Journal of Emergency Medicine, Trauma and Acute Care - 3 - The International and Scientific Conference of Alnahrain College of Medicine and Colleges of Medicine in Iraq confronting COVID-19 Pandemic (ISMC-2022) , يوليو ٢٠٢٢

Since December 2019, a local outbreak in China of atypical pneumonia has gradually spread all over the world in a few months; this set off a worldwide pandemic of a newly designated viral respiratory disease called COVID-19 which is caused by a new member of the Coronaviridae family, being named SARS-CoV-2 with multiple emerging variants¹. This pandemic shed a burden on different sectors of life particularly health, economy, and education². The current issue is dedicated to the first of its kind conference held by Alnahrain College of Medicine and Iraqi colleges of Medicine namely "The international scientific conference of Alnahrain College of Medicine and Iraqi colleges of Medicine in Iraq confronting COVID-19 pandemic". This conference aimed at providing a platform for demonstrating and analyzing observational and analytical studies and efforts of Colleges of Medicine and Iraqi health bodies in confronting the COVID-19 pandemic in Iraq. Such conference is necessary to discuss the burden of COVID-19 as well as the efforts and solutions toward this pandemic in Iraq. Moreover, this event shall serve as a good model for other low-income and third-world countries especially those in the region of the Middle East³.

The participating studies in this conference and the selected manuscripts published in this issue cover the challenges of medical education in colleges of Medicine during the pandemic and during the health quarantine, highlighting the role of medical faculties in researching and finding solutions to unprecedented challenges laid by the pandemic. Up to 66 observational and experimental studies on COVID-19 participated in the conference and 14 full articles on these studies are published in this special issue. These studies collectively turned up with essential conclusions and recommendations on how to tackle similar pandemics in the future. The current issue includes community medicine studies on the attitude of the population and medical students in Iraq toward the vaccination programs of COVID-19, efficiency and adverse effects of current therapeutics and immunization programs, severity and spread rate of the disease, the use of social media and telemedicine for online consultation, the impact of the pandemic on the surgical and medical practice, and the particular radiological changes in lungs of COVID-19 patients. In addition, the issue included immunological and virological studies on the causative agent of the disease, SARS-CoV-2, and its related morbid sequel.

It is firmly believed that the current issue on this pioneering conference on COVID-19 in Iraq serves a great purpose, analyzing the previous and current efforts laid for confronting COVID-19 pandemic and drawing conclusions and recommendations for proper alertness for future pandemics of comparable scale whether in Iraq or in the whole region of the Middle East.

Background: Innate immunity plays an important role in deciding the severity of coronavirus disease 2019 (COVID-19) and disease outcomes. Defensins are antimicrobial peptides that are produced by epithelial cells in mucosal locations and play a key role in innate immunity. Understanding COVID-19 mucosal agents and their role in disease severity is critical for developing therapeutic options and identification of prognostic markers for COVID-19. Objective: In this study, we aimed to determine the role of β-defensin-1 in patients with COVID-19 and compare it with that of the control group, as well as to look into the link between β-defensin-1 and oral hygiene and disease severity. Methods: This case-control study included 50 patients with COVID-19 and 35 controls of similar ages and sexes. From November 2020 to January 2021, the patients were admitted to Baghdad Teaching Hospital/Medical City. The simplified oral hygiene index was used to determine oral hygiene status. Blood samples were obtained from all subjects (patients and controls), and the serum levels of β-defensin-1 were measured using enzyme-linked immunosorbent assay (ELISA). Results: Findings showed a non-significant reduction (P>0.05) in the β-defensin-1 level among patients compared with that of the controls. In addition, patients with severe disease had a significantly lower level of β-defensin-1 than those with mild disease. There were no significant variations in the levels of β-defensin-1 between patients with good oral hygiene and those with poor oral hygiene (P>0.05). Conclusions: The reduction in β-defensin-1 levels indicates an abnormal immune response in these patients and may require a new treatment option for this condition in the future. Furthermore, in patients with severe disease, a considerable drop in β-defensin-1 might be used as an indicator of illness severity.

