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INTRODUCTION: It is important to better understand the presence of neutralizing anti-SARS-CoV-2 antibodies in the population, as they potentially prevent (re)infection. AIM: To correlate the Cycle threshold (Ct value) of SARS-CoV-2 and its impact on specific Anti-SARS-CoV-2 IgG titer, to reveal the effect of age and disease severity on antibodies titer. METHODOLOGY: A total of 153 infected participants laboratory-confirmed COVID-19 cases 4-11 months ago, aged 18-85 years old (mean = 43.58, SD ± 15.34) were enrolled in the study. They have not received any COVID-19 vaccine. A questionnaire was prepared including demographic data, age, gender, residence, and symptoms severity they suffered. Five mL of venous blood was taken from each participant to measure SARS-CoV-2 IgG antibodies against the receptor binding domain (RBD) by (VIDAS SARS-COV-2 IgG - Biomerieux kit). Ct values were measured by qRT-PCR (BIO-RAD-CFX96) kit which detected two virus genes, namely (RdRp-N genes). RESULTS: Lowest Ct values were detected significantly in age group 50-59 and 70-85 respectively. The highest mean of IgG was detected in age groups 70-85 and 50-59, and was found to be significantly correlated with disease severity. There is a direct relationship between Ct values and the titer of specific IgG, as increasing in viral load is associated with a higher level of antibodies. Antibodies were detected several months after infection with the highest mean after 10-11 months. CONCLUSIONS: Specific Anti-viral IgG are significantly associated with increasing age and disease severity, and the direct relation of IgG with viral load. Antibodies are detected several months post-infection but their protective efficacy is controversial.

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OBJECTIVE: Human papillomavirus (HPV) has been identified as an important causative factor in cervical cancer development. Cervical cancer is the fourth most prevalent malignant tumor among women globally. The purpose of this study was to investigate the prevalence and genotyping sequences of HPV in formalin-fixed paraffin-embedded (FFPE) cervical tissue using conventional polymerase chain reaction (PCR), and HPV-DNA sequencing. MATERIAL AND METHODS: Retrospective cross-sectional study. Forty (FFPE) blocks with different cervical lesions were taken; patients' ages ranged from 24 to 65 years. Detection and sequencing of HPV DNA were done by conventional PCR (L1 gene), which was achieved by universal PCR primers (MY09/11 oligonucleotides). Then sequencing and phylogenetic tree was constructed. RESULTS: Nine samples were found positive and detected by conventional PCR, they were identified in CIN1 and SCC at 7.5% (n=3) for each, 5.0% (n=2) KA, and 2.5% (n=1) in CIN3 cases, after sequencing were submitted to GenBank and accession numbers were obtained. The phylogenetic tree was constructed and the aligned sequences showed high homology with the nucleotide sequence of the references from the Genbank database. HPV 11, 16, 18, 22, 33, 52, and 58 were found to have little nucleotide heterogeneity and thus no amino acid heterogeneity.  Conclusion: Sequencing and  phylogenetic analysis of circulating HPV types in Duhok provides very essential data about nucleotides and amino acid heterogeneity, to reveal genetic diversity with strains included in the vaccines that have not been introduced to Iraq yet.

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Background: Hepatitis A virus infection is widespread in Iraq, therefore, assessing its seroprevalence is important for infection control at the community level. Aims: To determine hepatitis A virus seroprevalence in a representative sample in Duhok Governorate, northern Iraq; evaluate changes in the epidemiological pattern; and assess factors associated with its seropositivity. Methods: This cross-sectional study was conducted from July 2020 to November 2021. Random cluster sampling was used to select participants aged 5-74 years. Hepatitis A virus immunoglobulin G (IgG) was determined among the participants and demographic data were collected on sex, residency (urban or rural), age, history of jaundice, number of family members (≤ five or > five), and sources of drinking water. Results: A total of 1052 participants (625 males and 427 females) were enrolled. The overall seroprevalence of hepatitis A virus IgG was 68.3%: 24.4% in ages 5-10 years; 38.3% in ages 11-15; 86.9% in ages 16-20; 85.4% in ages 21-30; 95.3% in ages 31-40; and 89.2% in ages > 40 years. Factors significantly associated with hepatitis A virus IgG positivity were rural residence, male sex and family size greater than five (all P < 0.01). Conclusion: Hepatitis A virus seroprevalence in Iraq has been declining since the past decade, indicating intermediate-to-low endemicity of hepatitis A virus. However, people are still many susceptible, indicating the need for hepatitis A virus vaccination in the country.

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Human Papilloma virus infection is the fundamental reason for the development of ano-genital malignancies and knowing the best tool for diagnostic purposes is mandatory. This study investigated the prevalence and genotype distribution of HPV genotypes in formalin-fixed paraffin-embedded (FFPE) blocks from patients with different anogenital lesions. In this cross-sectional retrospective study, 125 blocks from patients with different anogenital lesions were collected. Three internal sections were taken for HPV detection and genotyping using the paraffin tissue processing kit and HPV Direct Flow CHIP. HPV positivity was detected in 90 (72.0%), with 77 (85.6%) females and 13 (14.4%) males as follows: SCC 64.0%, CINIII 66.7%, CINII 100.0%, CINI 83.3%, KA 83.7%, NILM 44.0%, Anus 66.6%. A total of 44% of histologically unremarkable (negative) cases were positive for HPV genotypes while in only 64% of SCC were HPV genotypes detected. Sixty-six (73.3%) cases were low-risk, and 16 (17.8%) cases were high-risk genotypes, mostly cervical lesions, while seven (7.8%) cases showed a mixed viral detection. The most frequent low-risk genotype was HPV6 genotype (62-68.9%), while the prevalent high-risk HPV was HPV16 genotype (12-13.3%). In this study, HPV16 was more frequently detected than HR-HPV, but mainly in cervical lesion, while HPV6 topped the LR-HPV infections amongst different anogenital lesions in Duhok-Iraq. Higher HPV positivity among cytological unremarkable and abnormal cases may reflect the higher sensitivity of the direct flow CHIP diagnostic technique. The results demonstrate that screening for HPV is essential to reduce cancer development and planning for the vaccine's introduction in Iraq.

