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Objective This systematic review and meta-analysis aimed at summarizing the existing clinical evidence to evaluate the prognostic performance of N-terminal prohormone brain natriuretic peptide (NT-proBNP) in predicting cardiovascular events, cardiovascular-related mortality, and all-cause mortality in patients with type 2 diabetes. Methods Searches were performed in Medline, Embase, Scopus, and Web of Science databases before August 1, 2021. The data were recorded as adjusted hazard ratio (HR). Results An increase in NT-proBNP increases the risk of cardiovascular events (HR = 1.63), cardiovascular mortality (HR = 1.86) and all-cause mortality (HR = 1.54). Seemingly, the best cutoffs for predicting cardiovascular events (HR = 2.30) and cardiovascular mortality (HR = 3.77) are levels greater than 100 pg/mL. The best cutoff of NT-proBNP in predicting all-cause mortality is levels greater than 225 pg/mL (HR = 4.72). Conclusion A moderate level of evidence demonstrated that NT-proBNP serum levels can predict future cardiovascular events, cardiovascular mortality, and all-cause mortality. Thus, it can be used as risk stratification for type 2 diabetes.

Objective The present study aimed to perform a systematic review and meta-analysis on the prevalence of one-year hospital readmissions and post-discharge all-cause mortality in recovered COVID-19 patients. Moreover, the country-level prevalence of the outcomes was investigated. Methods An extensive search was performed in Medline (PubMed), Embase, Scopus, and Web of Science databases until the end of August 3rd, 2021. A manual search was also performed in Google and Google Scholar search engines. Cohort and cross-sectional studies were included. Two independent reviewers screened the papers, collected data, and assessed the risk of bias and level of evidence. Any disagreement was resolved through discussion. Results 91 articles were included. 48 studies examined hospital readmissions; nine studies assessed post-discharge all-cause mortality, and 34 studies examined both outcomes. Analyses showed that the prevalence of hospital readmissions during the first 30 days, 90 days, and one-year post-discharge were 8.97% (95% CI: 7.44, 10.50), 9.79% (95% CI: 8.37, 11.24), and 10.34% (95% CI: 8.92, 11.77), respectively. The prevalence of post-discharge all-cause mortality during the 30 days, 90 days and one-year post-discharge was 7.87% (95% CI: 2.78, 12.96), 7.63% (95% CI: 4.73, 10.53) and 7.51% (95% CI, 5.30, 9.72), respectively. 30-day hospital readmissions and post-discharge mortality were 8.97% and 7.87%, respectively. The highest prevalence of hospital readmissions was observed in Germany (15.5%), Greece (15.5%), UK (13.5%), Netherlands (11.7%), China (10.8%), USA (10.0%) and Sweden (9.9%). In addition, the highest prevalence of post-discharge all-cause mortality belonged to Italy (12.7%), the UK (11.8%), and Iran (9.2%). Sensitivity analysis showed that the prevalence of one-year hospital readmissions and post-discharge all-cause mortality in high-quality studies were 10.38% and 4.00%, respectively. Conclusion 10.34% of recovered COVID-19 patients required hospital readmissions after discharge. Most cases of hospital readmissions and mortality appear to occur within 30 days after discharge. The one-year post-discharge all-cause mortality rate of COVID-19 patients is 7.87%, and the majority of patients' readmission and mortality happens within the first 30 days post-discharge. Therefore, a 30-day follow-up program and patient tracking system for discharged COVID-19 patients seems necessary.

Cancer cells tend to grow fast, and chemo drugs kill fast-growing cells. However, since such drugs move to almost all part of the body, they might have an influence on healthy cells which are normal and grow fast. If healthy cells are damaged, there will be several side effects. The side effects of chemotherapy in children are reported by cancer treatment teams; however, only little evidence is available on the routine clinical care. The present study aimed to assess chemotherapeutic side effects in children with cancer. A single chemo drug can treat cancer; however, in order to come up with better and quicker results, sometimes a number of drugs are used in a specific order or combination which is referred to as combination chemotherapy. More cancer cells can be killed using different drugs which have different working mechanisms. As a result of this method, the cancer will have more limited chances to become resistant to an of the chemo drugs. The present descriptive study consisted of 300 children who underwent chemotherapy, and interviews were carried out with them. The severity of side effects was calculated according to three grades: low, moderate, and high. The collected data was collected through direct interview with the child greater than 6 years old on side effects of chemotherapy on physical health. Chemotherapy affects the entire cell inside the body among children. The results demonstrated that chemotherapy commonly affects the gastrointestinal tract and musculoskeletal system.