Background: Healthcare providers are facing unprecedented challenges in the era of the coronavirus disease 2019 (COVID-19) pandemic. The current situation compels the use of alternatives for communication between the patients and healthcare providers. The use of telemedicine has expanded globally during the COVID-19 pandemic. The range of online consultations varies from advising patients to providing diagnosis and follow-up. Methods: We assessed the attitudes of health professionals toward the use of social media for online consultations during the COVID-19 pandemic using an online survey that was distributed to medical professionals in Iraq. Results: The total number of participants was 124 Iraqi medical professionals in different specialties (72.4% men and 27.6% women). The majority of participants (71.6%) reported that they had previous experience with online consultation and patient communication using social media before the onset of the COVID-19 pandemic. A large proportion of the participants (72.2%) indicated that online consultation was useful for patient health and safety. Conclusions: Despite the limitations facing online consultation and lack of proper infrastructure for telemedicine in Iraq, many health professionals indicated a positive attitude and recommend extending the use of online consultation after the era of the COVID-19 pandemic.

Background: Severe acute respiratory syndrome coronavirus 2 is the causative agent of coronavirus disease 2019 (COVID-19). The release of alarmins results in a “cytokine storm,” which can be attenuated by the immunomodulatory and anti-inflammatory effects of dexamethasone. Aim: To evaluate and assess the effect of dexamethasone in two different doses, on D-dimer, serum ferritin, C-reactive protein (CRP) levels, and granulocyte/lymphocyte (%) in patients with COVID-19. Patients and methods: A total of 100 patients were randomly divided into two groups; group A patients received a higher dose of dexamethasone than those in group B. Measurements of certain hematological and biochemical markers, including D-dimer, serum ferritin, CRP, and granulocyte/lymphocyte ratio were done for all the patients in both groups. These indices were compared at different times of treatment between the two groups. Results: The D-dimer and granulocyte/lymphocyte ratio measurements were statistically non-significant in both the groups in all three readings. The serum ferritin measurement was significant only on the 6^th day of treatment. The results demonstrated that group A patients had significantly lower CRP levels on both the 3^rd and 6^th days of treatment. Conclusion: Administration of a slightly higher dose of dexamethasone (8 mg per day for three days, then 6 mg per day for another 3 days) in patients hospitalized with COVID-19 effectively reduces the inflammatory and hematological biomarkers in patients who required supplemental oxygen therapy.

Background: Acute limb arterial thrombosis (LAT) is defined as a sudden reduction in arterial supply to the extremity to a degree that affects its viability. Patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease 2019 [COVID-19]) have unbalanced coagulation profiles and are prone to thromboembolic events. Prompt diagnosis of LAT and appropriate urgent intervention, whenever possible, can help decrease morbidity and mortality among these patients and increase the chance of limb rescue. Therefore, this was the stimulus for this study, where based on our clinical experience, we aimed to identify the prevalence and analyze the outcomes of acute LAT in patients admitted with COVID-19 in Baghdad, Iraq. Methods: This study included 135 patients admitted with COVID-19, aged 35–70 years. During admission, these patients were referred to the consultation vascular surgeons because of ischemic changes in their limbs. History, demographics, clinical history, and laboratory tests were collected from all the patients. Vascular Doppler ultrasound and CT angiography were performed in some patients (especially those with re-thrombosis) to finalize the diagnosis and to plan for vascular intervention. Appropriate therapeutic anticoagulants were immediately initiated and once the diagnosis of LAT was established, surgical intervention (under local anesthesia), including thrombo-embolectomy and revascularization, was performed. After postoperative management and anticoagulation were completed, post discharge followup was the final step. Results: The mean age of the enrolled patients was 55.3 ± 7.8 (range 35.1–70.9) years, 86 (63.7%) were males. The mean number of days after the initial COVID-19 manifestation was 22 (16–28). The mean serum levels of D-dimer, CRP, and ferritin were high (795.8 ng/mL, 49.1 mg/mL, and 994.7 ng/mL, respectively). The prevalence of associated risk factors including diabetes, hypertension, and ischemic heart diseases was relatively high. Two-thirds of the patients with LAT had involvement of lower limbs and mostly (69.6%) on the left side. The men represented more than half of the patients affected by LAT in their lower limbs. Re-thrombosis was encountered in 29.6% of the patients, mostly women. Of the total 135 patients with LAT, 14 (10.4%) underwent surgical amputation on presentation to surgical wards or afterwards, however; and unfortunately, 13 (9.6%) of the total patients with LAT died. Most of the recorded mortality among the patients with LAT occurred during hospitalization for COVID-19, nine (75%), regardless of their etiologies. Conclusions: COVID-19 is associated with a high risk of thromboembolic events including LAT. Those with blood group A tend to develop more “re-thrombotic events” than other groups. Even with the successful prescription of prophylactic anticoagulants, young and otherwise healthy cases may be prone to LAT. In patients with COVID-19 and owing to their hypercoagulable state, the surgical intervention of LAT might be harder and more challenging than anticipated. Cardiovascular surgeons and physicians should consider the benefits of extended postoperative anticoagulant administration.