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Background/Objective: Cervical cancer ranks the second among the most common gynecologic cancers. This study was established to determine the distribution of cervical HPV genotypes among different Pap readings in Duhok/Iraq. Methods: Between January and September-2016, HPV-DNA was tested in 64 women. Genotyping was carried out by the hybridization reverse blot technique. Cervical smears were taken, performed by ThinPrep technique and stained by Pap stain. Results: Twenty six (40.6%) cases were positive for HPV, 12 (46.2%) in normal and 14 (53.8%) in abnormal Pap smears. 39 (19 high-risk and 16 low-risk) genotypes were identified. The high risk group comprised 6 HPV16, 4 HPV18, 2 HPV66, 2 HPV52, 2 HPV39, 1 HPV56, 1 HPV31 and 1 HPV45. The 16 low risk strains encompassed 4 HPV6 strains, 4 HPV71, 2 HPV54 and 2 HPV83, HPV11, HPV61 HPV84, and HPV62. Mixed infections were described in 4 women (6.25%), limited to the NILM, ASC-US and LSIL smears. They included variable admixtures of 7 high risk genotypes, HPV39 (both copies), HPV66 (both copies), HPV52, HPV31, HPV45 and 6 low risk strains: HPV83, HPV6, HPV11, HPV54, HPV62 and HPV71. Conclusions: The higher frequency of HR-HPV than the LR-HPV with identification of 4 mixed cases indicates that our women are at risk of developing cervical cancer. Detection of HR-HPV in NILM and ASC-US smears with restriction of some strains to these 2 categories highlights the great value of HPV genotyping as a surrogate test to pick up unscreened women at risk of developing cervical malignancy particularly when a proper screening program is absent.

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BACKGROUND AND OBJECTIVES: Helicobacter pylori is a Gram negative bacteria that causes peptic ulceration and gastric adenocarcinoma. H pylori virulence factors, such as cagA and dupA, are important to study in populations as they contribute to disease risk. This study aimed to look at the distribution of the cagA and dupA genes in H pylori strains isolated from patients suffering from gastroduodenal diseases in Kurdistan region, Iraq. DESIGN AND SETTINGS: A cross-sectional study conducted between June 2011 and January 2012. Biopsies were collected from the Endoscopy Department in Duhok and Sulaimania hospitals, Kurdistan region, northern Iraq. PATIENTS AND METHODS: Upper gastrointestinal (GI) endoscopy examination was performed and 4 gastric biopsies (2 from the antrum and 2 from the corpus) were obtained from 204 patients. H pylori positivity was examined by CLO test; then the association between disease status and virulence factors was assessed by polymerase chain reaction. RESULTS: 154 (75%) of our samples were found to be H pylori + by CLO test. Endoscopic diagnoses for those who were positive were as follows: peptic ulcer disease (PUD) including duodenal ulcer, 45; gastric ulcer, 23; and no ulcer (NPUD), 86. The overall prevalence rates of cagA and dupA were 72.7% and 18.8%, respectively. While a significant association between cagA and PUD was observed (P. ≤.017; OR=0.4; CI=0.18­0.85), no relationship between dupA and PUD could be seen. CONCLUSION: These data suggested that the presence of cagA may be a predictor of clinical outcome in Kurdistan region, northern Iraq.

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BACKGROUND AND STUDY AIM: Several genes of Helicobacter pylori, such as vacA, cagA, iceA and babA, have been reported to significantly increase the risk of gastrointestinal diseases. The aim of this study was to study the relationship between H. pylori virulence factors and clinical outcomes and identify the independent markers of peptic ulcer disease in Iraq. PATIENTS AND METHODS: DNA was extracted from specimens taken from 154 unselected H. Pylori positive Iraqi patients. Genotyping was performed by the polymerase chain reaction (PCR), using specific primers for cagA, vacA (s, m), iceA and babA2 genes. RESULTS: A total of 56 (82%) peptic ulcer disease (PUD) patients carried cagA+ strains, significantly more than the 56 (65%) non-ulcer disease (NUD) patients (p=0.017). The difference in the prevalence of babA2 positivity was significant between patients with NUD (33.7%) and PUD (58.8%) (p=0.002). In addition, babA2 was associated as an independent factor, with PUD (p=0.005; odds ratio (OR)=0.4; confidence interval (CI)=0.18-0.68) followed by cagA (p=0.05; OR=0.4; CI=0.18-0.85). Forty-five isolates (29%) were typed as 'triple positive' strains, and their presence was significantly associated with PUD (p=0.001). CONCLUSION: The cagA and babA2 genotypes might be considered as useful markers for PUD patients. However, iceA1 and iceA2 seem not to be good markers for the disease. The presence of H. pylori strains with triple-positive status is of high clinical relevance to H. pylori-associated diseases.

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