Vol 28, No 1 (2024)

Background and objective: An outbreak of pneumonia of unknown origin was reported in Wuhan, Hubei Province, China, in December 2019. Cases of epidemic pneumonia have been linked to the Huanan Seafood Market; thus, it has been dubbed the severe acute respiratory syndrome coronavirus (SARS-CoV-2). The global spread of thousands of deaths from the coronavirus disease (COVID-19) has led the WHO to declare a pandemic on March 12, 2020. This study aimed to find out the prevalence of COVID-19 disease and vaccination coverage among public preparatory school teachers in Erbil.

Methods: A cross-sectional study was conducted among the target group of 772 teachers in 76 public preparatory schools. The study population was 3157 teachers, 1263 male and 1894 female, in Erbil city, from September 1, 2021, to March 30, 2022. A questionnaire was used to collect data through face-to-face interviews using a simple random sampling method.

Results: The study sample ages ranged from 26 to 62 years; the mean age, ±standard deviation, was 40.53 ± 9.75. The prevalence rate of COVID-19 was 63.1%. Of the study samples, 58.5% received information about COVID-19 disease from social media and 23.8% from satellite channels. 68.9% of the study samples received the COVID-19 vaccine, and the majority preferred the Pfizer vaccine.

Conclusion: The majority of the study samples were infected with COVID-19 disease; many of the study samples received the COVID-19 vaccine; misconceptions need further correction; an increase in updating information regarding mode of transmission; an explanation of COVID-19 disease preventive measures; raising awareness of COVID-19 vaccination; more interesting health campaigns; and using mass media and community programs to change health behavior and reduce future health consequences of COVID-19 disease.

Background and objective: Sulfonamides are a type of antibiotic that are used to treat several infections caused by microorganisms. Sulfonamides are bacteriostatic, meaning they prevent bacterial growth. This study aimed to produce compounds with better antimicrobial activity.

Methods: By condensation reaction, Schiff bases were synthesized from sulfonamides (sulfamethoxazole, sulfapyridine, sulfathiazole, sulfadiazine and sulfisoxazole) and vanillin to enhance antimicrobial activity of synthesized compounds. The agar dilution method was used to measuring the minimum inhibition concentration (MIC) of synthesized compounds.

Results: The synthesized compounds were characterized by FT-IR, ¹H-NMR, ¹³C-NMR and tested for the antibacterial activity against gram positive bacteria (Staphylococcus aureus), gram negative bacteria (Escherichia coli) and antifungal activity against (Candida albicans). Ciprofloxacin and Fluconazole used as standard drugs for bacteria and fungi.

Conclusion: The Schiff base was synthesized, characterized, and exhibited enhanced antimicrobial and antifungal activities.

Background and objective: The current COVID-19 pandemic has become a main health threat worldwide and concerns have been raised regarding the effect of the Covid-19 infection on the wellbeing of pregnant women and their unborn baby. This study aimed to determine the clinical manifestations in addition to maternal and perinatal outcomes in pregnant women with confirmed COVID-19.

Methods: A cross sectional study conducted in the Maternity Teaching Hospital and some private obstetric clinics in Erbil city/Kurdistan region, Iraq. The study started from the 1^st April 2020 until the end of April of 2021. Seventy-one women who represent all infectedwithCOVID-19 during that period during pregnancy who were 16 years old or more were included in the study. Swabs were taken from nasopharynx by citoswab were diagnosed by quantitative real-time polymerase chain (qRT-PCR) at central laboratory of Erbil city/Iraq. The data were collected through direct interview with the patients using a special questionnaire, prepared for this purpose.

Results: More than half (53.5%) of participants were 25-34 years old, 80.3% of women were housewives and 29.6% of them were illiterate. The majority (87.3%) of women did not have chronic illnesses and 43.7% of them were in second trimester during COVID-19 infection. The following symptoms were reported: fever (91.5%), cough (80.3%), headache (77.5%), weakness (73.2%), loss of smell (69%), aguesia (67.6%), sore throat (66.2%), arthralgia and myalgia (64.8%), flu like illness (62%), dyspnea (39.4 %), and diarrhea and/or vomiting (26.8%). The majority (84.51%) of women did notreport any fetal complications or none has happened and 1.4% of the fetuses suffered from fetal distress and FGR. Caesarean section was the commonest mode of delivery. A significant statistical association was found between age group and fetal complications suggesting that fetal complications increased with becoming older.