Background: The production of a successful vaccine has become a global dream since the declaration of coronavirus disease 2019 (COVID-19) as a global pandemic by the World Health Organization. However, doubts abound about vaccine safety. In this study, we aimed to estimate and compare the prevalence of adverse effects in Iraqi adults from the COVID-19 vaccines used in Iraq. Methods: The study was a retrospective, cross-sectional study conducted in August 2021. An online-based questionnaire was applied randomly and distributed to individuals ( ≥ 18 years). Results: Among the 1000 vaccinated participants from different regions in Iraq, 66.0% were from middle Euphrates, 61.3% were women, and 62.2% were in their third to fifth decade of life. Approximately, 68.4% of the participants received Pfizer vaccine, and 42.5% had a previous history of COVID-19 infection Figure 1. Most of the participants (84.1%) suffered general adverse effects after vaccination, including (in sequence of appearance) fatigue, fever, headache, injection site signs, and axillary pain. Most studied factors have no significant correlation with post-vaccine adverse effects (P ≤  0.05) such as age, sex, history of COVID-19 infection, and chronic disease. There was a significant correlation between adverse effects from the vaccine dose and age of recipients. Those with a history of comorbidities had a two-fold risk of developing adverse effects.Figure 1.  Prevalence of general adverse effects in the participants after vaccination with three types of COVID-19 vaccines (N = 1000).

Conclusion: Fatigue, fever, headache, injection site signs, and axillary pain were the most registered adverse effects, which were mostly mild to moderate. All the vaccines revealed an encouraging safety profile. Younger age, second vaccine dose, and presence of comorbidities were considered minor risk factors for more adverse effects.

Introduction: Since December 2019, coronavirus disease 2019 (COVID-19), which is caused by SARS-CoV-2, has spread locally in Wuhan, China, and later on, a worldwide outbreak occurred. Invasive fungal infections can cause complications in critically ill immunocompromised patients of COVID-19, especially those admitted to intensive care units and who required mechanical ventilation. Candida albicans have been the most common pathogenic species, followed by other Candida spp. Mannan is a major component of the Candida cell wall and can be detected by the enzyme-linked immunosorbent assay (ELISA) in blood and other fluids. Invasive pulmonary aspergillosis is considered a life-threatening infection, especially among immunocompromised patients. COVID-19-associated pulmonary aspergillosis has emerged as an important complication among patients in the intensive care units. Galactomannan (GM) is a major cell-wall component of Aspergillus spp. and can be found in body fluids. Blood GM can be detected by the enzyme immunoassay. The aim of the current study is to assess the frequency of aspergillosis and candidiasis among COVID-19 patients in some hospitals in Baghdad by using GM and mannan biomarkers. Methods: During the period from February 2020 to May 2021, 175 COVID-19 blood samples of patients were collected and a sandwich ELISA test was performed to detect GM Ag of Aspergillus spp. and mannan Ag of Candida spp. Results: Regarding C-reactive protein (CRP), significant differences were seen among Aspergillus/COVID-19 patients (p = 0.029). Regarding sex and age group, the results indicated that of a total of 175 adult patients with positive COVID-19, more than half of the patients were males. Regarding the distribution of mannan Ag and GM Ag in COVID-19 patients, it was seen that out of the 175 patients, 167 (95.43%) Candida mannan Ag were negative and only 8 (4.57%) were positive, and 170 (79.14%) Aspergillus GM Ag were negative and only 5 (2.86%) were positive. It was also seen that 2 patients (1.14%) who had both Candida mannan and Aspergillus GM were positive and 173 (98.6%) were negative. No statistically significant difference was seen in candidiasis and aspergillosis among patients with COVID-19 regarding age group, sex, underlying chronic diseases (hypertension and diabetes mellitus), and biochemical tests. Conclusion: COVID-19 infections increased with age and were seen more in males than in females. The percentage of infection with C. albicans and Aspergillus spp. among COVID-19 patients was not significant, and this may come from the random collection of samples from patients with different stages of illness. A significant correlation was found between Aspergillus GM Ag in COVID-19 patients and the CRP test.

