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"Drugs Iraq"
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Emotion Regulatory Brain Function and SSRI Treatment in PTSD: Neural Correlates and Predictors of Change
Posttraumatic stress disorder (PTSD)-a chronic, debilitating condition, broadly characterized by emotion dysregulation-is prevalent among US military personnel who have returned from Operations Enduring Freedom (OEF) and Iraqi Freedom (OIF). Selective serotonin reuptake inhibitors (SSRIs) are a first-line treatment for PTSD, but treatment mechanisms are unknown and patient response varies. SSRIs may exert their effects by remediating emotion regulatory brain activity and individual differences in patient response might be explained, in part, by pre-treatment differences in neural systems supporting the downregulation of negative affect. Thirty-four OEF/OIF veterans, 17 with PTSD and 17 without PTSD underwent 2 functional magnetic resonance imaging scans 12 weeks apart. At each scan, they performed an emotion regulation task; in the interim, veterans with PTSD were treated with the SSRI, paroxetine. SSRI treatment increased activation in both the left dorsolateral prefrontal cortex (PFC) and supplementary motor area (SMA) during emotion regulation, although only change in the SMA over time occurred in veterans with PTSD and not those without PTSD. Less activation of the right ventrolateral PFC/inferior frontal gyrus during pre-treatment emotion regulation was associated with greater reduction in PTSD symptoms with SSRI treatment, irrespective of pre-treatment severity. Patients with the least recruitment of prefrontal emotion regulatory brain regions may benefit most from treatment with SSRIs, which appear to augment activity in these regions.
Journal Article
Trends and Risk Factors for Mental Health Diagnoses Among Iraq and Afghanistan Veterans Using Department of Veterans Affairs Health Care, 2002-2008
Objectives. We sought to investigate longitudinal trends and risk factors for mental health diagnoses among Iraq and Afghanistan veterans. Methods. We determined the prevalence and predictors of mental health diagnoses among 289 328 Iraq and Afghanistan veterans entering Veterans Affairs (VA) health care from 2002 to 2008 using national VA data. Results. Of 289 328 Iraq and Afghanistan veterans, 106 726 (36.9%) received mental health diagnoses; 62 929 (21.8%) were diagnosed with posttraumatic stress disorder (PTSD) and 50 432 (17.4%) with depression. Adjusted 2-year prevalence rates of PTSD increased 4 to 7 times after the invasion of Iraq. Active duty veterans younger than 25 years had higher rates of PTSD and alcohol and drug use disorder diagnoses compared with active duty veterans older than 40 years (adjusted relative risk = 2.0 and 4.9, respectively). Women were at higher risk for depression than were men, but men had over twice the risk for drug use disorders. Greater combat exposure was associated with higher risk for PTSD. Conclusions. Mental health diagnoses increased substantially after the start of the Iraq War among specific subgroups of returned veterans entering VA health care. Early targeted interventions may prevent chronic mental illness.
Journal Article
Complex Comorbidity Clusters in OEF/OIF Veterans: The Polytrauma Clinical Triad and Beyond
Background: A growing body of research on US Veterans from Afghanistan and Iraq [Operations Enduring and Iraqi Freedom, and Operation New Dawn (OEF/OIF)] has described the polytrauma clinical triad (PCT): traumatic brain injury (TBI), posttraumatic stress disorder (PTSD), and pain. Extant research has not explored comorbidity clusters in this population more broadly, particularly co-occurring chronic diseases. Objectives: The aim of the study was to identify comorbidity clusters among diagnoses of deployment-specific (TBI, PTSD, pain) and chronic (eg, hypertension, diabetes) conditions, and to examine the association of these clusters with health care utilization and adverse outcomes. Research Design: This was a retrospective cohort study. Subjects: The cohort comprised OEF/OIF Veterans who received care in the Veterans Health Administration in fiscal years (FY) 2008–2010. Measures: We identified comorbidity using validated ICD-9-CM code–based algorithms and FY08–09 data, followed by which we applied latent class analysis to identify the most statistically distinct and clinically meaningful patterns of comorbidity. We examined the association of these clusters with process measures/outcomes using logistic regression to correlate medication use, acute health care utilization, and adverse outcomes in FY10. Results: In this cohort (N = 191,797), we found 6 comorbidity clusters. Cluster 1: PCT + Chronic Disease (5%); Cluster 2: PCT (9%); Cluster 3: Mental Health + Substance Abuse (24%); Cluster 4: Sleep, Amputation, Chronic Disease (4%); Cluster 5: Pain, Moderate PTSD (6%); and Cluster 6: Relatively Healthy (53%). Subsequent health care utilization patterns and adverse events were consistent with disease patterns. Conclusions: These comorbidity clusters extend beyond the PCT and may be used as a foundation to examine coordination/quality of care and outcomes for OEF/OIF Veterans with different patterns of comorbidity.