Conclusion: Manifestations such as fever, sore throat, cough, headache, fatigue, loss of smell and taste, arthralgia and myalgia were commonly observed in Covid-19 pregnant patients. Cough was still the highest reported symptom followed by weakness and dyspnea even six months post Covid-19 infection. Adverse maternal and neonatal outcomes were observed in pregnant patients infected with Covid-19.

Background and objective: Gestational trophoblastic disease (GTD) involves a range of interrelated disorders that originate from the placenta; it can be benign or malignant. In the Kurdistan region of Iraq, data about GTD and its consequences is scarce. This study aims to identify the prevalence of GTD and its types among a cohort of Kurdish women. 

Methods: A cross-sectional study was conducted for a one-year duration from April 1, 2020, to April 1, 2021, at the Emergency Department of Maternity Teaching Hospital, Erbil City. Pregnant women in their first trimester and early second trimester (4–14 weeks of gestation) with vaginal bleeding, pregnant women with vaginal bleeding due to incomplete miscarriage, and pregnant women with a history of missed miscarriage were included in the study. A specialized questionnaire was prepared for the purpose of data collection.

Results: Out of 380 incomplete miscarriage cases who were interviewed, fifty patients with gestational trophoblastic disease were included in the current study. The prevalence of GTD was 13.1%, and the majority of patients had a partial type of GTD. The current analysis indicated that there was a statistically significant association between the types of GTD, the personal history of molar pregnancy, and the age of participants. The analysis indicated that there is no statistical association between parity, blood group, and history of miscarriage and the type of GTD.

Conclusion: The prevalence of GTD was remarkably high, and the partial type of GTD was the most common form present among the participants. The majority of the cases were diagnosed during the first trimester of the pregnancy. Complete GTD was more common among patients of advanced age.

Background and objective: Infection control refers to the measures taken in hospitals and other healthcare facilities to limit and control infections. The primary purpose of infection control is to reduce infection rates. Inpatients must have a perception and attitude about healthcare-associated infections. The aim of this study was to determine the perceptions and attitudes of inpatients and their related factors regarding infection control measures in Erbil public hospitals. 

Methods: This cross-sectional study was carried out in Erbil public hospitals from September 1st, 2021, to September 1st, 2022). It included 400 patients admitted for different reasons in Rizgary Teaching Hospital, Erbil Teaching Hospital, and Maternity Teaching Hospital. Data were collected during the period (December 15th, 2021) to (March 29th, 2022). Data was gathered through a direct interview using the questionnaire format. 

Results: The highest percentage of inpatients were females (67.8%), and 60.3% had sufficient income. A high number of inpatients (43.5%) were admitted to the Rizgary teaching hospital. More than half (52.5%) of the inpatients believed they would get an infection if admitted to the hospital. Concerning being aware of healthcare-associated infections, only 16.0% of inpatients were aware of healthcare-associated infections. Most (83.0%) of the inpatients thought that hand washing reduced the chance of infection. 

Conclusion: The present study indicated that the perceptions and attitudes of inpatients regarding infection control issues in hospitals are low; accordingly, more efforts are needed to empower patients about infection control measures in hospitals.

Background and objective: Health professionals struggle to appropriately train resident doctors in overcrowded medical centers. The one-minute preceptor teaching approach is an effective teaching model that provides a solution to the problem. This study aims to determine the effectiveness of a one-minute preceptor in improving the clinical teaching skills of supervisors and the critical thinking skills of residents and to assess the residents' and supervisors’ attitudes toward a one-minute preceptor.

Methods: From October 1, 2021, to February 28, 2022, a cross-sectional study was conducted in the Family Medicine department at Hawler Medical University, in Erbil, Iraq. Eight family medicine supervisors and 30 resident doctors at the specialized Family Medicine Health Center were involved in the study. Pre-and-post assessment questions were administered to the supervisors before and after one-minute preceptor training to assess their knowledge. Kirkpatrick's evaluation model was used to evaluate supervisors’ knowledge and application of skills after training, and to assess whether intended outcomes occurred with the residents.

Results: All supervisors agreed that this approach to teaching should be incorporated into medical education (50% agreed and 50% strongly agreed) and improved their teaching skills (75% agreed, 25% strongly agreed). More than half of the residents agreed that this new teaching method should be incorporated into medical education. (50% agreed and 10% strongly agreed)

Conclusion: The one-minute preceptor teaching model intends to provide doctors with an effective framework to improve their instructional effectiveness.