Background: During the pandemic of COVID 19, several colleges throughout the world either delayed or canceled their activities to minimize the risk of virus transmission. However, these measures had high medical and social impacts on both undergraduate and postgraduate students. The aim of the current study was to measure the attitude of medical students at 5th and 6th study levels for e-learning and clinical training during the pandemic. Methods: A cross-sectional study was done from May to June 2021. A multistage sampling technique was used to collect the sample. A self-administered questionnaire was developed through reviewing the literature and was modified to be useful for the local culture. Results: The total number of participants was 417 from different Iraqi universities, females consisted 56.6% of them, and the mean age was 23.94 ± 1.06. The results revealed that 55% of the participants generally agreed with the opinion that combined learning was a collaborative system, which provided a facility of learning through communication skills. About half of the Iraqi medical students stated that “their medical education and training had been significantly disrupted during the pandemic”; 39% of them approved the statement “in comparison to period prior COVID-19 pandemic, my medical performance in final clinical exam was decline”. Conclusion: The pandemic status had a considerable negative effect on medical training, motivation, and intellectual abilities of Iraqi medical students at final study levels. However, online teaching provided a new opportunity of learning for medical students.

Background: The reversed halo sign described in the pre-COVID era in certain pulmonary pathologies, most notably cryptogenic organizing pneumonia, has been reported with varying frequency in coronavirus disease 2019 (COVID-19) pneumonia caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In this study, we aimed to analyze the pattern of the reversed halo sign and its variant, the bullseye sign in patients with COVID-19 pneumonia. Methods: In this study, a retrospective analysis of chest CT scans performed in the CT unit of Al-Imammain Al-Kadhymain Medical City for a three-month duration (from June to August 2020) was done. Of the 490 CT scans performed for patients with COVID-19, 330 had signs of COVID-19 pneumonia. These were evaluated for the presence of reversed halo or bullseye sign, and only obvious signs detected in at least two orthogonal planes were included. The number of these signs in each scan was documented, and an analysis of individual signs was performed. The following features were recorded; size, location, shape, and type of the peripheral rim (whether complete or incomplete, thin or thick, distinct or hazy, and uniform or non-uniform). Results: A total of 26 CT exams were included in the study. The average age of the patients was 44.85 ± 20.14 years, and the total number of typical reversed halo or bullseye sign lesions was 63. The rate of reversed halo/bullseye sign in this study was 7.88%. In 15 patients, the typical sign of reversed halo was seen, the bullseye sign was noted in eight patients, and three patients had both the reversed halo and bullseye signs. Nearly all the patients had other CT findings of COVID-19 pneumonia, except one with only a solitary bullseye lesion. The number of lesions ranged from one to nine with the average number of lesions per patient being 2.42. The mean size of the lesions was 3.39 cm with a size range 1–8.5 cm. Lesions were located in the periphery of the lung in most patients (93.7%). Basal predominance was seen in 76.19% patients, located in the lower lobes. A higher percent of bullseye lesions located in the upper and right middle lobes was observed (n = 12/23) than the typical reversed halo lesions (n = 3/40). Most lesions were oval (52.38%) or rounded (48.86%). In 77.78%, the peripheral rim was incomplete. The thickness of the peripheral rim was variable ranging from 2–19 mm. Most lesions (92.06%) exhibited a thin peripheral rim ( < 1 cm). The rim was clearly distinct in 53.97% of lesions. It was non-uniform in thickness in most cases (95.24%). Conclusion: The reversed halo sign is not infrequent among CT findings in patients with COVID-19 pneumonia. The typical reversed halo sign is more common than its variant, the bullseye sign. Variability in morphology and size does exist. In patients with COVID-19, these lesions exhibit thin, incomplete peripheral rims and are multiple in most cases.

