Vol 29, No 1 (2025)

Background and objective: The management of patients with head and neck defects from trauma and tumors (malignant and benign) is challenging, and the choice for reconstructive plan is most significant for better outcome regarding function (such as swallowing and speech), and aesthetic appearance. The anterolateral thigh free flap is one of the commonly used free flaps for reconstruction of complex wounds specially after oncosurgical resection. The objective of the study is to assess the versatility of anterolateral thigh free flap in reconstruction of complex wounds at head and neck.

Methods: Our retrospective study was carried out within five years from 2018 to 2022, in Erbil (the capital of Kurdistan Region, Iraq) at Maryamana and PAR private hospitals. We had ten patients with head and neck defects, and all the operations had been done under general anesthesia, five of them were myo-cutaneous and five were fascio-cutaneous flaps, they remained for about a week at the hospital for follow up and the antiplatelet (aspirin) with the anticoagulant (low molecular weight heparin) had been prescribed to all of them.

Results: Ten patients were included in the study, their mean age (SD) was 54.6 (21.1) years, the age range was 10-84 years, and 60% of them were males. The flap sites were the maxilla (40%), ear and temple (20%), in addition to the other sites. The commonest cause was maxillary cancer in 40% of the patients. All the flaps survived, and only one patient (10%) developed partial skin loss at the recipient site.

Conclusion: The anterolateral free flap has got many advantages and its viability and versatility is very high in management of complex wound defect in different sites of the body and to avoid risks it’s better to postpone thinning of the flap at the initial operation.

Background and objective: As we are in the era of COVID-19 as which is new disease for our communities and we are responsible for what’s new in our ophthalmology world, we want to report the new ocular finding in patients that got the infection and how this affected their vision.

Methods: The study was a hospital based prospective cross-sectional study which included patients with recent COVID-19 infection. The study was conducted in ophthalmology department of Erbil Teaching Hospital in Erbil city from June 2021 till April 2022. The participants were recruited from the outpatient clinic in a non-probability convenience sampling way.

Results: The most common ocular disease encountered in COVID-19 patients was posterior subcapsular cataract. Their ages were between 26->56. The cataract developed in twelve patients and it was bilateral in nine cases (18 eyes) with a varying degree of density. The next most common manifestation was multiple punctate epitheliopathy found in nine patients which was bilateral in all of them. Follicular conjunctivitis was encountered in eight patients; it resolved in a period of 5 to 8 days after the prescription of topical ant-inflammatory medications. Regarding the retina, eight patients had central retinal vein occlusion while branch retinal vein occlusion developed in two patients. Central serous chorioretinopathy developed in three patients and it was unilateral (3 eyes).

Conclusion: COVID-19 infection is a multi-systemic disease can cause a variety of ocular clinical symptoms and complications. Blurred vision and conjunctivitis like features are the most common ocular presentation of the infection.

Background and objective: Maternal obesity refers to a women obesity during pregnancy, it carries an increased risk of complications during pregnancy and childbirth. This study's major goal was to compare the maternal and perinatal outcomes of obese women to those of women with normal BMI.

Methods: A case control study was conducted on 400 delivering women, 200 of them obese women (case) and 200 will be pregnant women with normal BMI (control) at Maternity Teaching Hospital, Erbil city, Kurdistan Region, Iraq between 1^st April 2021 to 1^st April 2022 were recruited. Data were analyzed using the SPSS, version 25, to test statistical significance.

Results: No significant differences were detected between obese and normal weight women regarding the following maternal outcomes: mode of delivery (P = 0.874), medical complications (P = 0.182), and complications during pregnancy (P >0.05). 39.5% of the normal weight women needed induction compared with 22% of the obese women (P <0.001). The rate for augmentation of labor was 50% among obese women compared with 19% among the women with normal weight (P <0.001). Incidence of postpartum hemorrhage was 33% among women of normal weight and 22.5% among those who were obese (P = 0.019). The commonest neonatal bad outcome was macrosomia baby (16.3%). It occurred in 19% of the neonates of the obese women and in 13.5% of the neonates of women with normal weight (P = 0.080). The rate of admission to the NICU was 38.3% in the whole sample (41% in the obese and 35.5% in the group of normal weight).

