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Background and aim Human papillomavirus (HPV) is a common sexually transmitted infection and is the leading cause of genital warts and cervical cancer. However, research on HPV prevalence within the Iraqi population is limited, with only a few published studies. The aim of this study was to investigate the prevalence and genotype distribution of HPV among Iraqi women. Methods In this study, samples from 2,193 married women referred to PharmaGene laboratory for diagnostic evaluation between 2023 and 2025 were analyzed. HPV genotyping was performed using the HPV Direct Flow CHIP system. Result The overall positive rate was 12.7% ( n  = 279). Within the positive cases, 6.9% had only high-risk (HR-HPV) genotypes, 4.4% had only low-risk (LR-HPV) genotypes, and 1.4% were co-infected with both HR and LR-HPV genotypes. The most frequently detected HPV genotypes were HPV 18 (13.3%), HPV 11 (11.4%), HPV 16 (6.9%), HPV 62/81 (5.7%), HPV 39 (4.5%), HPV 51 (3.6%), and HPV 6 (3.6%). Among HPV-positive cases, the prevalence of single, double, triple, and quadruple or higher infections was 83.5%, 14%, 1.8%, and 0.7%, respectively. Conclusion This study presents novel epidemiological data on the prevalence and genotype distribution of HPV infection in Iraq, offering a valuable basis for enhancing cervical cancer screening and HPV prevention strategies. Furthermore, understanding the distribution of HPV genotypes may support the implementation of targeted vaccination programs.

Background Reaching and vaccinating zero dose and under-immunized children requires effective strategies and quality data. Primary health care unit level interventions like hands-on training, mentoring, participatory planning and review and enhanced headcount of under two-year children were implemented in four primary health care units Afar and Somali regions. The aim of this manuscript is to describe and share the experience on the effectiveness of these interventions in reaching and vaccinating zero-dose and under immunized children through well planned headcount. Method The intended interventions were implemented in four purposely selected woredas from Afar and Somali regions. One primary health care unit was chosen from each woreda based on different criteria. Following the interventions, headcount of under two-year children was conducted in all villages of four primary health care units’ catchment with active engagement of community leaders. Modified periodic enhanced routine immunization template was used to register enumerated children. Identified zero-dose and under immunized children were referred to nearby immunization sites with referral slip for vaccination. Immunization indicators and the reason for missing immunization, descriptive analysis done using Microsoft Excel. Result Improved primary health care linkage coupled with strengthened capacity enabled primary health care units to conduct enhanced head count to identify and vaccinate unreached children. The headcount led to the identification of 390 (24%) never vaccinated and 185 (11%) under-immunized children among 1478 enumerated 6 weeks-11 months children in 21 HPs under four primary health care units. Among 1,619 enumerated 12–23 months children, 332 (21%) were zero-doses and 355 (22%) were under-immunized children. Through referral linkage to immunization service, 92% (357/390) of never vaccinated and 97% (179/185) under-immunized 6 weeks − 11 months children were subsequently vaccinated for vaccines they missed. Likewise, 94% (620/658) above one-year children were vaccinated for the measles vaccine. The reasons for failure to vaccinate for 12–23 months old children were access barriers in 70% followed by lack of knowledge (15%). Conclusion and recommendations Strengthening the primary health care unit linkage and its technical and managerial capacity accompanied by headcount through the involvement of community leaders can benefit the identification and reach of children missing vaccination and other essential health services.

Backgrounds: Knee osteoarthritis (KOA) is a highly prevalent and progressive joint disease. Given the diverse clinical presentations and multifactorial nature of KOA, alongside observed regional variations, a localised understanding of the disease is vital for effective healthcare planning. Aims: This study aimed to identify the clinical characteristics and disease severity of patients diagnosed with KOA at the specialised tertiary centre in the Kurdistan Region. Patients and Methods: This study employed a cross-sectional design among patients who attended the 'Specialized Center of Rheumatic Diseases and Medical Rehabilitation' in Duhok City, Iraqi, Kurdistan and are diagnosed with KOA. In this regard, patients with any socio-demographic characteristics were included in the study. The patients with other rheumatic diseases were excluded from the study. Results: The study involved 262 knee patients with KOA, predominantly females aged 40-69 years (81.29%). Most of the patients were retired (39.69%) with a body mass index (BMI) averaging 32.72 kg/m2, indicating overweight or obesity (based on the CDC criteria). Symptoms such as pain (98.85%) and difficulty walking (49.62%) were common, with pain severity averaging 6.77/10. Most commonly used treatments included NSAIDs (63.74%) and physical therapy (8.78%), with many patients affected by mild-to-severe functional limitations. Younger patients had lower disease grades and pain levels, whereas higher grades correlated with increased pain and activity restrictions. Conclusions: Age and BMI impact KOA severity, including pain and functional limitations. The patients need for better diagnostic and nonpharmacological approaches to improve patient outcomes.

