Journal of Emergency Medicine, Trauma and Acute Care - 6 The Anbar 2nd International Medical Conference (AIMCO 2022), December 2022

Background: The socio-clinical characteristics have been considered an important variable associated with COVID-19 and a predictor of morbidity and mortality. Convalescent plasma therapy (CPT) was one of the modalities used worldwide for COVID-19 treatment. In Iraq, there is a paucity of studies evaluating the socio-clinical variables of patients with severe COVID-19 treated with CPT. Objectives: This study aims to describe the socio-clinical characteristics of patients with severe COVID-19 treated with and without CPT in one of the main COVID-19 treatment centers in Iraq. Materials and Methods: A descriptive cross-sectional study was conducted between May 15 and August 14, 2020, at the main COVID-19 treatment center in Anbar Governorate, west of Iraq. Out of 529 hospitalized patients, a total of 438 with severe disease were enrolled in the study. Results: The participants’ mean age was 49.9±13.8 years. The majority of the subjects were males, aged ≥40 years, residing in urban areas. 65.2% of the patients had at least one comorbidity, and 6.4% were smokers. Hypertension and diabetes mellitus represented the two commonest comorbid conditions. All patients have required oxygen therapy; 41.1% were performed with continuous positive airway pressure. Male patients aged ≥60, and patients with comorbidities received CPT at a higher frequency. Conclusion: This study corroborates the findings from other studies that certain socio-clinical characteristics had an association with hospitalization related to severe COVID-19. Convalescent plasma was administered in more than one-fifth of the COVID-19 hospitalized patients in Anbar during the early pandemic phase.

Background: Pneumothorax in neonates is a hazardous condition with a high incidence of complications and death. It is more frequent than at any other time of life and requires rapid management in the first three days of the neonatal period. Objectives: This study aims to identify the predisposing factors and incidence of pneumothorax in the neonatal care unit at Al-Ramadi Teaching Hospital for Maternity and Children. Materials and Methods: A retrospective cohort study was conducted in the neonatal care unit from 1st January to 31st December 2020. It included 6198 neonates admitted to the inborn and out-born neonatal care unit and collected from the archives files. Any newborn who developed pneumothorax was recorded as an outcome. Data regarding the age, gender, body mass index, antenatal care, antenatal steroids, gestational age, mode and place of delivery, and Apgar score for each case were registered. Results: In this study, pneumothorax was identified in 47 of the recruited newborns, giving an incidence of 0.8%. It occurred spontaneously in 25 (53.2%) of them. The proportion of pneumothorax was significantly higher among males, birth weight < 2500 g, delivered with gestational age < 32 weeks, 5 minutes Apgar Score < 7, those who needed active resuscitation, neonates whose mothers delivered through Cesarean section, delivered at home, did not receive antenatal care during the last pregnancy and did not receive antenatal steroids. Conclusion: The incidence of pneumothorax in newborns was 0.8%. The most important associated factors that may increase the incidence of neonatal pneumothorax were male gender, low birth weight, prematurity, low Apgar score at birth, Cesarean section mode of delivery, home deliveries, and lack of antenatal steroid injections.

Objective: This study aims to evaluate the occurrence of Y chromosome azoospermia factor (AZF) microdeletions and assess immune infertility incidence and whether there is a correlation between them.

Materials and Methods: The sample included 75 infertile men who were referred to private clinics in Ramadi city as a test group and 25 healthy fertile men as a control group. The tests included analysis of seminal fluid and detection of the antibodies against the sperms at both seminal fluid and serum and diagnosed chromosomal deletions via real-time polymerase chain reactions using specific sequence-tagged sites.

Results: The results reveal that 46 (61.33%) patients in the group of infertile men have AZF microdeletions, while no deletions are present in the control group. Out of the 75 infertile men, 5 patients (6.66%) from all the study groups have positive results for anti-sperm antibodies (ASA), while the others have negative results for ASA in both serum and seminal plasma.

Conclusions: The prevalence of AZF microdeletions in our study population is high in Anbar Governorate of Iraq, while we find a low incidence of ASA in this study. All the patients with positive ASA results are without deletions in the Y chromosome’s AZF region. So there is no correlation between AZF microdeletion and ASA generation in infertile men in the current study.