Conclusion: Pregnant women who were obese had a higher risk of delivery difficulties and neonatal intensive care unit hospitalization.

Background and objective: Physicians were more interested in using CT imaging techniques because of the limitations of RT-PCR during the COVID-19 pandemic and CT proved high specificity but moderate sensitivity in the diagnosis of the disease. The aim of the study was to find the correlation of the CT scan findings of the novel coronavirus disease with the duration of clinical presentation.

Methods: A cross-sectional study conducted in governmental and non-governmental tertiary hospitals in Erbil city that receive COVID-19 patients. The study started from May 2021 till June 2022. A convenience sampling method was used and 100 COVID -19 patients were included in the study. The Dutch Radiological Society CO-RADS assessment scheme was used to find the degree of suspicion for pulmonary involvement of COVID-19. The semi quantitative CT severity score was used to assess the degree of parenchymal involvement per lobe. A score less than 8 is considered mild, between 8-15 means moderate, and more than 15 is considered severe lung involvement.

Results: Significant differences were found between age groups and stages of disease (P = 0.028). The highest rate of severe cases was in two age groups (40-59 and 60-79 years); 50% and 40% respectively. The bilateral ground-glass appearance was the predominant feature in all three degrees of the disease, 76%, 60%, and 52% respectively. The Spearman's Correlation Coefficient (r) was calculated, and a positive correlation was found between the age and CT- scores (r =0.188, P = 0.061). A positive correlation was noticed between the time of first symptoms appeared and CT scores with a significant P-value (r = 0.382, P <0.001).

Conclusion: A positive correlation was detected between CT scoring and the duration of the clinical presentation. The CT scoring methods used in the current study were beneficial and applicable in predicting COVID-19 pneumonia.

Background and objective: Asthma is the most common health problem that impaired a patient’s quality of life (QoL). Metered dose inhaler is a key route for improving asthma control and quality of life, the objective of this study was to assess asthma inhaler medication adherence and its effect on the quality of life of asthmatic patients.

Methods: A cross-sectional study was employed at Rizgary and Hawler Teaching Hospital in Erbil City, in the Kurdistan Region of Iraq from March 2021 to November 2022. A non-probability/purposive sampling technique was used to choose 300 asthmatic patients. Data was collected through a questionnaire consist of demographical data, asthma quality of life, metered dose inhaler checklist, and an asthma control test. Chi-square, Mann Whitney u test and binary logistic regression were used to find out the result of the study and P value <0.05 was significant.

Results: Out of 300 patients with asthma, 58% were females, the mean age (±SD) was 46.7±9.04 years, 43% used the metered dose inhaler improperly, 61% was uncontrolled asthma and67%reported poor quality of life. The following variables were associated with a poor quality of life: age ≤40 (P = 0.023, OR = 1.95), insufficient family income (P = 0.020, OR= 1.92), duration of disease ≤ 10 years (P = 0008, OR= 2.30), and improper used meter dose inhaler (P = 0001, OR = 3.32) respectively.

Conclusion: Appropriate using the inhaler technique is associated with better quality of life in asthmatic patients. Healthcare providers teaching patients with asthma should have the basic skills and knowledge to use metered dose inhalers correctly to reduce readmission and mortality rate.

Background and objective: As Glaucoma is the second leading cause of blindness worldwide, this study aims to determine the most common factors that leads to the development of secondary glaucoma in patients attending the Outpatient Ophthalmology Department.

Methods: A hospital based prospective cross-sectional study which involved 100 patients. The study was conducted in ophthalmology department of Erbil Teaching Hospital in Erbil city from June 2021 till April 2022. The participants were diagnosed with secondary glaucoma.