Journal Article
Epidemiological trends, antifungal drug susceptibility and SQLE point mutations in etiologic species of human dermatophytosis in Al-Diwaneyah, Iraq
Dermatophytes show a wide geographic distribution and are the main causative agents of skin fungal infections in many regions of the world. Recently, their resistance to antifungal drugs has led to an obstacle to effective treatment. To address the lack of dermatophytosis data in Iraq, this study was designed to investigate the distribution and prevalence of dermatophytes in the human population and single point mutations in squalene epoxidase gene (
SQLE
) of terbinafine resistant isolates. The identification of 102 dermatophytes isolated from clinical human dermatophytosis was performed through morphological and microscopic characteristics followed by molecular analysis based on ITS and
TEF-1α
sequencing. Phylogeny was achieved through RAxML analysis. CLSI M38-A2 protocol was used to assess antifungal susceptibility of the isolates to four major antifungal drugs. Additionally, the presence of point mutations in
SQLE
gene, which are responsible for terbinafine resistance was investigated. Tinea corporis was the most prevalent clinical manifestation accounting for 37.24% of examined cases of dermatophytosis. Based on ITS
, T. indotineae
(50.98%),
T. mentagrophytes
(19.61%)
,
and
M. canis
(29.41%) was identified as an etiologic species.
T. indotineae
and
T. mentagrophytes
strains were identified as
T. interdigitale
based on
TEF-1α
. Terbinafine showed the highest efficacy among the tested antifungal drugs.
T. indotineae
and
T. mentagrophytes
showed the highest resistance to antifungal drugs with MICs of 2–4 and 4 μg/mL, while
M. canis
was the most susceptible species. Three of
T. indotineae
isolates showed mutations in
SQLE
gene Phe
397
Leu substitution. A non-previously described point mutation, Phe
311
Leu was identified in
T. indotineae
and mutations Lys
276
Asn, Phe
397
Leu and Leu
419
Phe were diagnosed in
T. mentagrophytes
XVII. The results of mutation analysis showed that Phe
397
Leu was a destabilizing mutation; protein stability has decreased with variations in pH, and point mutations affected the interatomic interaction, resulting in bond disruption. These results could help to control the progression of disease effectively and make decisions regarding the selection of appropriate drugs for dermatophyte infections.
Journal Article
AB569, a non-toxic combination of acidified nitrite and EDTA, is effective at killing the notorious Iraq/Afghanistan combat wound pathogens, multi-drug resistant Acinetobacter baumannii and Acinetobacter spp
Multi-drug resistant (MDR) Acinetobacter baumannii ( Ab ) and Acinetobacter spp . present monumental global health challenges. These organisms represent model Gram-negative pathogens with known antibiotic resistance and biofilm-forming properties. Herein, a novel, nontoxic biocide, AB569, consisting of acidified nitrite (A-NO 2 - ) and ethylenediaminetetraacetic acid (EDTA), demonstrated bactericidal activity against all Ab and Acinetobacter spp. strains, respectively. Average f ractional i nhibitory c oncentrations (FICs) of 0.25 mM EDTA plus 4 mM A-NO 2 - were observed across several clinical reference and multiple combat wound isolates from the Iraq/Afghanistan wars. Importantly, toxicity testing on human dermal fibroblasts (HDFa) revealed an upper toxicity limit of 3 mM EDTA plus 64 mM A-NO 2 - , and thus are in the therapeutic range for effective Ab and Acinetobacter spp . treatment. Following treatment of Ab strain ATCC 19606 with AB569, quantitative PCR analysis of selected genes products to be responsive to AB569 revealed up-regulation of iron regulated genes involved in siderophore production, siderophore biosynthesis non-ribosomal peptide synthetase module ( SBNRPSM ), and siderophore biosynthesis protein monooxygenase ( SBPM ) when compared to untreated organisms. Taken together, treating Ab infections with AB569 at inhibitory concentrations reveals the potential clinical application of preventing Ab from gaining an early growth advantage during infection followed by extensive bactericidal activity upon subsequent exposures.