Background: The pandemic SARS – CoV2 is a novel virus disease that first appeared in China in December 2019. On February 24, 2020, the disease spread throughout Iraq, and many different studies were conducted on it. This study highlights the procedures for diagnosing COVID-19 and evaluating tools among Iraqi patients through a systematic review of research conducted in Iraq during the past two years (2020–2021).

Methods: From March 2020 to December 31, 2021, articles on relevant themes were carefully searched in the main databases: Science Direct, PubMed, Embase, and Iraqi Academic Scientific Journals. Using keywords related to COVID-19 and Iraq yielded a total of 2743 articles. Articles were chosen for this systematic review based on inclusion and exclusion criteria, according to the PRISMA 2020 statement for reporting systematic review. Only Iraqi studies that reported data on diagnostic procedure outcomes were included, with a total of 21 articles chosen.

Results: A total of 21 articles were found to be relevant, which reviewed the biochemical and hematological parameters as diagnostic procedures and tools in Iraqi patients. The biochemical parameters are as follows: triglycerides, cholesterol, APRs, liver functions tests, kidney functions tests, antibodies, cytokines, and minerals. The hematological parameters are as follows: ABO group, red blood cell (RBC) indices, white blood cell (WBC) indices, and platelet indices.

Conclusion: Diagnostic procedures and tools for COVID-19 among Iraqi patients were in agreement with the majority of other global studies. High serum erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), ferritin, d-dimer, lactate dehydrogenase (LDH), and cytokines were associated with severe COVID-19 pneumonia and also hypoalbuminemia, lymphocytopenia, and neutrophilia. Biochemical and hematological parameters might be significant indicators for COVID-19 evaluation.

Background: Multiple myeloma (MM) is a clonal proliferation of malignant plasma cells that results in the production of a monoclonal paraprotein with a light or heavy chain that is seen in the urine and/or serum. The ultimate goal of the MM therapy is the achievement of complete response (CR). The aim of this study is to evaluate the efficacy of the commonly used therapeutic protocols of MM utilized at the National Center of Hematology in Baghdad, Iraq.

Materials and Methods: Fifty-two patients with MM were enrolled consecutively for a cross-sectional study between July 2015 and May 2022 at one of Iraq’s major hematology institutions, the National Center of Hematology, Mustansiriyah University. The enrolled patients were evaluated for the overall response rate (ORR), which constitutes CR, very good partial response, and partial response, in comparison to non-response (NR), which constitutes stable disease and progressive disease. Responses to the main MM triple therapeutic regimens used in Iraq, VCD, VRD, and VTD, were evaluated. These regimens are composed of cyclophosphamide (C), bortezomib (V), thalidomide (T), lenalidomide (R), and dexamethasone (D). According to its availability, subsequent autologous stem cell transplantation (ASCT) was performed for some patients.

Results: Of the 52 enrolled patients, 50 (96.2%) were assessed at a median follow-up time of 60.5 months. The mean ± SD age of the enrolled patients was 61.5 ± 11.0 years, and the male-to-female ratio was 3:2. However, two patients (3.8%) died before the end of the follow-up. The most common features the patients presented with were bone pain and/or backache in 67.3% of the patients, followed by lower limb weakness and mass (1.9% each). The radiological changes include osteolytic lesions in 34.6% and vertebral wedging in 15.4% of the patients. The most frequent laboratory findings were anemia (69.2%), with hemoglobin levels of 10.0 ± 1.5g/dL, detection of IgG-kappa paraprotein (51.9 %), and high levels of serum calcium in 23.1% (11.7 ± 1.1mg/dL) and serum creatinine in 21.2% (3.3 ± 1.5mg/dL) of the patients. ORR was 88.5%, while NR was reported in 11.5% of the patients. The outcomes were stratified according to the treatment used. It was found that ORR showed statistically significant differences and the VRD group demonstrated the best (P < 000.1). Twenty-one (40.4%) patients underwent subsequent ASCT, and the ORR showed non-significant differences compared to that when patients did not undergo transplantation (P > 0.05).