Results: Hundred patients were included in the study, their mean age (SD) was 52.3 (15.1) years, the median was 55.5 years, and the age range was 16 to 82 years. The largest proportion of the sample (32%) were aged 60-69 years, and more than half (61%) were males. The most common subtypes of secondary glaucoma were post ocular surgery (26%), the types of the operations that led to secondary glaucoma were pars plana vitrectomy (38.5%), cataract surgery (46.2%), and corneal surgery (15.4%). Post traumatic glaucoma represents (23%), the types of ocular pathologies that occurred after trauma were as follows: angle recession (43.5%), cataract (21.7%), lens subluxation (8.7%), retinal detachment (8.7%), hyphema (8.7%), and sphincter tear (8.7%). Drug induced glaucoma was present in (15%) of study population, The majority (86.7%) of patients were taking corticosteroids, 6.7% were taking tranquilizers, and 6.7% were taking other drugs. Pseudoexfoliative (PEX) glaucoma was found in 14% of all Study population. This study has found that Neovascular glaucoma was 12% (and had the highest baseline IOP among the other types of secondary glaucoma) while Inflammatory glaucoma was the least type of secondary glaucoma in this study (10%).

Conclusion: Secondary glaucoma is mostly monocular in nature. Post ocular surgery glaucoma was the leading cause of secondary glaucoma followed by post Traumatic glaucoma, and drug induced glaucoma is the third leading cause for secondary glaucoma in our society. The knowledge of secondary cause of glaucoma helps early detection and prompt treatment of these types of glaucoma.

Background and objective: The durability of humoral immune response for medium term period of COVID-19 vaccines in Rheumatoid arthritis patients and the role of immunosuppressive treatment have not been yet well investigated. Therefore, we aimed to evaluate the influence of time and immunosuppressive medications on the vaccine efficiency in rheumatoid arthritis patients compare to controls.

Methods: This case control study was conducted from November 2021 to January 2023 included one hundred thirty-one subjects, divided into four groups; where the first group consist of (n=49) unvaccinated rheumatoid arthritis patients, while the second group consist of (n=34), vaccinated rheumatoid arthritis patients, compared with other two group of healthy subjects (n=25 unvaccinated and 23 vaccinated). Blood samples were collected (12 to 16) weeks after the second vaccine dose receipt for measuring serum IgG.

Results: The difference in mean of IgG between the four study groups was non-significant (P = 0.079), the vaccinated rheumatic patients mean IgG 1.43 and 1.65 in vaccinated healthy control. The mean IgG among vaccinated RA patients on biological treatment was 1.70, and higher than non-biological treatment group (1.03). The prevalence of IgG positivity was significantly (P = 0.005) higher among the controls (56.3%) than the Rheumatoid arthritis patients (31.3%), and significantly higher among the vaccinated (50.9%) than the unvaccinated (32.4%) with (P = 0.033). The same pattern observed when the four groups are compared (P = 0.007).

Conclusion: IgG positivity rate obviously decreased mainly in Rheumatoid arthritis groups after medium time interval, with no significant effect for immunosuppressant drugs on vaccination response.

Background and objective: Folic acid is one of the essential vitamins for women of childbearing ages, and its deficiency is the second leading cause of anemia worldwide after iron deficiency. The purpose of the study was to find out the factors associated with supplemental folic acid knowledge of pregnant women visiting primary health care centers in Erbil city.

Methods: A cross-sectional study was conducted and involved all the twenty-three primary health care centers in Erbil city. The data collection period was from 1^st September 2021 to 1^st March 2022. A convenience sample of 727 pregnant women visited primary health care centers in the Erbil city were collected through face-to face interviews by using a pre-designed questionnaire format.

Results: The study found that pregnant women had poor knowledge about using folic acid during pregnancy. There was a highly significant (P <0.001) positive association between the knowledge of pregnant women about folic acid and the increasing socio-economic class level, older age groups, a greater number of pregnancies, more birth spacing, and the absence of anemia, abortion and existence of congenital malformation during the previous pregnancies.

Conclusion: The majority of pregnant women have limited awareness about benefits of folic acid, especially among low socio-economic classes.