Background: Antimicrobial resistance (AMR) is a serious global public health threat and rationale antimicrobial use through surveillance and monitoring is crucial to address AMR. To date, no study has been undertaken in Iraq using validated methodologies to document current antimicrobial use and areas for improvement given high AMR rates. Methods: Point prevalence survey (PPS), using the Global PPS methodology, conducted among the three major public hospitals in the largest city in Kurdistan Regional Government (KRG) in northern Iraq from September and December 2019. Adult inpatients receiving antibiotics on the day of the survey were included. Antibiotic prescribing quality was evaluated using agreed indicators. Findings: Prevalence of antibiotic use was high (93.7%; n=192/205) and prescribed, third generation cephalosporins were most commonly prescribed (52.6%; n=140/266). Of the 166 prescriptions with diagnosis recorded, respiratory tract infections (RTI) accounted for the majority (44%, n=73/166). Reasons for treatment was recorded for only 61.7% (n=164/266) of antibiotics and high use (89.9%) of parenteral therapy was observed. All therapy was empirical, no stop/review dates were recorded and no treatment guidelines were available. Majority of the prescribed antibiotics (62%; n=165/266) were from the WHO Watch list. Interpretation: Prevalence of antibiotic use was the highest not only in the region but globally including Africa and there was significant evidence of sub-optimal prescribing practice. Swift, action is needed to develop ASPs to improve future prescribing and reduce AMR. One-two areas should initially be targeted for quality improvement including development of local clinical guidelines, documentation of antibiotic indication and stop/review dates. Funding Statement: This study was self-funded. Declaration of Interests: Nothing to declare. Ethics Approval Statement: No unique patient identifiers were recorded and all study data were anonymised completely. The study did not involve any direct contact with patients; consequently, patient consent was not required. The study protocol was approved by the Research and Ethic Committee of Sulaymaniyah General Health Directorate.

Microalbuminuria is the most leading cause for cardiovascular disease, diabetic nephropathy, end stage renal diseases, and death among diabetic patients. The study carried out to find out the prevalence of microalbuminuria in a sample of Sulaimani diabetics and to determine its relation to different associated risk factors. The first part of study was a cross-sectional study conducted through examination of records of diabetic patients registered in Sulaimani Diabetic Center from June 2010 to May 2012. The second part was a case- control study that conducted in the same center, including 50 cases of diabetics with positive microalbuminuria, and 50 controls with negative one, that were registered in the same center and matched by age and gender. A specially designed questionnaire was used by researcher to collect information from the records. SPSS version 21.0 was used for data analysis. Males accounts for half of cases and controls, highest proportion of sample was found among age group (60-69) years about 34%. The prevalence of microalbuminuria was 29%. The study showed a statistical significant association of microalbuminuria with obesity, smoking, hypertension, retinopathy, ischemic heart disease, poor glycemic control, and dyslipidemia. In conclusion moderate prevalence of microalbuminuria was found among diabetic patients, the prevalence was more common in poor glycemic control, and hypertensive diabetics. There was significant relation between microalbuminuria and diabetic nephropathy.