Background: On January 30, 2020, the World Health Organization (WHO) declared the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, also called coronavirus disease 2019 (COVID-19) a pandemic after its emergence in Wuhan, China, in December 2019. In this study, we aimed to evaluate the potential of interleukin-6 (IL-6) and D-dimer serum levels and genotypes of rs5186 (A1166C) in the AGTR1 gene as potential prognostic markers for COVID-19 disease outcome in Iraq. Methods: This cross-sectional study was conducted with 100 Iraqi adults of both sexes, aged 21–81 years, and recently diagnosed with COVID-19. The participants of this study were admitted to Al-Al-Kindy Teaching Hospital and Ibn Al-Qiph in Baghdad City from February 01, 2020, to May 01, 2020. Patients with COVID-19 were divided into two categories; those who recovered and were discharged and those who were admitted to the intensive care unit (ICU)/died. Ethical concerns were considered in accordance with the consent form provided by the Iraqi Ministry of Health for the purpose of collecting samples. Interleukin-6 (IL-6) levels in the patients’ serum samples were estimated using the Sandwich-Enzyme Linked Sorbent Assay (ELISA) method with horseradish peroxidase (HRP) conjugated antibody specific for IL-6. D-dimer was estimated in the serum samples using antigen-antibody (anti-human D-dimer antibodies) reaction. Genotyping of rs5186 (A1166C) in the AGTR1 angiotensin II receptor type 1 gene in the cohort study was determined using an allele-specific PCR approach. Results: D-dimer serum levels (1.55 μg/mL) was significantly (P <  0.001) higher in patients admitted to the ICU or those who died compared with those (0.2 μg/mL) of patients who recovered and were discharged. The IL-6 levels in patients admitted to the ICU or those who died and in patients who recovered and were discharged were 12.31 and 11.65 pg/mL, respectively, without significant difference (P > 0.05). The frequency of AC+CC genotypes of rs5186 (A1166C) in the AGTR1 gene in patients who were admitted to the ICU or those who died was 30.43%, higher than that of patients who recovered and were discharged (11.69%) with a significant difference (Odds ratio [OR] = 3.31, 95% confidence interval [CI] = 1.07–10.21, P = 0.038). Analysis of allele distribution revealed a higher frequency of the A allele among patients who recovered and were discharged (93.51% versus 82.61%) than among those who were admitted to the ICU or those who died with a significant difference (OR = 3.03, 95% CI = 1.12–8.21, P = 0.029). Conclusion: D-dimer may be a prognostic biomarker for poor COVID-19 disease outcomes. The genotype AC+CC of rs5186 (A1166C) in the AGTR1 gene seems to be a risk factor and may be a prognostic factor for poor COVID-19 disease outcomes. However, a bigger sample size is highly recommended in prospective studies for better assessment of the potential of IL-6, D-dimer, and genotyping of rs5186 (A1166C) in the AGTR1 gene as prognostic biomarkers for COVID-19 disease outcome.

Background: Trauma is one of the leading causes of deaths worldwide for all age groups, especially in the younger age group. The purpose of the current study is to assess/analyze the factors for mortality in penetrating abdominal traumas with respect to the total number of intra-abdominal organs injured, related extra-abdominal injuries, gender, type of injury, time of arrival, and amount of blood transfusion needed during the pandemic. Methods: A retrospective study including 523 patients underwent laparotomy in Al-Emamien Al-Kadhimin Medical City from March 2020 to September 2021 for a penetrating abdominal injury due to blast injury, bullet, shrapnel injury, and stab wounds. The study population with penetrating abdominal traumas and indicative abdominal signs was subjected to exploratory laparotomy. Results: In this study, 465 (88.9%) males and 58 (11.1%) females participated; the highest rate was found in small bowel injuries (40.73%) followed by large bowel injuries (21.99%), whereas the lowest rate was found in gallbladder injury (1.34%). Chest injuries represent the highest rate among extra-abdominal injuries (18.36%), whereas head and neck represent the lowest rate (1.34%). Regarding the risk factors affecting the mortality rate, the highest rate of mortality was found in the case of gunshot (13.11%), followed by shrapnel (6.38%) and stab wound injuries (5.26%), which was the lowest. Conclusion: Penetrating abdominal injuries were the most common among males, small bowel injuries are the commonest organs affected by the penetrating abdominal injuries, shrapnel injuries were the commonest causes in our country, and the highest mortality rate was related to gunshot and number of organs affected and delay of arrival to the hospital and number of pints of blood received.