Background and objective: Trypsin is best known for playing a role in enteric digestion, among the most commonly examined serine proteases. Trypsin is expressed extra-pancreatically by a number of cancer types (for instance, Ovarian cancer), and it is thought that both in vivo and in vitro carcinogenesis are facilitated by trypsin. A new study suggests that trypsin overexpression may promote Coronavirus transmission. In this investigation, several corn trypsin inhibitor (CTI) variants will be expressed and purified, and their trypsin inhibitory action will be assessed.

Methods: CTI was cloned and expressed, and then different variants of rCTI were expressed and assessed for their ability to inhibit trypsin enzyme activity. 

Results: The Arg34Ala amino acid substitution negated all inhibitory activity, whereas Gly32Trp, Trp22Ala reduced inhibitory activity by considerable degrees, respectively six-fold and seven-fold; Arg27Ala, Glu39Ala, Arg42Ala, Arg27Ala-Arg42Ala didn't affect inhibitory activity either.

Conclusion: CTI's central inhibition loop is critical for binding trypsin, and the data confirm that Arg34, Trp22, and Gly32 of the loop are involved. It is possible to design new, specific, and safe drug candidates based on the residues for the treatment of ovarian cancer using this framework. This study can also serve as a starting point for designing drugs that reduce the symptoms of COVID-19 caused by trypsin-induced cytokinestorm.

Background and objective: Polycystic ovarian syndrome (PCOS) is a common endocrinological pathology affecting around 15-20 % women of reproductive age globally. The characteristic features of PCOS are hyperandrogenemia, oligo/anovulation and polycystic ovaries on imaging studies. Serum insulin level is one of the major risk factors. The aim of this study was to show the significance of the insulin level in all phenotypes of the PCOS.

Methods: This cross-sectional study was carried out in the Kurdistan Region of Iraq at the Erbil Maternity Teaching Hospital. It comprised 101 women who had been unequivocally diagnosed with PCOS by laboratory and imaging studies throughout a one-year period beginning on May 2021.

Results: The women's body mass index ranged from 19 to 35, while their ages ranged from 18 to 49.Phenotype A formed the largest group of patients by 39.6% and phenotype D were the smallest group by 14.9% of the total patients with significant difference in the serum insulin level between different phenotypes by P-value of (0.035). The mean insulin sensitivity in all phenotypes of PCOS were 31.05 with significance of high serum insulin level by P-value of 0.003.

Conclusion: The current study found out that high serum insulin level plays a major role in the development of PCOS.

Keywords: Polycystic ovarian syndrome; Hyperandrogenism; Oligo/anovulation; Reproductive age; Body mass index.

Background and objective: The coronavirus disease pandemic, was a serious threat to global health, which attacked the community in December 2019 without warning and had disastrous effects. Inflammatory factors are important for COVID-19 mortality. We aimed to identify potential demographic risk factors as well as the potential role of procalcitonin and other inflammatory biomarkers as indicators of severity and outcome in patients with COVID-19.

Methods: A cross-sectional prospective study that was conducted in Lalav Hospital, West Emergency Hospital and a Private clinical center in Erbil city, Iraq. The cases (106) were collected from August 2021 to November 2021. All included patients were diagnosed with COVID-19 through laboratory confirmation using real-time reverse transcriptase–polymerase chain reaction (RT-PCR).

Results: Our results showed that serum procalcitonin levels were significantly higher and positively correlated with mortality in COVID-19 patients (P = 0.005). The severity of COVID-19 and abnormal serial measurements of plasma D-dimer and serum C- reactive protein levels were found to be significantly correlated (P = 0.028 and P = 0.041, respectively). Diabetes, hypertension, and advanced age were noted as risk factors.

Conclusion: Procalcitonin may be an indicator of disease severity. Serial procalcitonin measurements and the recognition of potential risk factors are crucial for predicting the prognosis among COVID-19 patients.

Background and objective: The aims of the present research were to study the clinicopathological features of adult classical Hodgkin lymphoma (cHL) in Hawler city and to evaluate the significance of immunohistochemical expression of CD68 positive tumor associated macrophage in the tumor microenvironment as a marker for prediction of malignant progression.