Background: Low back pain (LBP) in low- and middle-income countries has received less attention. Aims: To identify the prevalence of low back pain and associated factors in female hospital staff. Methods: We included 320 female hospital staff in a tertiary medical setting in the Kurdistan Region. Results: The study involved 320 participants aged 18-45 years, included doctors (37.19%), nurses (19.06%), administrative staff (11.88%) and others (31.88%). It found that 75% experienced LBP in the past year, with 60% reporting pain lasting 7-12 months. Pain severity was mostly mild (44.58%) or moderate (35%), and 80.83% experienced occasional pain. LBP interfered with daily activities for 45.42% of participants. Work-related factors contributing to LBP included prolonged standing (61.88%), sitting (39.38%), repetitive bending (22.19%), awkward postures (16.25%), crouching (16.25%) and stooping (16.25%). Those aged 31-35 are more likely to experience LBP than those aged 18-25 (odds ratio [OR]: 2.82; P = 0.0453) along with married individuals (OR: 2.34; P = 0.0136), doctors (OR: 3.06; P = 0.0136) and nurses (OR: 2.29; P = 0.0136), and healthcare workers (HCWs) compared to non-HCWs (81.67% vs. 66.43%; P = 0.0018). Evening or rotating shifts (OR: 8.23; P = 0.002) and awkward postures (OR: 2.41; P = 0.0358) also increased risk. Regular breaks reduced LBP likelihood (OR: 0.36; P = 0.0360), whereas a pregnancy history raised it (OR: 2.03; P = 0.0097). Conclusions: The female hospital staff had a high prevalence of LBP, linked to increasing age, being an HCW, working evening or rotating shifts and involving inappropriate postures.

The alarming rise in diabetes owing to drug resistance necessitates the implementation of prompt countermeasures in the treatment module of diabetes. Due to their unique physicochemical features, silver nanoparticles may have potential applications in the medical and pharmaceutical industries. Silver nanoparticles (AgNPs) were synthesized from the culture filtrate of Salmonella enterica (ATCC-14028). UV-Vis spectrophotometry, FTIR, SEM, and energy dispersive X-rays were used in the characterization of the nanoparticles. Transmission electron microscopy (TEM) revealed that AgNPs are spherical and highly scattered and vary in size from 7.18 nm to 13.24 nm. AgNP stability and protein loss were confirmed by thermogravimetric analysis (TGA) at different temperatures. The AgNPs had excellent antibacterial activity and a strong synergistic effect against methicillin-resistant bacteria Staphylococcus aureus (MRSA) ATCC-4330 and Streptococcus epidermis (MRSE) ATCC-51625. The DPPH experiment revealed that the AgNPs had high antioxidant activity. The antidiabetic assay revealed that these AgNPs had an IC50 for alpha-amylase of 428.60 μg/ml and an IC50 for alpha-glucosidase of 562.02 μg/ml. Flow cytometry analysis of Hep-2 cells treated with AgNPs (40 μg/ml) revealed higher expression of 2-NBDG glucose absorption (uptake) compared to control metformin. These AgNPs have promising antidiabetic properties and could be used in pharmaceuticals and biomedical industries.

To assess the accuracy of CBCT in implant-supported prostheses and to evaluate metal artifacts with and without implants or implant prostheses. Accuracy and artifacts were assessed in the dried mandible at three points on the buccal and lingual cortical plates on the mandible's body near the crest and the base. On the buccal cortical plate, these points were labelled as A, B and C near the crest and D, E and F near the base of the body of the mandible. Similarly, points a to f were marked on the lingual cortical plate corresponding to points A to F. The study had two control groups, C0 for physical linear measurement (PLM) and C1 for radiographic linear measurement (RLM) and artifact assessment. There were seven test groups, TG 1 to 7, progressing from a single implant to implant full-arch prosthesis. For accuracy assessment, PLM was compared to RLM. CBCT artifacts were investigated in images integrated at 0.25 mm, 10 mm, and 20 mm at regions of interest on concentric circles at different intersecting angles by comparing grayscale values at C1 and TG1 to 7. The data were collected and statistically analyzed. A significant difference was observed between C0 and C1, and RLM in test groups at the superior axial plane. Similarly, PLM and test RLM in the sagittal plane at A-B, B-C, and D-E were statistically significant. A significant difference between PLM and RLM was also observed in the vertical plane at A-D, B-E, and C-F. Quantification of CBCT artifacts in the presence of implants or prostheses revealed that full-arch prostheses had the highest mean grayscale value, whereas single implants with a prosthesis had the lowest. The mean grayscale change was greatest around the implant and implant prosthesis. The mean grayscale value was maximum at 20 mm voxel integration scales (VIS) and lowest at 0.25 mm. CBCT is a clinically reliable device. Metal in implants or implant-supported prostheses prevents true assessment of the peri-implant area; therefore, lower VIS is suggested in the presence of implants or implant prostheses.