Conclusions: In this study, VRD was the most effective protocol with a better ORR. In addition, the age of the patients presenting with MM in Iraq was less than in western countries. Also, most of the patients were presented with bone lesions, and IgG was the predominant type of myeloma paraproteins.

Background: Various digestive symptoms caused by COVID-19 are frequently reported. This study aims to describe the most frequent digestive signs in patients with COVID-19, the relationship between the severity of digestive symptoms and some serological markers associated with liver manifestation, the detection of SARS-CoV-2 in a stool sample, and the mortality rate of those patients.

Materials and Methods: A descriptive cross-sectional study on 100 confirmed COVID-19 cases with digestive and hepatic manifestation in one center (Fallujah Teaching Hospital), Anbar governorate, Iraq, during a period of study. Questioner’s data were formed for all patients regarding age, sex, and comorbidities such as diabetes and hypertension. Liver function enzymes such as alanine aminotransferase (ALT), aspartate aminotransferase, alkaline phosphatase, total bilirubin (TBIL), and direct bilirubin and haematological parameters such as ferritin D-dimer, C-reactive protein (CRP), albumin, amylase, leukocyte count, and prothrombin time were used. SARS-CoV-2 prevalence in stool is determined using reverse transcription polymerase chain reaction according to manufacturer’s instructions. The mortality rate of patients with COVID-19 was also determined. Data were followed up until April 22, 2022.

Results: Patients with digestive symptoms who had COVID-19 had an average age of 45.03 (SD 20.078), 52 (52%) were men, and 48 (48%) were women. No statistically significant variances were observed in the severity of digestive symptoms among age groups. The three digestive symptoms that patients with COVID-19 experienced most frequently were fatigue, fever, and abdominal colic. SARS-CoV-2 was detected in the stool of 11% of the patients with COVID-19 with digestive signs. The COVID-19 mortality rate was 9%. Statistically, significant variance was observed in ALT (P value 0.01) and TBIL (P value 0.0027) levels between mild, moderate, and severe gastrointestinal (GI) diseases. The levels of CRP varied considerably among those with mild, moderate, and severe GI conditions (P value 0.0182, according to the findings). In mild, moderate, and severe GI disorders, ferritin levels differed considerably (P value 0.05).

Conclusions: The faecal sample with a nasopharyngeal swab is needed to confirm COVID-19 diagnosis; hepatic manifestations are connected with increased COVID-19 mortality in individuals with digestive symptoms.

When mutation is inactivated in the follicle-stimulating hormone receptor (FSHR) gene of patients with amenorrhea, the receptor’s functionality is abolished by completely blocking it, altering the ligand–receptor complex or altering the essential hormone signal transduction. This study aims to detect the frequency and pattern of chromosomal abnormalities and the presence of inactivating mutations (Ala575Val) at position 1540 of the FSHR gene in Iraqi women diagnosed with secondary amenorrhea (SA) and primary amenorrhea (PA). This cross-sectional study was carried out between February and August 2022. Depending on the initial diagnosis of amenorrhea, women were split into two groups: PA and SA. The polymerase chain reaction–restriction fragment length polymorphism (PCR-RFLP) was done for those women with normal karyotyping and hypergonadotropic hypogonadism [follicle stimulating hormone (FSH) > 20 mIU/ml] to determine the genetic cause, such as inactivating mutation in Exon 10E. The FSH of blood in study patients with PA was 72.28 ± 23.60, luteinizing hormone (LH) was 20.60 ± 13.55, and BMI was 24.012 ± 4.06. In SA, the FSH, LH, and BMI values were 69.821 ± 35.95, 16.788 ± 14.12, and 26.12 ± 4.37, respectively. Also, highly significant differences were observed compared with healthy control subjects (P-value < 0.005). The high matching between the results obtained by PCR-RFLP and those obtained by Sanger sequencing techniques used in this study confirmed no detected mutation in Ala575Val at position 1540 in all patients with PA and SA. The study concluded that in the PCR study, Ala575Val encoding genes are highly detected, while in PCR-RFLP, no action of MscI restriction enzyme in position 1540 (region of Ala575Val genotype) has emerged. This gives the impression that women with amenorrhea in the Iraqi population might not have any inactivating mutations in the FSHR gene.