Methods: This is a retrospective cross-sectional study carried out in Rizgary Teaching Hospital and Nanakaly Hospital in Hawler city –Iraq in which 110cases of cHL patients were enrolled from January 2015 to July 2022.Clinical data were obtained from the hospital’s medical records. All specimens were revised for histopathological and immunohistochemical diagnosis of CD15 and CD30 followed by staining with CD68 using IHC.

Results: The IHC showed 56.36% of cases expressed intermediate staining score for CD68 immune marker whereas 27.27% expressed high staining score. A positive association was found between staging of the cases and CD68 immune expressions.

Conclusion: Positive CD68by immunohistochemical analysis on TAM have diagnostic significance, its overexpression may predict cancer progression.

Background and objective: Prenatal vitamin D insufficiency has been linked to serious negative neonatal outcomes. This study aimed to evaluate the prevalence of vitamin D deficiency in pregnant women and compare maternal and umbilical cord vitamin D levels.

Methods: A cross-sectional study was conducted on 60 women who gave birth vaginally at Maternity Teaching Hospital in Erbil city, Kurdistan region, Iraq from January to December 2021. Total serum 25(OH) vitamin D concentration was measured from each woman during labor and her newborn umbilical cord blood. To determine how strong the link between both levels is, the Pearson (r) correlation coefficient was used.

Results: More than 98% of participants had a significant vitamin D3 deficiency, compared to 88.3% of their newborn children. There was A strong correlation between newborns’ and mothers’ vitamin D3 levels (r = 0.726, P <0.001).Thenewborns' mean D3 levels (15.8 ± 8.3 mmol/l) were not appreciably (P = 0.064) greater than their mothers' (13.2±7.0 mmol/l) mean D3 levels. There was a strong, significant correlation between newborns’ and mothers’ vitamin D3 levels (r = 0.726, P <0.001). The majorities of the women were either illiterate or only had primary education, and more than half of them lived in rural areas.

Conclusion: Regarding severe vitamin D3 deficiency, no discernible differences between mothers and their offspring were found, and newborns' vitamin D3 levels correlated strongly and significantly with their newborns.

Background and objective: Around 180,000 people die from burn injuries annually, which can result from heat, radiation, electricity, friction, or chemicals. Axillary and web post-burn contractures are prevalent and significantly limit the range of motion and quality of life, traditional contracture release procedures can result in donor site morbidity and low functional outcome. Range of motion after Starplasty flap for contractures in different part of the body

Methods: A longitudinal study that includes 20 cases selected to undergo Starplasty operation, and then were followed for three months. The study was conducted in three main hospitals in Erbil city (Rizgary Teaching Hospital, Western Emergency Hospital and Emergency Hospital), The investigation started in November 2020 and continued until June 2022.

Results: A total of 20 patients, including both children and adults, underwent contracture release surgery using Starplasty. The mean preoperative ROM (range of motion) was 30.5% of the normal value, which was increased to 56.6%, 66.0%, 75.3%, and 88.2% of the normal value, postoperatively (after one week, one month, and three months, respectively). On all follow-up occasions, the mean ROM increased significantly (P <0.001).

Conclusion: Starplasty was a successful and safe procedure in treating both Axillary and web space contractures. In the absence of significant complications and graft failure, a response exceeding 50% of the normal range of motion can start as early as one week postoperatively.

Background and objective: Isoxazoles are significant heterocyclic products that are used in various applications in the field of medicinal chemistry. Along with prescription drugs, a variety of bioactive pharmaceutical substances, such as valdecoxib, leflunomide, and danazol, include the isoxazole core. The present work aimed to synthesize and test the antibacterial, antioxidant, and antifungal activities combined with the theoretical investigations.

Methods: Various 2,4-disubstituted isoxazoles have been synthesized through a 1,3-dipolar cycloaddition reaction via nitrile oxide. The structures of synthesized compounds were fully characterised by multinuclear NMR spectroscopy. Anti-bacterial activity was investigated against Escherichia coli and Staphylococcus aureus by Muller Hinton agar using agar diffusion method. The biological effect of the synthesized compounds was investigated with the docking study.

