Health risk assessment of heavy metals in some vegetables-Erbil City-Kurdistan Region of Iraq

Heavy metals can have significant impacts on human health due to their toxicity and potential to accumulate in the body over time. Some heavy metals, such as lead, cadmium, mercury, and arsenic, are particularly harmful even at low concentrations. The estimation of hazards of vegetable intake to human health as well as explore the of heavy metals accumulation in different vegetables (cucumbers, tomato, eggplant, and bell peppers) collected in Erbil city from different source locally and imported from nearby country are conducted. The heavy metals concentration (cooper, zinc, lead and cadmium) was measured and analyzed by inductively coupled plasma-optical emission spectrophotometry. The maximum concentration of Pb was 27.95 mg/kg and the minimum was 6.49 mg/kg; for Cd, the concentration was 1.43 and 0.99 mg/kg, 74.94 and 5.14 mg/kg for Zn; and for Cu, the result was 56.25 and 8.2 mg/kg for the maximum and minimum, which they are within limits described by Food Agricultural Organization, but more than health limits and health risks calculated by mean of hazard quotient (HQ) techniques for Cu and Pb which they are more than 1. The local sample that collected in Erbil city show less concentration of heavy metals and low HQ in comparison with imported samples. The carcinogenic risk study shows elevated risk of accumulative consuming of edible part of those plant which they exceed the permissible limit that is 10-6.

Hydrogeochemical evolution processes, groundwater quality, and non-carcinogenic risk assessment of nitrate-enriched groundwater to human health in different seasons in the Hawler (Erbil) and Bnaslawa Urbans, Iraq

The main objectives of this research are to assess groundwater, a primary source of drinking water in the urban areas of Hawler (Erbil) and Bnaslawa in northern Iraq, and the non-carcinogenic human health risks of nitrate contamination associated with drinking water quality. For this purpose, twenty-seven groundwater samples were collected from wells to assess the hydrogeochemical characteristics and groundwater quality for both natural and anthropogenic purposes during the wet (May 2020) and dry (September 2020) seasons. During the wet and dry seasons, NO3- in groundwater ranged from 14.00 to 61.00 mg/L and 12.00 to 60.00 mg/L, with an average value of 35.70 and 29.00 mg/L, respectively. Approximately 25.92% of the samples exceeded the permissible limit of the WHO (2011) drinking water standard. The ratios of NO3-/Na+ vs. Cl-/Na+ and SO42-/Na+ vs. NO3-/Na+ indicate the effect of agricultural activities and wastewater leaking from cesspools or septic tanks on the quality of groundwater during the wet and dry seasons. The entropy weighted water quality index method ranked 62.5% and 75% of the urban groundwater as not recommended for drinking, and the remaining samples are moderately suitable in both wet and dry seasons. The non-carcinogenic human health risk assessment displayed that during the wet and dry seasons, 29.6% and 25.9% of adults, 48% and 30% of children, and 48.1% and 29.6% of infants were exposed to increased concentrations of nitrate in groundwater. Due to high nitrate in drinking water, non-carcinogenic human health risk levels vary as infant > child > adults. The main findings obtained from this study can assist policymakers in better understanding the hydrogeochemical properties of groundwater in terms of drinking water safety, thereby facilitating the management of water resources to take the necessary measures.

Impact of primary percutaneous coronary intervention on ST-segment elevation myocardial infarction patients: A comprehensive analysis

BACKGROUND

Myocardial infarction, particularly ST-segment elevation myocardial infarction (STEMI), is a key global mortality cause. Our study investigated predictors of mortality in 96 STEMI patients undergoing primary percutaneous coronary intervention at Erbil Cardiac Center. Multiple factors were identified influencing in-hospital mortality. Significantly, time from symptom onset to hospital arrival emerged as a decisive factor. Consequently, our study hypothesis is: "Reducing time from symptom onset to hospital arrival significantly improves STEMI prognosis."

AIM

To determine the key factors influencing mortality rates in STEMI patients.

METHODS

We studied 96 consecutive STEMI patients undergoing primary percutaneous coronary intervention (PPCI) at the Erbil Cardiac Center. Their clinical histories were compiled, and coronary evaluations were performed via angiography on admission. Data included comorbid conditions, onset of cardiogenic shock, complications during PPCI, and more. Post-discharge, one-month follow-up assessments were completed. Statistical significance was set at P < 0.05.