Objectives/Background: Since the outbreak of COVID-19, healthcare professionals suggested a wide range of recommendations in the fields of diagnosis, treatment, and prevention. Laboratory biomarkers are considered one of the crucial diagnostic tools for COVID-19, assessing its severity and progress predictor. Owing to the lack of consensus regarding changes in biomarkers and their correlations, researchers are encouraged to detect more interesting findings. A few studies were conducted in Iraq considering this aspect. This study aimed to investigate certain biomarkers in patients with severe COVID-19 and their relations to mortality outcomes. Also, this study aimed to identify the correlation between these markers in severe disease.

Patients and Methods: A cross-sectional study was conducted at the Fallujah Teaching Hospital, west of Iraq, which included all admittance with severe COVID-19 between September 20, 2021, and February 30, 2022. A questionnaire was designed to collect socio-clinical characteristics and in-hospital outcomes (recovery/death). Procalcitonin (PCT) and certain biomarkers were analyzed, based on that outcome, and correlations between these markers were assessed.

Results: For 75 patients who were enrolled in this study, the mean age was 62.3 ± 14.3 years, of which females constituted 62%. The most preponderance age was ≥60 years with a statistically significant higher rate of death (37.3%) when compared to other ages (P = 0.007), while other socio-clinical characteristics revealed nonsignificant differences. High PCT levels were found in 34.7% of the enrolled patients, while neutrophilia, lymphopenia, and elevated levels of troponin, ferritin, and C-reactive protein (CRP) were the prominent abnormal biomarker findings. However, only ferritin and troponin mean levels revealed significant differences in relation to the outcomes (P = 0.019 and 0.010, respectively). A moderate positive correlation was found between PCT and interleukin-6 (IL-6) (r = 0.586, P = 0.005), and also PCT correlates positively with CRP (r = 0.49, P = 0.005) and troponin (r = 0.41, P = 0.001). Additionally, there were significant positive correlations of troponin with IL-6 (r = 0.41, P = 0.005) and PCT (r = 0.37, P = 0.001). Also, IL-6 correlates positively with troponin (r = 0.62, P = 0.005).

Conclusions: We found an elevated level of PCT in almost three-quarters of patients with severe COVID-19, with a non-significant difference with the specific recovery/death outcomes. In addition, high troponin levels, neutrophilia, and lymphopenia regardless of the outcome were found. Also, there were valuable correlations between certain biomarkers in patients with COVID-19.

Background: Vaccine development against coronavirus disease 2019 (COVID-19) is vital for pandemic containment. Reluctance or fear of taking the vaccine is a significant impediment to achieving full population immunity coverage. Medical students’ knowledge and education about vaccination are essential, as they will serve as healthcare providers.

Objectives: This study aimed to verify the major factors and barriers affecting vaccine acceptance.

Materials and Methods: A cross-sectional study was carried out in four of the main medical universities in the middle of Iraq. The survey was achieved via an online questionnaire in December 2021 from 638 medical students.

Results: Out of 4500 medical students, there were 638 participant respondents to the survey with a response rate of 14.2%. The main factor affecting vaccine acceptance is the probability of getting infected. The vaccination rate was significantly higher in those vulnerable to infections (p-value = 0.03). Most students (50.3%) believe that the vaccine was safe, and the vaccination rate was statistically significant in those groups (p-value = 0.0001). About 46.2% of the students believe that the vaccine is effective against the infection of COVID-19 (p-value = 0.0001), 44.8% of students were sure that the vaccine did not have major complications (p-value = 0.00001), and 41% (n = 262) of participants thought that the immunity acquired after SARS-CoV-2 infection is better than the immunity acquired by vaccination (p-value = 0.00001).

Conclusion: Vaccine efficacy and beliefs in immunity following COVID-19 were the most influential factors in vaccine intake. The concept of vaccination is widely accepted among medical students, and there is raised awareness about how important to get vaccinated.