Results: Herein, nine new target compounds were synthesized in moderate to high isolated yield. Naphthalene and chlorophenyl isoxazole substitutes have been found to enclose a higher effectiveness against bacterial, fungus and radical scavenging abilities based on the docking binding site energy.Compounds5a-e exhibited various antibacterial activities against Escherichia coli as gram-negative bacteria ranging from 21 to 40 mm of the inhibitory zone (30 µg). The compound 5eexhibiteda significant antioxidant activity using the 1,1-diphenyl-2-picrylhydrazyl radical (DPPH) (97.8 %). A range of docking energy scores between -9.4 and -13.7Kcal/mol were observed for the compounds5a-g and 9a-c.

Conclusion: The newly synthesized 2,4-disubstituted isoxazole compounds could serve as potent leads for the development of antimicrobial agents.

Background and objective: Helicobacter pylori infection and metabolic syndrome are two progressive factors noticed in developing countries, but their association is still controversial. This study aimed to determine the prevalence and association of Helicobacter pylori infection in both subjects with and without metabolic syndrome.

Methods: A case-control study was conducted at the Ble General Hospital, 658 subjects taken and divided into two groups first those who were diagnosed as metabolic syndrome (328 subjects) and second control group (330 subjects). Helicobacter pylori-specific IgG antibody and some biochemical tests were performed for both groups besides other parameters like blood pressure and BMI.

Results: Having metabolic syndrome is associated with a higher probability of having Helicobacter pylori Abs (OR = 1.6; 95% CI = 1.096-2.341). Age group 40-49 years had more probability to have Helicobacter pylori Abs (OR = 2.054; 95% CI = 1.086-3.883). The prevalence of metabolic syndrome reported higher in females (77.4 %). No significant differences were detected between the rapid method and the ELIZA method for the detection of stool Ag (P = 0.921) but differences were significant in the detection of Helicobacter pylori Abs (P <0.001).

Conclusion: The study demonstrates that having metabolic syndrome is associated with a higher probability of having Helicobacter pylori Abs compared with the controls. This study also showed immunochromatography is reliable for the detection of Helicobacter pylori stool Ag but not Ab.

Background and objective: Asthma is a common respiratory disease that affects people all over the globe. WHO estimates that nearly 300 million people around the globe suffer from asthma. In 2025, experts predict there will be 400 million of them, with a yearly mortality rate of 250,000. The aim of this study is to examine the role of an educational program in improving the quality of life of asthmatic teenager students in Erbil city.

Methods: In the school year of 2021-2022, 70 students with asthma aged 12 to 19 years from Erbil city participated in quasi-experimental research. Sydney Asthma Quality of Life Questionnaire (AQLQ-S) and the Juniper Asthma Quality of Life (AQLQ-J) were the study instruments used (after modifications) to assess the asthma quality of life.

Results: The majority (62.9%) of the students were between the ages of 15 and 17 years. More than half of the sample were females, 82.9% were from urban areas, and the majority were in intermediate school. The results revealed that before the educational program was implemented, 31.4 % of the asthmatic students had a low quality of life, while 68.6 percent had a moderate quality of life. Quality of life and asthma control both showed substantial gains from the educational strategy.

Conclusion: An educational intervention implemented in the classroom can significantly improve asthma outcomes, including a decrease in the number and severity of asthma symptoms and an increase in the ability to keep asthma under control.

Background and objective: When a blood clot forms in an artery or a vein, it is called thrombosis. Thus, D-dimer can be thought of as a biomarker of activation of coagulation and fibrinolysis, and it is frequently used to rule out venous thromboembolism (VTE). This study was conducted to find out the relationship between RBC, WBC, Hb, platelets with the thrombotic variable, which is represented by D-dimer and impact of Pfizer vaccine on these variables.

Methods: Forty male and female patients aged 40 – 65 years with complete data records were included in this analysis for evaluation the correlations among RBC, Hb, WBC, platelets, and d-dimer. Ten students (male and females) aged 19-22 years and 10 old subjects aged 44-73 years were used for estimation the effect of the Pfizer vaccination on previous parameters.