RESULTS

Our results unearthed several significant findings. The in-hospital and 30-d mortality rates among the 96 STEMI patients were 11.2% and 2.3% respectively. On the investigation of independent predictors of in-hospital mortality, we identified atypical presentation, onset of cardiogenic shock, presence of chronic kidney disease, Thrombolysis In Myocardial Infarction grades 0/1/2, triple vessel disease, ventricular tachycardia/ventricular fibrillation, coronary dissection, and the no-reflow phenomenon. Specifically, the recorded average time from symptom onset to hospital arrival amongst patients who did not survive was significantly longer (6.92 ± 3.86 h) compared to those who survived (3.61 ± 1.67 h), P < 0.001. These findings underscore the critical role of timely intervention in improving the survival outcomes of STEMI patients.

CONCLUSION

Our results affirm that early hospital arrival after symptom onset significantly improves survival rates in STEMI patients, highlighting the critical need for prompt intervention.

Radioactivity levels, soil-to-grass and grass-to-milk transfer factor of natural radionuclides from grazing area in Erbil governorate, Iraq

The levels of naturally occurring radionuclides in soil, grass, and milk were measured in this study in order to calculate the transfer factor of radionuclides from soil to grass and grass to milk obtained from Erbil governorate in Iraq. High efficiency gamma spectrometry used for the measurement. It has been determined that the mean activity concentrations of 232Th, 226Ra, and 40K are 3.08, 8.37, and 253 BqKg-1 in soil, 0.5, 0.39, and 203.05 BqKg-1, in grass, and 0.29, 0.084, and 29.69 BqL-1, in milk, respectively. For soil to grass, the transfer factor values for 232Th, 226Ra, and 40K were found to be 0.18, 0.052, and 0.84, respectively, for soil to grass. For grass to milk, the transfer factor values for 232Th, 226Ra, and 40K were found to be 0.45, 0.166, and 0.11 dayL-1, respectively. The average transfer factor for 232Th, 226Ra, and 40K in all samples were lower than the world average value.

Early childhood caries: parents' knowledge, attitude and practice towards its prevention in refugee camps in Erbil, Iraq

BACKGROUND

Early childhood caries is a significant oral health issue in socially deprived communities, including refugees, where prevention plays a crucial role in minimizing the challenges and costs associated with treating early childhood caries. To improve oral health outcomes, it is important to understand parents' knowledge, attitudes, and practices. This study aims to assess the oral health knowledge, practices, and attitudes of refugee parents.

METHODS

This cross-sectional study included 503 parents/caregivers residing in Erbil's refugee camps in Iraq, with healthy preschool children aged one to six years. Structured questionnaire was utilized in conducting individual interviews with parents to evaluate their knowledge, attitudes, and practices. The questionnaire collected demographic information and data on access to oral health services.

RESULTS

A total of 503 out of 505 households actively participated in the study, resulting in a high response rate of 99.6%. Demographic analysis revealed that the majority of respondents were female parents, constituting 92.05% of the sample. Within the participant pool, the primary age groups were 26-35 years (55.3%) and 18-25 years (26.2%). Educational background analysis revealed that a significant proportion of parents had attained a secondary school education (29.6%) or primary school education (27.4%). Statistical analysis further established a noteworthy association between educational background and knowledge level. The investigation of participants' knowledge uncovered notable gaps and misconceptions pertaining to early childhood caries, with an overall mean score of 5.1. Assessing the overall attitude of parents, a mean score of 3.87 (SD = 1.29) suggested a generally unfavorable attitude towards oral hygiene practices and prevention of early childhood caries. In terms of actual practices, parents demonstrated a mean practice score of 5.7.

CONCLUSIONS

This study emphasizes knowledge gaps and misconceptions among parents in refugee camps regarding early childhood caries in preschool children. Findings revealed low knowledge scores, limited understanding of hidden sugars, delayed oral hygiene practices, and limited knowledge about fluoride.

Assessing the Impact of Health Education Intervention on Asthma Knowledge, Attitudes, and Practices: A Cross-Sectional Study in Erbil, Iraq

Asthma causes chronic coughing, wheezing, dyspnea, and chest pressure. This study assessed asthmatic patients' knowledge, attitudes, and practice (KAP) of bronchial asthma and proper education on its meaning, risk factors, symptoms, diagnosis, management, and prevention practices. We performed a cross-sectional interventional asthma KAP survey in Erbil, Iraq. We adapted a validated study questionnaire from KAP studies in other nations to the Erbil situation and culture. In Erbil, Kurdistan, Iraq, two major hospitals' asthma clinics were studied. We chose 250 asthmatic patients from October 2018 to July 2019. Health education was comprehensive. The health education program used a Kurdish PowerPoint with a printout. Twenty-five groups received two weeks of one-hour health education pre-intervention. Each group was questioned before, 2 weeks after, and 12 weeks after health education. All data were analyzed by SPSS v26. The mean age of the respondents was 37.52 ± 15.16, with 48.7% of the respondents having a positive family history of asthma. After 2 weeks of health education intervention, respondents had a higher knowledge score and positive attitudes compared to pre-education, and after 12 weeks of education, there was a significant difference (p < 0.001) with improvised prevention practice. Health education programs led to considerable improvements in asthmatic patients' knowledge, attitudes, and practices regarding their condition. After receiving health education for a period of two weeks, the majority of the participants answered correctly regarding asthma, its causes, and the elements that trigger asthma attacks.