Background and objective: Formaldehyde is the most widely used chemical in daily life; thus, chronic exposure to formaldehyde has been shown to have adverse effects on different organs in humans and animals. Different of industries use formaldehyde including the medical, detergent, cosmetic, food, rubber, metal, wood, leather, petroleum, and agricultural industries and as a hydrogen sulfide scavenger in oil operations. This research was designed to investigate variable tracheal changes arising from chronic formaldehyde exposure by measuring different histomorphometric parameters in accordance with S-100 protein expression.

Methods: In this experiment, twenty Wister rats were used, divided into the control group (n=10) and the experimental group (n=10). Animals in the experimental group had approximately 21 days of formaldehyde vapor 40ppm. At the end of the study tracheal samples were collected and used for histopathologic assessments and IHC staining.

Results: In comparison to the control group, the experimental group revealed various histological lesions in tracheal structures from lining epithelium till adventitia including highest degrees and scores of; Epithelial necrosis, goblet cell hyperplasia, fibrosis in the submucosa, squamous metaplasia, chronic tracheitis and glandular changes. Results of IHC showed that the S-100 expression in the experimental group displayed higher percentages in different cells (epithelial cells, chondrocytes, and inflammatory cells) which were reported as strong intensity (3+), then moderate intensity (2+), and accompanied by weak intensity (1+), which revealed minimum percentages compared to the control-negative group in which the weak intensity (1+) recorded the highest percentages.

Conclusion: Chronic exposure to formaldehyde causes significant histological changes that may lead to cancer induction. S-100 may appear as pro-inflammatory and proliferative marker, also S-100 expression associated with chondrocyte hypertrophy.

Background and objective: There are many factors that influence mortality in critically ill patients with COVID-19 infection in the intensive care unit. The aim of this study was to investigate the risk factors that predict the mortalities of critical COVID-19 patients admitted to the intensive care unit in Sulaimani in 2021.

Methods: This is an observational retrospective study of critically ill patients with COVID-19 pneumonia admitted to the main intensive care unit of the Sulaimani government between June and December 2020. Overall baseline characteristics are presented based on the patient's survivors versus non-survivors. Mann-Whitney U test was used to compare whether there is a difference between survivors and non-survivors for the independent basic characteristics of the patients. Binary logistic regression was used to identify the predicted factors of survivors.

Results: A total of 220 patients were admitted to the intensive care unit, of whom 167 died, with a case fatality rate of 75.9%. The risk factors that predicted mortality in critical COVID-19 patients were an increasing age of more than 59 years (P-value = 0.008), comorbidities (P-value = 0.038), and a lack of use of antiviral drugs (P-value = 0.011). Whereas the factors significantly predicted a reduction in mortality were increasing oxygen saturation (P-value <0.001), systolic blood pressure (P-value = 0.002), non-invasive mechanical ventilation (facemask) (P-value = 0.001), and continuous positive airway pressure (P-value = 0.003).

Conclusion: The risk factors that predicted mortality in critical COVID-19 patients were increasing age, comorbidities, and a lack of use of antiviral drugs. Whereas increasing oxygen saturation, systolic blood pressure, non-invasive mechanical ventilation (facemask), and continuous positive airway pressure significantly predicted a reduction in the likelihood of death.

Background and objective: Type-1 diabetes mellitus is the most common chronic endocrine disorder of childhood and adolescence and is characterized by immune-mediated destruction of pancreatic cells, which has been proven to be correlated with and increase the risk of developing autoimmune thyroid disease, celiac disease, Addison’s disease, and further autoimmune diseases. The aim of this study is to evaluate the prevalence of autoimmune disease-related markers in type 1 diabetes mellitus in children and adolescents in Erbil city.

Methods: One hundred children and adolescents with type 1 diabetes mellitus were enrolled in this cross-sectional study. Patients <1 year old were excluded from the study. Autoimmune thyroid antibodies (anti-thyroid peroxidase and anti-thyroglobulin) along with tissue transglutaminase (IgA and IgG) antibodies were measured with further evaluation by thyroid function test and endoscopy with biopsy (for positive serological autoantibodies level).

Results: Elevated anti-thyroglobulin, anti-thyroid peroxidase, and tissue transglutaminase IgA and IgG antibodies were determined in 24.0%, 26%, 10%, and 8%, respectively. 50.0% of cases with positive anti-thyroid peroxidase antibodies had overt hypothyroidism; on the flip side, 3.8% had subclinical hypothyroidism. As well, the high level of thyroid autoantibodies was significantly correlated to the prevalence of overt hypothyroidism (P <0.001). Nine of the patients with positive tissue transglutaminase antibodies were verified to have biopsy-proven celiac disease.

