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Background: Sepsis and septic shock have high mortality rates and often require a prolonged hospital stay. Patient outcomes may vary according to multiple factors. We aim to determine the prevalence of antimicrobial resistance and factors associated with mortality and hospital stay. Methods: Clinical and microbiological data of patients with sepsis or septic shock were retrospectively collected for 15 months. Patients with negative blood cultures and patients that did not meet the SEPSIS 3 criteria were excluded. Results: We included 48 septic shock and 28 septic patients (mean APACHE II 20.32 ± 5.61 and mean SOFA 9.41 ± 3.17), with a mean age of 60.5 ± 16.8 years and 56.6% males. WBCs, neutrophils, INR, and fibrinogen levels were significantly associated with mortality. 59.5% of the cultured bacteria were gram-negative (most common E. coli) and 27.8% were gram-positive (most common S. aureus), while 7.6% were other types of bacteria and 5.1% were fungi. Resistance patterns to gram-negative were varying, and resistance to piperacillin/tazobactam, carbapenems, and aminoglycosides were from 60% to 100% (A. baumanii), while they were highly sensitive to Colistin. E. coli was also resistant to ceftriaxone (77.8%) and sulbactam/cefoperazone (44.4%). Resistance rates for Gram-positives were high, from 86% to 100% for oxacillin, while for vancomycin, teicoplanin, and linezolid, they were often low but arrived up to 42.8%. According to our logistic regression analysis, patients over 65 year-old and those who received corticosteroids had a significantly increased risk of in-hospital mortality (OR: 4.0; OR: 4.8). Conclusion: Sepsis still poses a significant threat to patients’ health, even when positive blood culture results allow the administration of specific antibiotic treatment., Hospital Practice, 50(5), pp.407-415; 2022

Pathogens and Global Health, 117(2), pp.101-103; 2023

COVID-19 is an infectious pandemic disease which is caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Up to date, scientists are trying to identify a new specific antiviral drug to overcome this disease. Different methods are under study and evaluation in the entire world to control the virus, including blood plasma, blood purification, and antimicrobial and antiviral agents; however, there are no approved drugs yet. This review is focused on the conducted clinical trials worldwide, including the Iraq- Kurdistan region, China, USA, and Europe, to find relevant data on the agents with potential efficacy to treat the COVID-19 infection. The utmost commonly assessed therapies for this disease were chloroquine phosphate, hydroxyl-chloroquine, azithromycin, lopinavir/ritonavir, favipiravir, remdesivir, and alternatively, blood plasma, ivermectin in combination with doxycycline, and dexamethazone. This review suggests that blood plasma transfusion, the combination of hydroxyl-chloroquine with azithromycin, and remdesivir were the most abundant and efficient therapies. Thus, more light could be shed on these particular drugs on the road of drug investigation against COVID-19 pneumonia.

Introduction: dentofacial deformities are mainly congenital problems that distort the face structure. However, they have many adverse effects on adolescents’ quality of life and self-esteem. Case presentation: We report a case of an 18-year-old female with no family history or previous surgical method. She presented to our hospital with a facial deformity, including a midline shift of 1.5 teeth to the left side and a malalignment of dentation. Orthopantomography (OPG) X-ray and cephalometric X-ray assessed the deformity extent and determined the appropriate surgical procedure. As a result, the patient underwent genioplasty and bimaxillary (BiMax) surgery to correct the problem. Discussion: Facial deformities occur during the normal embryonic phase and develop clearly when the patient reaches puberty due to a growth spurt. Some researchers encourage early correction, while others recommend the surgery only after completing the growth. However, the perfect age for this surgery is 19 years old for boys and 17 for girls after the cessation of facial growth. Therefore, our patient underwent surgery at 18 years old, which is the desirable age. Conclusion: Genioplasty and BiMax are reasonable procedures to treat facial deformities and correct malalign-ment of dentation in an 18-year-old patient without major complications., Annals of Medicine and Surgery, 79, art. no. 104088; 2022

Introduction: Smooth muscle tumors of the vulva are more difficult to diagnose and are frequently mistaken as Bartholin cysts prior to surgery. Case presentation: A 41-year-old female presented with a left vulvar mass that increased in size compared to the previous year. The patient had normal urination and a regular menstrual cycle. The presentation was not associated with dyspareunia, abnormal bleeding, and signs of infection (e.g., fever, vaginal discharge). The history of any sexually transmitted disease was inconclusive. There was also no family history of malignancy. Physical examination showed a solitary swelling mass, measuring 5 × 2 cm in the left labia majora at the site of the Bartholin gland. The mass was firm in consistency, partially movable, and non-tender with no inguinal lymphadenopathy. Histopathology after surgical removal revealed a benign vulvar leiomyoma. Discussion: Labia majora leiomyoma at the site of the Bartholin gland is rather uncommon. Some cases can develop into atypical leiomyoma or even leiomyosarcoma with local tissue infiltration. Conclusion: If the clinical picture is unusual, it is better to send the patient for ultrasound and MRI to exclude other causes followed by performing wide local surgical excision of the mass to allow proper histopathological and/or immunohistochemistry examination to differentiate between benign and malignant tumors., Annals of Medicine and Surgery, 77, art. no. 103720; 2022