Journal Article
An Outbreak of Multidrug-Resistant Acinetobacter baumannii-calcoaceticus Complex Infection in the US Military Health Care System Associated with Military Operations in Iraq
Background. We investigated an outbreak of multidrug-resistant Acinetobacter baumannii-calcoaceticus complex infection among US service members injured in Iraq. Methods. The investigation was conducted in Iraq and Kuwait, in the 2 military hospitals where the majority of injured service members were initially treated. After initially characterizing the outbreak, we evaluated 3 potential sources of infection for the period March 2003 to December 2004. The evaluation included screening samples that were obtained from the skin of patients for the presence of colonization and assessing the soil and health care environments for the presence of A. baumanii-calcoaceticus complex organisms. Isolates obtained from samples from patients in US Military treatment facilities, as well as environmental isolates, were genotypically characterized and compared using pulsed-field gel electrophoresis. Results. A. baumanii-calcoaceticus complex organisms were present on the skin in only 1 (0.6%) of 160 patients who were screened and in 1 (2%) of 49 soil samples. A. baumanii-calcoaceticus complex isolates were recovered from treatment areas in 7 of the 7 field hospitals sampled. Using pulsed-field gel electrophoresis, we identified 5 cluster groups in which isolates from patients were related to environmental isolates. One cluster included hospitalized patients who had not been deployed to Iraq. Among the clinical isolates, only imipenem, polymyxin B, and colistin demonstrated reliable in vitro antimicrobial activity. Generally, the environmental isolates were more drug susceptible than were the clinical isolates. Conclusions. Our findings suggest that environmental contamination of field hospitals and infection transmission within health care facilities played a major role in this outbreak. On the basis of these findings, maintaining infection control throughout the military health care system is essential. Novel strategies may be required to prevent the transmission of pathogens in combat field hospitals.
Journal Article
Mental and Physical Health Status and Alcohol and Drug Use Following Return From Deployment to Iraq or Afghanistan
Objectives. We examined (1) mental and physical health symptoms and functioning in US veterans within 1 year of returning from deployment, and (2) differences by gender, service component (Active, National Guard, other Reserve), service branch (Army, Navy, Air Force, Marines), and deployment operation (Operation Enduring Freedom/Operation Iraqi Freedom [OEF/OIF]). Methods. We surveyed a national sample of 596 OEF/OIF veterans, oversampling women to make up 50% of the total, and National Guard and Reserve components to each make up 25%. Weights were applied to account for stratification and nonresponse bias. Results. Mental health functioning was significantly worse compared with the general population; 13.9% screened positive for probable posttraumatic stress disorder, 39% for probable alcohol abuse, and 3% for probable drug abuse. Men reported more alcohol and drug use than did women, but there were no gender differences in posttraumatic stress disorder or other mental health domains. OIF veterans reported more depression or functioning problems and alcohol and drug use than did OEF veterans. Army and Marine veterans reported worse mental and physical health than did Air Force or Navy veterans. Conclusions. Continuing identification of veterans at risk for mental health and substance use problems is important for evidence-based interventions intended to increase resilience and enhance treatment.