Background: Abnormalities in liver function tests (LFTs) are found in 14%–53% of hospitalized COVID-19 patients. These could occur in patients with or without previous chronic liver diseases. Knowing the risk factor of liver manifestations in COVID-19 subjects is crucial for the proper management of these patients.

Objectives: We aimed to identify the risk factors for liver manifestations as well as other risk factors in COVID-19 subjects who complained of digestive manifestations.

Materials and Methods: COVID-19 patients with and without liver manifestations at the Emergency Department of Al Fallujah Teaching Hospital were enrolled in this study. This study covered a period from September 15, 2022, to April 22, 2022. Comparisons between patients with or without abnormal LFTs were made. The possible risk variables connected to abnormal LFTs and hepatic manifestation were investigated using univariable and multivariable logistic regression analysis.

Results: Out of 100 COVID-19 patients, there were 64 suffering from mild gastrointestinal (GI) symptoms. There were 26 mild cases with abnormal LFTs (40.6%). Although there were nine (total number 22) and seven (total number 14) of the moderate and severe cases with liver involvement, there was no statistically significant difference between the digestive manifestations severity and liver involvement. Increased alanine aminotransferase (ALT) levels were linked to a greater incidence of LFTs, according to multivariable analysis (odds ratio [OR]: 45.05; P < 0.0001), elevated aspartate aminotransferase (AST; OR: 3.462; P = 0.00041), elevated direct bilirubin (DBIL) (OR: 3.643; P < 0.001), and elevated d-dimer levels [OR]: 2.690; P < 0.0137) in liver involvement group compared with non-involvement patients.

Conclusions: Elevated ALT, AST, DBIL, and d-dimer are potential risk factors for liver manifestations in COVID-19 patients with digestive symptoms.

Objective: The aim of this paper was to assess the prevalence and association between H. pylori infection and alcohol, or cigarette use among Iraqi patients.

Methods: 115 individuals needed upper gastrointestinal endoscopies in total. Reverse transcription polymerase chain reaction (RT-PCR), urea breath test, rapid urease test, CagA-IgG, and culture were all used to confirm H. pylori infection. The information on alcohol consumption, smoking, sex, and age was collected using a standard questionnaire.

Results: The gold standard test, RT-PCR, was used to detect H. pylori infection in 81 (70.4%) of patients. H. pylori infection was not affected by age (OR: 0.976; CI: 95% (0.944-1.009; P > 0.05), sex (OR: 1.26, 95% CI: 0.57–2.75; P > 0.05), or alcohol intake (OR: 0.293; CI: 95% (0.081-1.058; P > 0.05) according to the binary logistic regression analysis. Additionally, there was a considerable inverse association between smoking and H pylori infection (OR: 0.094; CI: 95% (0.025-0.352; P < 0.05). According to binary logistic regression analysis, both smoking (OR: 0.036; CI: 95% (0.007-0.182; P < 0.05) and alcohol intake (OR: 0.179; CI: 95% (0.041-0.988; P < 0.05) were inversely and significantly related with H. pylori illness whereas H. pylori infection did not alter with age (OR: 1.001; CI 95% (0.959-1.044; P > 0.05) in the male subgroup.

Conclusions: According to the study, males who smoke and drink are more likely to have H. pylori infections. Furthermore, there was no positive association between age and H. pylori infection.

Background: Acute aortic dissection (AAD) is a serious emergency. This prospective study aims to reveal the clinical characteristics and outcomes of medical and surgical treatments of AAD at the Ibn Al-Bitar Cardiac Centre.

Methods: Over a 30-month period ending on Feb 27, 2019, 33 patients (27 males) admitted within 14 days after the onset of AAD symptoms were enrolled. The diagnosis was based on clinical findings and was confirmed by echocardiography and/or CT aortography. Intensive medical therapy was immediately initiated. Stanford classification was applied. Uncomplicated type B aortic dissections (AD) were managed conservatively while complicated type B and all type A dissections were referred for surgery. Perioperative data were entered into a Microsoft Excel-designed database, and the results were collected and statistically analyzed.