Conclusion: Children and adolescents with type 1 diabetes mellitus are at risk of developing positive antithyroid and celiac-related autoantibodies, so they are at risk of progressing to autoimmune thyroid and celiac diseases.

Background and objective: Atorvastatin calcium (ATV) has a solubility in aqueous solutions of greater than 0.1 mg/ml to less than 1 mg/ml, which is very slightly soluble. When developing dosage forms for these medications, formulation scientists still face challenges. This study's goal was to use various hydrotropic agents in the formation of solid dispersion-based hydrotropic blends to improve the solubility properties of atorvastatin calcium.

Methods: In this study, twenty-two distinct binary, ternary, and quaternary formulations of ATV were prepared by employing five different hydrotropic agents and combining at least two hydrotropic agents in concentrations of 10% and 20% (w/v). Moreover, solid dispersion by the solvent evaporation method and physical mixture-based hydrotropic blends in the ratio of (1:2) have been formulated. The produced formulations were characterized using an FTIR analysis.

Results: According to the findings, binary formulations containing 20% (w/v) concentrations of sodium benzoate (SB), sodium salicylate (SS), and resorcinol (R) enhanced the solubility ratio of ATV by 439.31, 689.57, and 106.21 folds, respectively. Furthermore, ternary formulations (FT14) and quaternary formulations (FQ18) resulted in the enhancement of ATV solubility by 938.45 and 995.12 folds, respectively. Ternary solid dispersion demonstrated the highest enhancement in solubility ratio by 87.68 folds and resulted in a higher dissolution rate of ATV than pure samples of the drug. Finally, FTIR analyses excluded any interactions between medications and excipients by showing no noticeable shift in the peaks.

Conclusion: Solid dispersion based hydrotropic blends can provide the production of the dosage forms of practically insoluble drugs with a favorable enhancement ratio in solubility.

Background and objective: Thrombocytopenia, described as a platelet count of less than 150,000 mm3, is a common diagnosis during the period of pregnancy, existing in 7–12% of pregnancies. Mild thrombocytopenia occurs if platelet counts are less than 100,000 mm3, while moderate thrombocytopenia is between 50,000 and 100,000 mm3, and severe thrombocytopenia occurs if platelet counts are less than 50,000 mm3. It could be connected to physiologic changes or pathological diseases; some of them have an impact on pregnancy and may offer a serious risk to both the mother and the unborn child. This study sought to estimate the proportions of the underlying causes as well as the prevalence of thrombocytopenia among pregnant women visiting the antenatal care center in Erbil.

Methods: A cross-sectional study was performed in a maternity teaching hospital in Erbil city, Kurdistan region, Iraq. A convenience sample of 600 pregnant women was used from 28 weeks to 40 weeks of gestation. Over a period of 1 year, starting in January 2021 and ending in December 2021.

Results: The prevalence of thrombocytopenia among the 600 cases was 24.8%, but the majority (75.2%) had a normal platelet count; the degrees of thrombocytopenia were severe in 1.8% of the cases, mild in 8.3%, and moderate in 14.7% of the cases.

Conclusion: A statistically significant association between preeclampsia and HELLP syndrome has been reported as a serious condition that leads to thrombocytopenia. High serum albumin levels in pregnant women related to hypertension had a major impact on the number of platelet counts and should be considered a severe disease.

Cytochrome p-450 (CYPs) convert xenobiotics, chemicals, and drugs in the liver into intoxic materials that can be easily eliminated in the body. However, these CYPs sometimes mediate fatal diseases by converting drugs (for instance, paracetamol) into toxic substances that cannot be eliminated or excreted quickly from the body and hence cause hepatocyte damage that decreases the function of the liver. This article review aimed to determine the history, nomenclature, family, and subfamily of CYPs and mainly stress cytochrome P450 roles in drug metabolism. Some toxic byproducts induce autoreactive antibodies by binding to the CYPs, which causes further damage to hepatocytes. The most common causes of liver damage are type II autoimmune hepatitis, drinking alcohol, and free radicals, which cause DNA mutations. Another condition that leads to liver damage is the inability of the liver to detoxify the drug, which leads to further damage to the liver. There are some isoforms of CYPs, such as 3A, 1A, and 2C19, that are severely affected when the liver is no longer able to relieve toxic products, but some isoforms of CYPs are less affected during damage to the liver, which includes 2E1, 2D6, and 2C9. There are parameters for the involvement of CYPs in liver disease, depending on the cause of the damage, which is either drugs or alcohol. Thus, further research must be done to know the exact etiology and management of the diseases related to liver damage through CYPs.