Background Predictive markers represent a solution for the proactive management of severe dengue. Despite the low mortality rate resulting from severe cases, dengue requires constant examination and round-the-clock nursing care due to the unpredictable progression of complications, posing a burden on clinical triage and material resources. Accordingly, identifying markers that allow for predicting disease prognosis from the initial diagnosis is needed. Given the improved pathogenesis understanding, myriad candidates have been proposed to be associated with severe dengue progression. Thus, we aim to review the relationship between the available biomarkers and severe dengue. Methodology We performed a systematic review and meta-analysis to compare the differences in host data collected within 72 hours of fever onset amongst the different disease severity levels. We searched nine bibliographic databases without restrictive criteria of language and publication date. We assessed risk of bias and graded robustness of evidence using NHLBI quality assessments and GRADE, respectively. This study protocol is registered in PROSPERO (CRD42018104495). Principal findings Of 4000 records found, 40 studies for qualitative synthesis, 19 for meta-analysis. We identified 108 host and viral markers collected within 72 hours of fever onset from 6160 laboratory-confirmed dengue cases, including hematopoietic parameters, biochemical substances, clinical symptoms, immune mediators, viral particles, and host genes. Overall, inconsistent case classifications explained substantial heterogeneity, and meta-analyses lacked statistical power. Still, moderate-certainty evidence indicated significantly lower platelet counts (SMD -0.65, 95% CI -0.97 to -0.32) and higher AST levels (SMD 0.87, 95% CI 0.36 to 1.38) in severe cases when compared to non-severe dengue during this time window. Conclusion The findings suggest that alterations of platelet count and AST level—in the first 72 hours of fever onset—are independent markers predicting the development of severe dengue., Author summary The major concern in dengue fever is the abrupt occurrence of severe complications, for which only close monitoring of patients is the treatment scheme. Thus, the markers managing to predict the subsequent progression of complications—in the early stage of disease course—could alleviate the clinical management burden. Ideally, the predictors foretell the outcomes before the severe complications occur—usually on days 4–7 following fever onset. In this study, therefore, we reviewed the available markers collected during the first 3 days of fever onset. We found robust evidence of significantly lower platelet counts and higher AST levels in those who subsequently developed severe dengue than those who did not. In this regard, platelet count could serve as an independent warning sign rather than combining with hematocrit—as seen in the current classification—which remains unaltered during this time window. Also, abdominal pain and vomiting could predict the outcomes, but using these signs is arduous when their manifestations vary as per the patient without cutoffs. Hepatomegaly rate is substantially higher in severe dengue, but likely yields a high false-negative prediction rate. There is a need for larger studies to confirm the relatedness of hyaluronan in severe dengue.

Introduction Trichobezoar is a rare disorder that almost exclusively affects young females. Up to 90% between 13 and 20 years of age. The current study aims to report and discuss a rare case of Misdiagnosis of Trichobezoar. Case presentation A 14-year-old girl student patient admitted to the Baxshin hospital, with a large trichobezoar filling the entire stomach with a long tail of hair extending within the pylorus into the proximal jejunum at a length of 70 cm; associated with abdominal pain, constipation, and vomiting. Laboratory data showed mild iron deficiency anemia, with a normal liver, and renal function test, patients' electrolytes showed a normal profile. Confirmation of the presence of the mass was done through abdominal Computed Tomography (CT) with contrast. The physician initially diagnosed as alopecia and suspected the abdominal pain was related to the postprandial emesis because the patient didn't provide a history of trichotillomania and used treatment for alopecia for a long time. Discussion The presence of a mass in the abdomen of a child is considered one of the most severe findings. Physical examination of the patient plus a full history taken, and the age of the patients provide a clear clue to the origin of the mass. Further investigation, including laboratory data and imaging findings, provides better understanding and a firm diagnosis. Trichobezoar should be considered by the physicians in this case. Conclusion In the early diagnosis of the trichobezoar, the physicians should investigate for any medical history of clinical trichophagia, trichotillomania, or a psychological problem., Highlights • The initial step of trichobezoar diagnosis is a direct question about consuming hair. • Trichobezoar formation is caused by a delay in diagnosing trichotillomania and trichophagia. • Physicians should investigate for any medical history of trichophagia, trichotillomania, or a psychological problem. • The clinical feature of trichobezoar usually associated with alopecia of the scalp and other regions of the body