Borno state in north-eastern Nigeria is the epicentre of the >10 years’ insurgency activities that have affected the region since 2009, resulting in the destruction of health facilities, killing of health workers, massive population displacement and lack of access to populations to provide health services. This article demonstrates how the involvement of community informants from insecure areas (CIIA) to conduct polio surveillance in security-challenged settlements of Borno state contributed to the expansion of polio surveillance reach beyond polio vaccination reach. In each of the 19 security compromised Local Government areas (LGAs) with community informants from insecure areas, Android phones enabled with Vaccination Tracking System (VTS) technology and Open Data Kit (ODK) mobile application were provided to capture geo-coordinates as evidence (geo evidence) for polio surveillance activity conducted. These geo evidence captured were uploaded and mapped to show insecure settlements reached with polio surveillance and those yet to be reached. A total of 3183 security compromised settlements were reached for polio surveillance between March 2018 and October 2019 with valid geo evidence, 542 of these security-compromised settlements had not been previously reached by any other intervention for polio surveillance or polio vaccination. The capturing of geo-coordinates as a proxy indicator of polio surveillance activity conducted by informants provided significant evidence of settlements reached for sustained polio surveillance even when a case of Acute Flaccid Paralysis (AFP) had not been reported from these settlements. Using the geo evidence captured by CIIA in insecure settlements, we have demonstrated the expansion of polio surveillance reach beyond polio vaccination reach in Borno state.

The recent Nipah virus (NiV) epidemic and human metapneumovirus (hMPV) outbreak have had a significant impact on human health and society worldwide. The attachment glycoprotein (G) and fusion glycoprotein (F0) of NiV and hMPV are essential for pathogenesis and are potentially pronounced targets for antiviral treatment. In the present study, we utilised computational methods to analyse the predictive antiviral potential of phytochemicals present in Cleistanthus bracteosus and in the essential oils of Artemisia scoparia and Thuja orientalis against NiV and hMPV. Molecular docking and dynamics simulations were the primary tools for assessing the binding interactions of compounds detected by GC-MS. Three out of four compounds tested (digoxigenin, cedrene and cedrol) exhibited remarkable binding affinities between −7.7 kcal/mol and −6.2 kcal/mol for NiV fusion glycoprotein (F0), and between −8.3 kcal/mol and −7.1 kcal/mol for NiV attachment glycoprotein (G). Similarly for hMPV fusion glycoprotein (F0), the aforesaid compounds showed binding affinities between −8.1 kcal/mol and −6.4 kcal/mol. Moreover, MD simulations illustrated phytochemical interacting amino acid residues associated with each receptor of NiV and hMPV. These phytochemical compounds were further evaluated using ADMET platforms. In conclusion, the present in silico work predicts for the first time the predicted potential of using major compounds present C. bracteosus , A. scoparia and T. orientalis as a novel anti-viral therapeutic strategy to control the entry and pathogenesis of NiV and hMPV. Despite few RMSD fluctuations in protein-ligand complexes stemming from structural alterations in the beta-turn-beta and helix-coil-helix, the simulations remain mostly stable from 50 ns till 100 ns.

Non-adherence to medicine results in poor disease control and increased morbidity. We determined the prevalence of treatment adherence and its associated factors in Kurdish patients with rheumatoid arthritis (RA) in Kurdistan Region. Disease severity was classified as mild (20%), moderate (46%), and severe (35%). Of the patients, 53% had other chronic diseases. Fifty-four percent always took their medications, 27% most of the time, and 17% sometimes. The study found that 38% expe­rienced some side effects and found managing the medication schedule easy (52%) or very easy (34%). The patients reported that 30% missed a dose of medication, with the frequency of missed doses being rare (60%), occasional (16%), or frequent (24%). Sixty percent had regular access to medications. The barriers were the cost (78%) and availability of medications (27%), and side effects were reported to be significant barriers to adherence (26%). This study showed that the RA patients had high adherence to the treatment, with a high satisfaction rate.

Background/Objectives: Fracture-related infections (FRIs) are a significant complication in conflict zones, where limited resources and damaged infrastructure complicate orthopedic care. Methods: This study retrospectively reviews the management of FRIs during medical missions to Gaza from April to July 2024. Results: Among 135 patients treated for war-related fractures, 30% were identified with suspected FRIs, which were primarily following explosive injuries. Contributing factors to the high incidence of infection included malnutrition, poor sanitation, and the scarcity of sterile surgical supplies. The absence of standard infection control measures further complicated treatment. Conclusions: These findings highlight the critical need for a comprehensive approach that incorporates infection prevention, sustainable healthcare planning, and quality assurance tailored to the realities of conflict zones. The study underscores the importance of international support to ensure the availability of essential medical supplies and to develop effective, context-specific strategies for infection management. By applying these insights, healthcare providers can improve patient outcomes and reduce the burden of FRIs in resource-limited settings affected by conflict.