Results: The male-to-female ratio was 9:2. The age range was 22–75 years, with a mean age of 48.8 ± 13.9 years. The main risk factors were hypertension (66.66%), smoking (42.42%), and Marfan’s syndrome (15.15%). In 84.84% of the cases, chest pain was the presenting symptom. CT aortography revealed dissection of the thoracic aorta in 91% of the cases and the abdominal aorta in 51.5% of the cases. A total of 24 (72.7%) patients had type A AD, and 7 (21.2%) patients had type B AD, whereas two (6.1%) had Non-A Non-B categories. Among those with type B AD, 71.42% had complications. For 48.5% of the patients, surgery was offered. The overall mortality rate was 48.5%, matching the rates that had been already published. Surgery had a lower mortality rate than medical treatment (37.5% vs. 62.5%). The mortality rate of type A was higher than type B (58.3% vs. 28.6%).

Conclusions: Urgent surgery performed by expert surgeons is essential to save victims of AAD primarily type A dissection.

Background: Adolescent hypertension is associated with significant health problems and can be progressive into adulthood.

Objective: The study was conducted to assess the prevalence of hypertension among intermediate school children (12–15 years) in Ramadi city and identify some of the possible associated factors.

Methodology: A cross-sectional study was done on a sample of students who attended governmental intermediate schools in Ramadi city during the first school term (between October 1, 2019, and January 31, 2020). A total of 1817 pupils from different schools were included in this study. Blood pressure was measured for every child to obtain blood pressure percentile. Blood pressure percentile was derived from the blood pressure table in “THE FOURTH Report on the Diagnosis, Evaluation, and Treatment of High Blood pressure in children and Adolescents”. Weight and height were measured for every child to obtain the body mass index. Associated factors (age, gender, residence, physical activity, sleeping hours per day, and family history of hypertension) were assessed by a questionnaire specially prepared for this purpose.

Results: In this study, the prevalence of hypertension was 87 (5.7%), and prehypertension was 148 (9.8%) among intermediate school children in Ramadi city. The prevalence was nearly the same for males and females: without significant association with increasing age. Blood pressure was significantly influenced in children whose parents were hypertensive, a child who was obese, physically inactive, sleep for more than 10 hours per day.

Conclusion: Hypertension prevalence was found among adolescents in Ramadi city, west of Iraq. Efforts are needed to diagnose those cases and to explain the expected risk factors to their families.

Background: Many advances have been made in managing neonates with esophageal atresia/tracheoesophageal fistula (EA/TEF). This resulted in a progressive decrease in mortality as a result of improved neonatal intensive care and neonatal mechanical ventilation; however, this is not the case in developing countries.

Objectives: We aimed to evaluate the efficacy of postoperative ventilation in neonates with EA/TEF in Iraq as a developing country.

Materials and Methods: It is a prospective study for all neonates with EA and/or TEF admitted to the pediatric intensive care unit (PICU) in Alkhansaa Teaching Hospital between December 2012 to December 2014. Forty operated neonates were randomly divided into two groups according to the record number of presentations (even = G1, odd = G2): Twenty patients (group l) had been assigned to be post-operatively on a ventilator as a routine protocol. While group 2 planned to be extubated in the theater. We evaluated the complications and mortality rates in two groups.

Results: For 24 months, 40 neonates with EA/TEF were admitted to PICU; Thirty-two were operated on within 24 hours of life. There were no significant differences between the two groups regarding fetal maturity (p-value 0.490), gender, and weight. The mean period for mechanical ventilation was four days. Six neonates had tube mal-positioning complications, leading to lung collapse, hypoxia, and pneumonia (p-value 0.250). Anastomotic leaks occur in 10 neonates (five in each group) (p-value 0.642), which sometimes leads to sepsis (p-value 0.347). Trachea-malacia was recorded after weaning in 5 intubated patients (p-value 0.078). The mortality rate in G1 was 35%, while in group 2 was 25% (p-value 0.366).

Conclusions: Although the study’s sample is small, it is recommended to avoid mechanical ventilation in the postoperative care of neonates with EA and/or TEF.