Background: Hodgkin lymphoma (HL) is a highly curable malignancy. It is a unique neoplasm, in whichthe malignant cell, the Reed-Stenberg cell (RSC), it constitutes approximately 40% of all lymphomas thatpresent during childhood.Objective: Obtain local data on the pattern of childhood and adolescent Hodgkin lymphoma in our communityat presentation and then compare it with the international figure.Patients and Method: Eighty five patients with newly diagnosed pediatric Hodgkin lymphoma were admittedto Hiwa Hematology/Oncology hospital in the Sulaimaniya province of Iraqi Kurdistan were included inthis study.They were studied prospectively from March 2006 to March 2014.Result: Data analyzed using SPSS software; version 13 and P-value obtained by Chi-square test, a medianage at diagnosis was about 13.7 years with peak age of incidence was between 15-18 year, with malepredominance. Most common site of the primary tumor was cervical lymph nodes; Nodular sclerosis wasthe most common histopathology and the majority was stage IIA.Conclusion: The stage in our study was age dependent but neither there was relation between the site of theprimary tumor and the risk categories nor relation between risk categories and sex.

WHO adopted World Health Organization/International Society of Hypertension (WHO/ISH) risk charts to predict cardiovascular disease risk in low and middle income countries. The aim of this study was to estimate the cardiovascular risk in adults ≥40 years old by using the two versions of the WHO/ISH risk prediction charts “with and without cholesterol”, and to find out the risk by other parameters not found in the chart; also, to evaluate concordance between the two approaches. A cross-sectional study was conducted from August 2016 to February 2017 in two primary health care centers in Sulaimani City among 500 persons aged 40-82 years. The desired information was collected by using a pretested questionnaire; anthropometric measurements and laboratory investigations were also carried out for the participants. Cardiovascular risk was assessed by the WHO/ISH risk prediction charts for the Eastern Mediterranean region in category D. Mean age of the participants was 52.5(±9.55) years and 70.4% of the participants were females. Only 260 participants had the results of total cholesterol and triglycerides. The results revealed that, using the risk assessment charts with and without cholesterol, 22.3% and 19.2% respectively of the study population were in the ten-year cardiovascular risk category of ≥20%. Risk categories were concordant in 86.2% of the population; and when we applied single risk factor approach 51.5% would require drug treatment. The WHO/ISH risk chart is an affordable and simple tool to estimate cardiovascular disease risk. Nearly one fifth of adults aged ≥ 40 years in Sulaimani City are at high-very high risk of developing cardiovascular event in the next ten years as assessed by WHO/ISH risk prediction charts. The use of the without cholesterol version of the chart to estimate cardiovascular disease risk could be useful is settings where cholesterol cannot be measured.

Introduction Cancer prevalence and geriatric patients (GP) are increasing and about half of the patients with cancer will be offered radiotherapy (RT). Addressing GP and their RT needs is an important issue in order to understand this heterogeneous group of patients. Materials and Methods A descriptive cross-sectional study, using a convenience sample from Sulaimani city's inhabitants, aged 70-year and more, who were treated with RT at the only city's RT center, Zhianawa Cancer Center (ZCC), in 2015. Results 153 patients' charts were reviewed. GP represented 20% of the patients referred to ZCC. Male: Female ratio was 3:1. One third presented with distant metastases, and 46% were treated with curative intent versus 54% with palliative intent. 94% completed the planned sessions of the curative RT vs 90% of the palliative RT. 23% of GP who were referred for RT didn't receive it. 9% got interruptions during RT course. 10% of GP living >40 km away from the treatment center refused treatment. Mean time interval between the date of referral and the date of starting treatment in the palliative setting was 19 days. Only 41% of patients with curative setting had regular follow-up. Conclusions Being the 1st study in this regard in a war-torn nation, Iraq, our results demonstrated that GP is a sizable group of ZCC patients and that RT is a valuable modality in GP cancer treatment. “Age per se” is not a factor to avoid this modality when there is an indication to use it. Longer distance to reach the center was a challenge in some of our GP. Due to inadequate number of RT machines, GP have to wait long time before getting their RT, even for palliative purposes. Further studies in this field are warranted.

Records of patients admitted in Sulaimani Teaching Hospital, who had complicated UTI, were studied for a period of five years, from 1 December 2006 to 1 December 2010. All study subjects who had positive records of urine sample cultures inoculated on MacConkey and blood agar media were included in the study. The isolated bacteria were identified using biochemical tests. Disk diffusion susceptibility test was used to determine susceptibility of bacterial agents to antibiotics.