Radiological health assessment of infant milk in Erbil Governorate, Iraq

In this research, the radioactivity caused by natural radionuclides (⁴⁰ K, ²³²Th, and ²²⁶Ra) was evaluated in infant milk consumed in Erbil, Iraq. The measurements were performed using an HPGe gamma-ray spectrometer. The variation of activity concentrations in milk samples was (99.56-256.9 Bq kg^-1) for ⁴⁰ K, (BDL-0.53 Bq kg^-1) for ²³²Th, and (0.27-5.59 Bq kg^-1) for ²²⁶Ra, as determined by the results. The radiological parameters of E_ing, D_org, and ELCR were calculated and compared to international standards. The correlation between computed radiological hazard parameters and natural radionuclides was analyzed statistically using Pearson's correlation. Overall, the results indicate that infant milk consumption in Erbil is radiologically safe and that consumers of these brands of milk are unlikely to be directly exposed to radiological health risks.

Incidence and geographical distribution of tuberculosis disease in Erbil city, Iraq

OBJECTIVES

This study aimed to identify the geographical distribution of TB in Erbil city, Kurdistan Region, Iraq, determine potential risk factors associated with TB distribution, and provide recommendations to improve TB control programs in the region.

METHODS

The records of TB patients registered at the Chest and Respiratory Disease Center in Erbil, Iraqi Kurdistan Region, from January 2012 to December 2016 were reviewed and analyzed. The number of cases by the quarter of residence within Erbil city were analyzed spatially and presented in an appropriate map.

RESULTS

The estimated annual incidence of TB in Erbil city constantly increased from 16 per 100,000 inhabitants in the year 2012 to 21.7 per 100,000 inhabitants in the year 2016. Most of the TB cases were from the middle zone of Erbil city (44%), followed by the outer zone (43.8%) and the central zone (12.2%). The largest number of the cases were from Brayaty quarter (40), followed by Badawa (35) Nawroz (35) and Kurdistan (31) quarters. Clusters with a large number of cases were mainly located in the southern part of the city.

CONCLUSION

The estimated TB incidence constantly increased in Erbil city from 2012 to 2016. Mapping the distribution of TB cases in Erbil city provided useful information about the epidemiological situation of TB that can be used to direct future TB control strategies.

Effects of low carbohydrate diet compared to low fat diet on reversing the metabolic syndrome, using NCEP ATP III criteria: a randomized clinical trial

INTRODUCTION

The purpose of this study is to compare the change in the metabolic syndrome prevalence and risk factors between participants who followed a low carbohydrate diet and those who followed a low fat diet for six months in Erbil city/ Iraqi Kurdistan.

METHODS

Out of 289 apparently healthy obese adults who were chosen by a stratified multistage probability sampling method, 94 of them agreed to participate in the study. They were assigned to low carbohydrate and low fat diet groups. Both groups were followed up for 6 months and the data were taken at baseline, after 3 months and after 6 months of intervention. Ninety-four obese adults completed the intervention. One-way repeated measures ANOVA was used to compare differences of metabolic dependent variables between the two independent variables, the low carbohydrate and low fat diet, at baseline, after 3 months and after 6 months of intervention.

RESULTS

The Participants in low carbohydrate diet group had greater decrease in the prevalence of MetS. At the baseline, according to the ATP III criteria, the prevalence of metabolic syndrome was 44.4% (24/54) in low carbohydrate diet group and 60% (24/40) in low fat diet group. The prevalence of MetS was decreased significantly to 16.7% (9/54) after 3 months and to 3.7% (2/54) after 6 months in low carbohydrate diet (p < 0.001). Moreover, the prevalence of MetS was decreased significantly to 32.5 (13/40) after 3 months and to 22.5% (9/40) after 6 months in low fat diet (p < 0.001). No statistically significant difference was found between low carbohydrate diet & low fat diet at the baseline (p-value = 0.136) and after 3 months and after 6 months of intervention.

CONCLUSIONS

Both low carbohydrate diet and low fat diet have significant effects on reducing the prevalence of MetS in obese adults when followed up for 6 months. Compared to low fat diet, low carbohydrate diet had greater effect in reducing the prevalence of metabolic syndrome. Both diet programs were found to be effective in improving the metabolic state of obese adults.

