.29, P=0.001), and depression (Estimate: -0.72, P=0.001) than females. Participants with a diploma had lower anxiety (Estimate: 0.65, P=0.004) and stress (Estimate: 0.77, P=0.002) levels compared to those with only elementary education. CONCLUSIONS: The study found moderate levels of anxiety among COVID-19 survivors, with mild depression and normal stress levels. To address these issues, it is recommended that policymakers develop targeted mental health interventions. Healthcare providers should focus on early identification and treatment, providing personalized counseling and support to enhance coping mechanisms and overall psychological well-being. By implementing these measures, mental health outcomes for COVID-19 survivors in Iraq can be significantly improved.

Clustered Regularly Interspaced Short Palindromic Repeat-1 (CRISPR-1) Locus as a Tool for Tracing the Zoonotic History of Salmonella enterica Strains.

Background Salmonella enterica is a significant foodborne pathogen that causes considerable illness and death in humans and animals. The clustered regularly interspaced short palindromic repeat (CRISPR)-CRISPR-associated protein (Cas) system in bacteria acts as an adaptive immune defense against invasive genetic elements by incorporating short intergenic spacers (IGSs) into CRISPR loci. These loci serve as molecular records of past interactions with phages and plasmids, providing insights into the transmission and evolution of bacterial strains across different hosts. Aim This study aimed to investigate the diversity of IGSs in the CRISPR-1 locus of S. enterica isolates from humans and camels. The objective was to assess the potential of IGSs to distinguish strains, track sources, and understand patterns of zoonotic transmission. Materials and methods Genomic DNA was extracted from multiple strains of S. enterica, and the CRISPR-1 locus was polymerase chain reaction (PCR) amplified and sequenced. The sequences were compared to identify distinct patterns of IGSs and potential host-specific characteristics. Sanger sequencing and bioinformatics tools were used to classify the IGSs and determine their similarity to known sequences in the National Center for Biotechnology Information (NCBI) database. Results Sequence analysis revealed five distinct CRISPR-1 types among S. enterica isolates from humans and three among camel isolates. The presence of shared IGSs between human and camel S. enterica isolates suggested zoonotic or reverse-zoonotic transmission events. Additionally, host-specific unknown IGSs (UIGS) were identified. Importantly, camel isolates initially identified as S. enterica subspecies enterica serovar Enteritidis based on rrnH gene sequencing were reclassified as S. enterica serovar Enteritidis based on CRISPR-1 profiling, demonstrating the higher resolution of CRISPR-based genotyping. Conclusion The diversity of IGSs in the CRISPR-1 locus effectively differentiated S. enterica strains and provided insights into their evolutionary origins and transmission dynamics. CRISPR-based genotyping proves to be a promising tool to complement traditional serotyping methods, enhancing the molecular epidemiology of salmonellosis and potentially leading to better management and control strategies for this pathogen.

Exploring Young Adults' Reluctance to Engage With Psychiatric Hospitals in Erbil, Iraq: Identifying Barriers to Psychiatric Care.

BACKGROUND AND AIM: In Erbil, Iraq, the reluctance of young adults to engage with psychiatric services is influenced by a complex array of barriers, including stigma-related, attitudinal, and instrumental factors that hinder effective mental healthcare access. This study aimed to identify these specific barriers to accessing psychiatric care among young adults in Erbil. MATERIALS AND METHODS: The study utilized a cross-sectional online survey conducted between April 5th and May 1st, 2024. Data collection was carried out through purposive sampling and involved a comprehensive questionnaire. Electronic informed consent was obtained from all participants before they started the survey, which collected demographic data and utilized the Barriers to Access to Care Evaluation (BACE v3) tool. Statistical analysis was conducted using SPSS version 27 (IBM Corp., Armonk, NY). Descriptive statistics (frequency and percentage) were used for categorical data, while the mean and standard deviation characterized continuous variables. Chi-square tests, including Fisher's exact test and odds ratio (OR), were used to analyze categorical data, with a significance level set at p < 0.05. RESULTS: A total of 407 participants were enrolled in the study. The study highlighted several barriers to mental health care. Stigma-related barriers were significant, with participants fearing being seen as weak (mean score = 2.14, SD = 0.96) and concerns about being labeled "crazy" (mean score = 1.80, SD = 1.19). Regarding attitudinal barriers, there was a notable preference for dealing with issues independently (mean score = 2.04, SD = 0.98) and a tendency toward resolving problems without professional help (mean score = 1.88, SD = 0.98). Additionally, instrumental barriers were identified, including the rare availability of culturally diverse mental health professionals (mean score = 1.78, SD = 1.09) and practical difficulties such as arranging transportation to appointments (mean score = 0.61, SD = 0.87). CONCLUSION: The study demonstrated that young adults in Erbil face significant stigma and attitudinal and instrumental barriers to accessing psychiatric care. In response to these findings, it is recommended for the government to prioritize mental health awareness, actively destigmatize mental health issues, and improve service accessibility to foster a supportive care environment. Additionally, mental health professionals and educational institutions should collaborate to provide targeted support programs and resources for young adults.

Knowledge and Attitudes Regarding Depression Among a Sample of Iraqi Non-Psychiatric Nurses: A Cross-Sectional Study.