Background: A cytokine storm is a serious clinical condition that complicates infectious diseases, for example, coronavirus disease 2019 (COVID-19), and non-infectious diseases such as autoimmune diseases and cancer and may often lead to death. The patients who are affected by the cytokine storm are almost always severe/critical and at risk for acute respiratory distress syndrome or eventually death. Pro-inflammatory cytokines such as interleukin 6 (IL-6), IL-1 beta, and tumor necrosis factor alpha (TNF-α) have been repeatedly shown to be related to the COVID-19 disease severity and mortality. In this study, our objective was to evaluate the attenuated effect of rivastigmine (RA) in a cytokine storm in Swiss Albino mice in which the cytokine storm was induced by lipopolysaccharide (LPS) and to explore their effects on IL-1 β, IL-6, and TNF-α levels. Methods: This study was carried with 60 male Swiss albino mice that were divided equally and randomly into six groups as follows:

1. • Group AH: Apparently healthy control group which received no induction, not treated.
2. • Group LPS: Induced using LPS at 5 mg/kg and no treatment administered.
3. • Group DMSO: Induced and treated with 1% dimethyl sulfoxide (DMSO).
4. • Group RA: Induced and treated with 0.5 mg/kg RA.
5. • Group MPA: Induced and treated with 50 mg/kg methylprednisolone (MPA).
6. • Group RMPA: Induced and treated with 0.25 mg/kg rivastigmine and 25 mg/kg of methylprednisolone.

All the mice were treated with drugs or vehicles for three consecutive days before LPS induction. The mice were then injected with LPS intraperitoneally at a dosage of 5 mg/kg for systematic inflammatory stimulation. After 48 hours of LPS induction, all the mice were euthanized by light anesthesia with chloroform, and blood was collected for the quantitative determination of IL-1β, IL-6, and TNF-α levels using the enzyme-linked immunosorbent assay (ELISA) technique. Results: Administration of LPS to Swiss albino mice caused a significant elevation of IL-1β, IL-6, and TNF-α levels than in the healthy control group. Significant reduction of these parameters were observed in the RA and MPA groups when compared with those in the non-treated group. Conclusion: RA was found to be effective in attenuating the induced cytokine storm by suppressing IL-1β, IL-6, and TNF-α levels, and the results with RA were comparable to that of MPA. A combination of half-doses of both RA and MPA administered together shows no obvious advantage when compared with that of each of them alone.