Journal Article
A review of antibiotic misuse and bacterial resistance in Iraq
Background: Antimicrobial resistance poses a serious threat to healthcare globally. Reviewing current practice regarding antibiotic prescription and use is crucial to understanding antimicrobial resistance issues in Iraq and how to tackle them. Aim: To review and analyse studies addressing antimicrobial resistance as well as antibiotic prescription, dispensing and use in Iraq. Methods: In June 2023, we searched Google Scholar for, and reviewed, empirical studies related to antibiotic use and antimicrobial resistance in Iraq. Results: Thirty-seven eligible studies published between 2012 and 2023 were included in the review. Multi-drug-resistant bacteria, such as E. coli and P. aeruginosa, were commonly reported by the studies. Most physicians in public hospitals prescribed antibiotics frequently and empirically without relying on culture and sensitivity tests, and community pharmacists often dispensed antibiotics to patients without prescriptions, indicating self-medication and misuse of antibiotics in Iraq. Antibiotic residuals were found in raw meat and drinking water. Although there were antimicrobial resistance control regulations and plans, they were not fully implemented. Conclusion: This review shows that antimicrobial resistance and antibiotic misuse are serious problems in Iraq. The responsible authorities should work together to implement and enforce compliance to the antimicrobial resistance control plans using the One Health approach.
Journal Article
Investigation of carbapenemase-encoding genes in Burkholderia cepacia and Aeromonas sobria isolates from nosocomial infections in Iraqi patients
Burkholderia cepacia and Aeromonas sobria are difficult to eradicate due to their innate resistance to a variety of medications, and cause various diseases. The aim of this study was to investigate the occurrence of carbapenemase genes and patterns of antibiotic resistance in isolates of B. cepacia and A. sobria . Randomly, 120 clinical specimens have been collected in patients with nosocomial infections. Selective media were used to culture ear swabs, urine, burns, wounds and cerebrospinal fluids. According to biochemical tests and the VITEK-2 system, 75 of these demonstrated positive growth with B. cepacia and A. sobria . Metallo-β-lactamase (MBL) synthesis was phenotypically screened using the meropenem-EDTA disc test. The recA gene in B. cepacia and the genes encoding carbapenemase in both species were found using PCR tests. Among the 75 isolates assessed 20 (26.6%) were A. sobria and 55 (73.3%) were B. cepacia . Piperacillin, cefepime, and ceftriaxone showed antimicrobial resistance of 100%, followed by ceftazidime (97.3%), cefazolin (96%), and piperacillin/ tazobactam (94.6%). Intermediate resistance was reported with aztreonam (61.3%), meropenem (49.3%), trimethoprim-sulfamethoxazole (49.3%), gentamicin (46.6%), levofloxacin (44%), and ciprofloxacin (44%). It is important to note minocycline (40%), amikacin (40%) imipenem (36%) and tigecycline (34.6%), had the lowest resistance rates, hence their relatively higher efficacy against the tested isolates. In this investigation, the B. cepacia was confirmed to be found via the recA gene. The overall prevalence of carbapenemase genes was 92.8% (52/56) with bla KPC accounting for 80.8% (42/52) and bla GES for 19.2% (10/52) of the total. Specifically, 38 (90.51%) of the 42 (76.36%) B. cepacia isolates that were positive in carbapenem resistance carried bla KPC gene, 2 (4.81%) isolates carried bla GES , and 2 (4.81%) had no detectable carbapenemase gene. In the case of the 14 A. sobria carbapenem-resistant isolates, there were 4 isolates (28.6%) that had bla KPC , 8 isolates (57.1%) that had bla GES and there were 2 isolates (14.3%) that did not have any carbapenemase genes. None of isolates studied tested positive for the bla IMP gene. The recent study concluded that recA gene identification was more sensitive and specific technique for detection B. cepacia complex isolates. Since the prevalence of carbapenemase producers is high, careful infection control measures, rapid diagnostics, and antimicrobial stewardship must be implemented by clinicians. It is necessary that combination therapy be guided and early detectable to ensure better outcomes and restrict resistance.
Journal Article