Introduction: Nurses, comprising the largest profession in healthcare, play a significant role in the identification and management of mental health disorders in hospitals. Objectives: The study assessed the knowledge and attitudes of non-psychiatric nurses and their encounters with depressive patients throughout their careers. Methods: This was a cross-sectional descriptive study with 400 non-psychiatric nurses from different hospitals in the Kurdistan Region of Iraq during October and November 2022. The independent Student's t-test, one-way analysis of variance, and binary logistic regression were used to assess possible factors associated with knowledge and attitude toward depression. Results: In this study, 400 non-psychiatric nurses were examined, revealing a mean age of 31.57 ± 8.59 years. Their mean scores for knowledge and attitude toward depression were 5.41 out of a maximum of 11 (standard deviation 1.15) and 5.15 out of 18 (standard deviation 1.83), respectively. Notably, differences in mean knowledge scores were observed concerning participant marital status (P = .044), while disparities in mean attitude scores are related to participant gender (P = .010). Upon binary logistic regression analysis, none of the independent variables exhibited an association with good knowledge. Nevertheless, gender emerged as a significant factor influencing attitude toward depression (odds ratio: 0.51; 95% confidence interval: 0.30-0.86; P = .012). Subsequently, in the multivariate binary logistic regression analysis, gender sustained significance (adjusted odds ratio: 0.573; 95% confidence interval: 0.348-0.942; P = .028) as the key variable impacting attitudes toward depression among non-psychiatric nurses. Conclusion: Based on the results of this study, nurses have insufficient awareness and management skills for depression. It has been experienced and reported that nurses lack knowledge and an attitude toward depression management. The study highlights a significant gap in nurses' skills for managing depression, urging the immediate improvement of training programs. Customizing these programs to enhance nurses' abilities in identifying and managing depression is crucial.

Knowledge, Attitudes, and Willingness of Healthcare Workers in Iraq's Kurdistan Region to Vaccinate against Human Monkeypox: A Nationwide Cross-Sectional Study.

Although human monkeypox infections had not been recorded in the Kurdistan region of Iraq as of August 2023, the rapid growth of cases worldwide and the detection of monkeypox in neighboring Middle Eastern nations call for careful planning and timely response measures. Educating and empowering frontline healthcare workers (HCWs) so that they can act to curb the spread of monkeypox infections are core elements of primary prevention and protecting public health. Therefore, this study aimed to assess HCWs' knowledge and attitudes about monkeypox and their willingness to vaccinate against monkeypox. By employing a convenience sampling method, an online survey was disseminated via Google Forms between 1 November 2022 and 15 January 2023. The researchers utilized regression analyses to ascertain the factors associated with the three parameters: knowledge, attitude, and the willingness to vaccinate. A total of 637 HCWs were included in the analysis (ages ranged between 21 and 51 years). The mean overall scores were 8.18 of a max score of 16 (SD 3.37), 3.4 of 5 (SD 1.37), and 2.41 of 5 (SD 1.25) for knowledge, attitude, and willingness to vaccinate, respectively. A multivariate logistic regression analysis demonstrated that HCWs who had heard about monkeypox before 2022 rather than later had a higher level of knowledge (AOR: 4.85; 95% CI: 2.81-8.36; p < 0.001). In addition, those who had newly joined the workforce or had less than 1 year experience in practice had more positive attitudes about curbing monkeypox (AOR: 0.35; 95% CI: 0.20-0.59; p < 0.01) than those who practiced for longer. No significant predictors of willingness to vaccinate against monkeypox were identified. The research revealed that HCWs exhibited a relatively low level of monkeypox knowledge. They also had poor attitudes towards monkeypox vaccination and were therefore reluctant to receive the vaccines. Imparting knowledge about the infectious disease can cultivate better awareness and attitudes among HCWs as to their roles in mitigating the spread of an epidemic in the foreseeable future.

Synthesis of Silver Nanoparticles by Raoultella Planticola and Their Potential Antibacterial Activity Against Multidrug-Resistant Isolates.

Background: Nanoparticles can be chemically, physically, or biologically synthesized. Biosynthesis of silver nanoparticles (AgNPs) utilizing microbes is a promising process due to the low toxicity and high stability of AgNPs. Here, AgNPs were fabricated by Gram-negative Raoultella planticola. Objectives: This study aimed to assess the ability of Raoultella planticola to produce nanoparticles (NPs) and evaluate their antibacterial potential against multidrug-resistant pathogens (MDR). Additionally, the study aimed to compare the antibacterial activity of biosynthesized nanoparticles to well-known conventional antibiotics Azithromycin and Tetracycline. Materials and Methods: AgNPs were characterized using visual observation, UV-visible spectroscopy (UV-vis), X-ray diffraction (XRD), transmission electron microscopy (TEM), scanning electron microscopy (SEM), and Fourier-transform infrared spectroscopy (FTIR). The TEM and SEM were used to determine the size and shape of the nanoparticles. The XRD data were recorded in the 2θ ranging from 20-80° to analyze the crystalline structure of nanoparticles. The antibacterial activity was detected using a 96-well microtiter plate. Results: The UV-vis absorption recorded from the 300 - 900 nm spectrum was well defined at 420 nm, and the XRD pattern was compatible with Braggs's reflection of the silver nanocrystals. FTIR showed absorbance bands corresponding to different functional groups. TEM and SEM images showed non-uniform spherical and AgNPs of 10-80 nm. XRD data confirmed that the resultant particles are AgNPs. The AgNPs showed effective activity against multi-drug resistant (MDR) Pseudomonas aeruginosa, Salmonella sp., Shigella sp., E. coli, Enterobacter sp., Staphylococcus aureus, and Bacillus cereus. The AgNPs demonstrated effectiveness in lower concentrations compared to broad-spectrum antibiotics. Conclusion: These data reveal that AgNP generated by R. planticola was more efficient against MDR microorganisms than commercial antibiotics. However, the cytotoxicity of these nanoparticles must be further studied.