Background: SARS-CoV-2 mRNA vaccines such as Pfizer–BioNTech have confirmed a high efficiency; however, there is a limitation of data existence about the duration of immune responses and their relation to age and side effects. The aim of this study is to estimate the SARS-CoV-2 S1-RBD IgG level after 30 days (1 month) and 120 days (4 months) of the second dose of Pfizer–BioNTech vaccine administered to the medical students of the University of Diyala. Methods: The study was conducted after the approval of the Medical College of Al-Iraqia University, the Medical College of the University of Diyala, and the Iraqi Ministry of Health. We selected 45 students from the Medical College of the University of Diyala randomly who were fully vaccinated (two doses of Pfizer–BioNTech vaccine, 0.5 ml of the vaccine for each dose), and they agreed to give 5 ml of their blood twice (after 1 month and 4 months), which was carried out in the Higher Education Laboratory inside the Medical College, University of Diyala. The period of sample collection was 5 months (from September 2021 until February 2022). A serological analysis to measure SARS-CoV-2 S1-RBD IgG was done by using Diasino, SARS-CoV-2 S1-RBD IgG ELISA Kit, China, which was carried out in the Higher Education Laboratory, inside the Medical College, University of Diyala. Demographic data were taken from the study participants (age and gender). The same individuals of the study were divided into two groups according to the time frame (1 month and 4 months) after the second dose of the Pfizer–BioNTech vaccine administration. For statistical analysis, we used SPSS version 26 and STATISTICA version 12 to input, check, and analyze data. For qualitative variables, standard approaches of frequencies and percentages were used, whereas for quantitative variables, mean and standard deviation were used. A P-value of less than 0.05 was considered as significant for SARS CoV-2 S1-RBD IgG plasma levels. Results: The study found that the male–female ratio was 17.8: 82.2, and the mean of the age of the vaccinated students was 20.977 years. The serum quantities of SARS-CoV-2 S1-RBD IgG and IL-6 levels post second dose of the Pfizer–BioNTech vaccine after 30 days (1 month) and 120 days (4 months) were shown to be statistically non-parametric. Using the independent two-sample Mann–Whitney test, a significant difference (P <  0.05) was observed for SARS-CoV-2 S1-RBD IgG and IL-6 levels between 120 days (4 months) after the second dose of the Pfizer–BioNTech vaccine and 30 days (1 month). Conclusion: SARS-CoV-2 S1-RBD IgG and IL-6 levels decreased significantly after 120 days (4 months) of the second dose of Pfizer–BioNTech vaccination.

Background: The COVID-19 pandemic affects all aspects of life all over the world; general surgeons are highly affected along with other healthcare personnel. A gloomy course of the disease makes it hazardous till now; its impact and ways of protection should be of concern for us so that we can keep on our works. Methods: A survey was carried out at our hospital among general surgeons and surgeons of other specialties of the course with junior doctors and residents. A questionnaire was answered by them concerning their work with the impact of the virus, collecting data from the statistical unit electronically. Iraq has started lockdown for a period of 24 months from March 2020 to March 2022. Results: This study is a cross-sectional study using Google Forms and spread over surgical teams of different specialties at the Imemein Kadhumein Medical City Center. From about 248 responses, 118 responses were taken from the survey. Out of the 50 surgeons, 40 (80%) were infected and out of the 68 residents 62 (91.1%) were infected in our hospital (open and laparoscopic). About 20% of the doctors completely stopped attending outpatient clinics, until vaccination started on March 2021, an overall decrease of 60%. A drop of >75% of income was noticed by 45% of them; and 25% of them feel  < 75% of the income was received. But others have no change or increase in income as patients shift toward private hospitals because the government ones become loaded with COVID patients. Information about the illness and its sequelae was found through the net to be about 81% and through television to be 16%, whereas others were through national and institutional announcements. Conclusion: Standardized measures in detection, treatment, and/or vaccination should be taken into consideration based on the solid scientific facts to have a road map for surgeries during this or subsequent pandemics, getting the best outcome for doctors and patients.

Background: Vaccination proved useful in the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection; however, there were instances of breakthrough infection occurred. Unvaccinated people are liable to have a severe infection while infection in vaccinated people has different outcomes, especially in relation to the type of vaccine. In this study, we aimed to assess the severity of the disease in unvaccinated people and the severity of break through infection in vaccinated people in relation to the type of vaccines available in Iraq. Method: Two groups of Iraqi patients were studied, of which the first included 8,096 patients with COVID-19 pneumonia, including their vaccination status; and the second group included 1,124 patients who received the vaccine and developed the disease later. The severity of infection in these groups in relation to the three types of vaccine administered in Iraq was evaluated. Results: Among the 8,096 patients who developed severe and critical COVID-19 pneumonia, most (96%) were not vaccinated. Among 1,124 patients who received the vaccine and developed breakthrough infection, Sinovac was associated with mild cases while Pfizer and AstraZeneca were associated with moderate and severe cases. Conclusion: Infection in unvaccinated people tended to be more severe and critical than that in vaccinated people, where it was mild or moderate. Of the vaccines given in Iraq, Sinopharm appeared to be superior to the other two in terms of breakthrough infection.