This study was aimed to investigate the structure of bioactive components of black seed oil (BSO) and their antimicrobial and cytotoxic effects. Initially, the structural examination was conducted using various spectroscopic techniques, such as FTIR, TLC, and UV-visible spectroscopy, which are important in determining substituents, functional groups, and the presence of conjugated double bonds in BSO. From the FTIR spectra, a variety of sharp, strong, and weak peaks were specified relating to the main components of thymoquinone (TQ), dithymoquinone, thymohydroquinone, and thymol in BSO. The results of UV-visible spectroscopy confirmed the presence of thymoquinone as a major compound, and conjugated double bonds were also found. In addition, qualitative TLC analysis was used to identify thymoquinone from the methanol-extracted layer in BSO, by calculating the retention factor (Rf) value. Furthermore, antimicrobial activity of BSO was studied against various types of bacteria. Strong bacterial inhibitory effects were observed, especially against Bacillus subtilis, with an average inhibition zone of 15.74 mm. Moreover, through the use of the MTT assay in vitro, it was shown that BSO does not exhibit any cytotoxicity towards human peripheral blood mononuclear cells (PBMCs). It was also found from the structural characterization of BSO that the existence of TQ is responsible for potential antibacterial activity without any cytotoxic effects. The main observation of this work is that BSO has antimicrobial activity even against methicillin-resistant Staphylococcus aureus (MRSA).

Vitamin D is one of the fat-soluble vitamins that have a great role in phosphate and calcium balance and bone structure. To our knowledge, there are limited data on the relation between dietary pattern and serum vitamin d concentration. Therefore, the aim of the current study is find out whether, there are any associations between serum vitamin D and with any specific dietary pattern. A cross sectional study was implemented in Baxshen hospital in order to find the prevalence of vitamin D deficiency and its relation with dietary pattern among healthy participants. 1131 participants were enrolled in the current study male and female with age 18 – 65 years old, living in Sulaimani city and its districts have not used any supplement in the past 6 months before enrolling the study. Two questionnaires were used for collecting of data, the first one was included demographical data of the participants. Including their age, gender, marital status, educational level, address, and etc. The second one was data on dietary pattern; particularly we focused on some vitamin D dietary sources. A three-day dietary records estimate was taken from the patients and this data were coded and put in dietary software (windiet) and then analyzed. The age of the sample ranged from 18 to 65 years old with the mean of 34.34 years old with a standard deviation of 12.6. One hundred sixty-two (14.3%) of the 1131 participants were female, nine hundred sixty-nine (85.7%) of the participants were male. 65.5 % of them exposure to sun less than 30, 34.5% exposure to sun more than half hour. About 84.6% of participants had severe deficiency of vitamin D and 6.9% of participants had adequate vitamin D. Fish, eggs and yogurt conception was common among those participants whom their serum vitamin D was adequate, in contrary, there were less consumed among those who had vitamin D deficiency. The percentage of obese (99.8%) was significantly higher than normal weight and overweight among severe deficiency Vitamin D. Furthermore, a highly percentage of adequate was (93.6%) in the normal weight. The mean of vitamin D intake was 761 ± 195.65 IU, in normal weight group, and the mean of vitamin d intake was 125.98 ± 53.15 IU, in obese group. This study has concluded that the reach Dietary sources of vitamin D is not enough to provide the body adequate amount of vitamin D, in addition, Obese and overweight individuals tend to have less serum vitamin D status compared to normal weight individuals and finally recommended daily amount of vitamin d intake should be established for Kurdistan people.

Leaves of Lawsonia inermis have long been used for several purposes in traditional herbal medicine. This report is to evaluate the effect of Lawsonia inermis on the wound healing in rats. Eight adult male rats were used. Animals have been anesthetized. A wound was created on the dorsal nape of the neck. Group 1 were left without treatment. Group 2 treated with 10% Iodine and vehicle. Group 3 and 4 were treated with a low dose and high dose of Henna respectively for 15 days. On the 1 ,5,10 and 15, the wound area of each animal was measured. Wound contraction was calculated. On the day 15, tissue samples were taken from the wound and examined by a histopathologist. At day 15, the average wound size decreased in group 1 and group 2 to 5.5 mm and 6.5 mm respectively and in group 3 and group 4 to 0 and 2.5 mm respectively. Histological results revealed that low dose and high dose produce better wound healing if compared with the control positive and control negative. The result of this pilot study has revealed that Henna extract leaves have remarkable effects on wound healing and warrents further studies.