Serum cystatin C (CstC) is a type of protein produced by cells at the normal level; when the kidney is in normal condition or function, it inhibits the interstitial cysteine protease. The objective of the current study is to evaluate the levels of CstC and inflammation markers in type 2 diabetes mellitus (T2DM) patients with early diagnosed microalbuminuria (MBA) and find if there is a relationship between CstC and different parameters. Fifty T2DM patients with a mean age of 44.41 ± 6.51 years in the Al-Yarmouk Teaching Hospital were recruited according to the presence of MBA, and they were compared with 40 nondiabetic individuals with a mean age of 42.22 ± 5.33 years as control. Serum CstC, interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α) were estimated by enzyme-linked immunosorbent assay. The mean values of serum CstC, IL-6, and TNF-α in the diabetic patients with MBA were all significantly increased compared to those of the nondiabetic individuals (P < 0.001). In T2DM patients with MBA, there were positive correlations between serum CstC levels and serum creatinine, creatinine urea, and cystatin-c/creatinine ratio. Similarly, there was a strong positive correlation between serum CstC and serum of the inflammatory markers IL-6 and TNF-α. However, there was a negative association between CstC and the estimated glomerular filtration rate-Larson equation. The results of the current study suggest that serum CstC, IL-6, and TNF-α may potentially serve as biomarkers for the early detection of MAB in patients with T2DM.

Background: Globally, there is an increment in the cesarean section rate. Although the cesarean section is a lifesaving surgery in some cases, it is not safer than vaginal delivery and associated with higher maternal and perinatal complications. Many cesarean sections nowadays are performed for non-medical reasons, and decision-making is affected by social factors and the health standards of the community.

Objectives: The objective of this study is to assess the non-medical reasons for cesarean sections.

Method: This cross-sectional descriptive study was conducted in two teaching hospitals in Anbar province/Iraq. Women who underwent planned cesarean section at term were included. The inclusion criteria were cephalic fetal presentation, normally sited placenta, and no previous uterine scar. A questionnaire was set regarding the medical causes of planned cesarean section and any non-medical reasons that affect the decision-making. Seniors in obstetrics and gynecology in these hospitals responsible for these women were asked to fill in these questionnaires.

Results: Out of 82 women included in the study, 11% were aged 35 years or more and 65.9% were nullipara. About 43.9% of the cesarean sections were performed for a purely medical cause and 34.1% had a medical cause for terminating the pregnancy. Still, decision-making was affected by non-medical reasons, and in 22% of the cases, cesarean sections were done without medical causes. A maternal request for cesarean section was the most common reason for those who underwent cesarean section without a medical cause.

Conclusion: Proper maternal counseling about the potential risks of cesarean section and improving health care in the labor room can help in decreasing the cesarean section rate and its associated mortality and morbidity.

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by SARS-CoV-2. Since 2019, it has spread all over the globe, causing a pandemic that is still ongoing. COVID-19 vaccines protect against this disease through different strategies. Pfizer-BioNTech and Sinopharm vaccines were the most used vaccines in Iraq. Both vaccines have a specific mechanism to trigger the immune system in cells. This research aims to compare the biochemical and immunological responses in vaccinated individuals with either the Pfizer-BioNTech COVID-19 vaccine or the Sinopharm vaccine. This cohort study included 120 Iraqi adults vaccinated with two doses, 21 days apart, using either the Pfizer or the Sinopharm vaccine. Forty subjects received the Pfizer vaccine, 40 subjects received the Sinopharm vaccine, and the other 40 subjects were unvaccinated. After 6 weeks, the second dose was administered, and the blood samples were collected. Our findings revealed that the biochemical biomarkers, urea, creatinine, aspartate aminotransferase, and alkaline phosphatase, seem to be not affected by the vaccines used. However, both vaccines significantly reduced alanine aminotransferase levels (p < 0.05). In contrast, the immunological biomarkers such as IgG, IgM, C3, IL-2, and hs-CRP remarkably responded to both vaccines (p < 0.01), while procalcitonin levels were significantly increased by the Pfizer vaccine (p < 0.05). The study concluded that the Pfizer-BioNTech vaccine boosted the immune system more than the Sinopharm vaccine. A booster dose is advised for people who have already taken Sinopharm or have long-term immunosuppressive diseases.