Results: The results of this study showed that there is no correlation between all these measures and the D-dimer. Only there was a positive correlation between RBC and Hb, and between WBC and Hb. In addition, there was an increase in WBC, platelets and D-Dimer after one week of receiving the Pfizer vaccine in young and old groups.

Conclusion: There is no correlation between a rise or a decrease in the counts or levels of hematological measures (RBC, WBC, Hb, platelets) with the occurrence of thrombosis. The study also revealed that the Pfizer vaccine had an elevated effect on the WBC, platelets, and d-dimer measurements after one week.

Background and objective: Corona virus pandemic shifted research toward focusing on identifying individuals at risk of contracting the virus. New reports linked obesity with outcome of COVID19, cytokine storm been implicated in immunopathogenesis of COVID19. This study aimed to investigate the impact of bodyweight on the cytokine dysregulation in COVID-19 patients.

Methods: This study included 294 participants, classified into four groups: exposed, non-exposed, vaccinated and non-vaccinated, this classification made on the basis of viral exposure and vaccinations status. The participants further divided into obese and non-obese. The concentration levels of IL-2, IL-8 and lymphocyte measured for all the participants enrolled in this study.

Results: IL-2 concentration was moderately increased following vaccination in non-exposed and exposed individuals, the highest level (200 pg/ml) detected among COVID-19 exposed group. Similar changes were detected for IL-8 concentration following vaccination. The highest level of IL-8 (211.3 pg/ml) was among exposed-vaccinated group. In addition, vaccination induced lymphocyte counts in both control vaccinated and exposed vaccinated groups 31.4 cells/ml and 33.2 cells/ml respectively. Moreover, obese groups showed highest levels of both IL-2 and IL-8 concentrations in all study groups compared to non-obese ones, this finding was also applicable for the lymphocyte concentration levels but to lesser extent.

Conclusion: Obesity might increase the risk of developing a severe COVID-19 infection. Although there was upregulation in IL-2 and IL-8 among obese participants, but they were statistically non-significant. Vaccination could have a role in modulation of these cytokines.

Background and objective: Neuropathic pain is a type of pain that originates from damage or dysfunction of the somatosensory nervous system. Managing neuropathic pain is a challenging task as it is chronic and has limited treatment options. Pregabalin and duloxetine aim to alleviate neuropathic pain symptoms and enhance quality of life for patients. The comparative effectiveness of these drugs, particularly at lower doses that are typically provided in the Kurdistan Region of Iraq, is still a topic of inquiry that is presently being carried out. The objective of the study is to evaluate and compare the effectiveness of pregabalin and duloxetine on pain management and sleep quality in patients with neuropathic pain. Such insights are crucial for optimizing neuropathic pain management strategies and improving patient outcomes.

Methods: in this prospective study, 80 patients displaying signs and symptoms of neuropathic pain such as sharp, stabbing, numbness, and/or burning pain as well as tingling, loss of balance and coordination, and/or muscle weakness, especially in the feet were prescribed either pregabalin (n=40) or duloxetine (n=40) with mean doses of 82.5± 5.16 mg/day and 34.5± 2.46 mg/day, respectively, administered once or twice daily for 4 weeks. The results were based on the effectiveness of the drugs in reducing visual analogue scale and pain related sleep interference scale scores.

Results: Both pregabalin and duloxetine reduced the signs and symptoms of neuropathic pain, demonstrating similar efficacy within the first 3 weeks of the treatment. However, by the 4th week, duloxetine exhibited superior effectiveness in managing neuropathic pain (P = 0.001). On the other hand, findings showed no significant difference in the reduction of sleep scores (P = 0.978).

Conclusion: Both pregabalin and duloxetine are similarly effective in managing neuropathic pain during the first 3 weeks of treatment. However, when the treatment duration extends beyond 3 weeks, duloxetine demonstrates superior effectiveness in reducing neuropathic symptoms.