TRIAL REGISTRATION

The trial is registered retrospectively at the US National Institutes of Health ( ClinicalTrials.gov ). The registration in the US National Institutes of Health was done in 23/12/2020 with the registration number: NCT04681924 .

Screening of antibiotic residues in raw milk of cows and buffalos by diffusion assays

Although antibiotics are valuable drugs for treatment of certain infections, their presence in foodstuff derived from animals is a potential public health hazard. They pose a serious threat as they are implicated in direct toxicity; allergic reactions; disturbance of the normal gut microbiota, carcinogenesis, and emergence of antibioticresistant bacteria. This study investigated the occurrence of antibiotic residues in raw milk samples derived from cows and buffaloes. Samples were collected randomly from different retail outlets in Erbil city (Iraq) from January 1^st to June 30^th, 2019. The residues were detected by two diffusion assays against Bacillus subtilis bacteria on agar plates. The total occurrence of residues ranged from 11.9% to 13.4% of screened milk samples. No significant differences were found between milk type or location of animal rearing (urban or suburban). Regarding the seasonal variations, spring was found to be associated with gradual decrease in antibiotic residues levels in milk. Such occurrence rate of residues is alarming and require authorities to observe the quality of raw milk introduced to markets for consumption. Further evaluation of antibiotic stability period in raw milk is also necessary.

Genotype-phenotype correlation of HbH disease in northern Iraq

BACKGROUND

HbH disease results from dysfunction of three, less commonly two, α-globin genes through various combinations of deletion and non-deletion mutations. Characterization of the mutations and the underlying genotypes is fundamental for proper screening and prevention of thalassaemia in any region. The aim of this study was to explore the genetic arrangements of HbH disease and to correlate the genotypes with the clinical phenotypes.

METHODS

A total of 44 HbH disease patients were enrolled in this study. They were clinically and haematologically assessed. The patients were tested for 21 common α-globin gene mutations using multiplex PCR and reverse hybridization. According to the genotype, the patients were categorized into two separate sub-groups, deletion and non-deletion types HbH disease.

RESULTS

Within the studied HbH disease patients, eight different α-globin gene mutations were detected in nine different genetic arrangements. The --^MED and -α^3.7 deletions were the two most frequently encountered mutations (37.5 and 35.2% respectively). Patients with deletion genotypes constituted 70.4%. The most common detected genotype was --^MED/-α^3.7 (59.1%), followed by α^poly-A1α/α^poly-A1α (13.6%). For the first time, coinheritance of two relatively mild mutations (-α^3.7/αα^Adana) was unpredictably detected in a 1.5 year-old child with Hb of 7.1 g/dL.

CONCLUSION

The HbH disease patients' clinical characteristics were variable with no ample difference between the deletion and non-deletion types. These results can be of benefit for the screening and management of thalassaemia in this region.

Molecular spectrum of α-thalassemia mutations in Erbil province of Iraqi Kurdistan

α-Thalassemia is a globally prevalent genetic disorder of hemoglobin (Hb) structure where the rate of α-globin chain synthesis is reduced or absent based on the underlying α-globin mutation(s). This study aimed to define the spectrum of α-globin gene mutations and assess their relative frequency within a group of α-thalassemia carriers. A total of 96 young subjects with unexplained hypochromia and microcytosis were recruited. They were referred from the premarital hemoglobinopathy screening and genetic counseling center in Erbil. All subjects were genetically tested for 21 common α-globin gene mutations using multiplex PCR and reverse hybridization. Six different α-globin gene mutations and nine different genotypes were detected in 84 carrier subjects. Their mean Hb was 12.9 (± 1.29) g/dL, of whom 49 subjects (58.3%) had a normal Hb level. The two most frequently encountered mutations were -α^3.7 deletion (62.86%) and α2^-5nt mutation (20%). Deletions were encountered in 71.43% of the mutated alleles. The most commonly observed genotype was -α^3.7/αα (46.43%), followed by -α^3.7/-α^3.7 and α^-5ntα/αα genotypes (10.72% each). Carriers of α^poly-A1α/αα and -α^3.7/-α^-5ntα genotypes showed significantly lower Hb, mean cell volume, and mean cell Hb values comparing to carriers of most other genotypes. In our population, the spectrum of α-globin mutations was confined to a limited number of mutations with deletions being mostly observed.

Mortality trends in Erbil, Iraq, 2007-2011

BACKGROUND

Reliable and valid information on trends of mortality and common causes of death is essential to guide priorities for the allocation of resources within the health sector in order to improve health services for the population, increase longevity and improve quality of life.

AIMS

This study aimed to determine crude, gender, age and cause specific death rates and to examine mortality trends in a five-year period between 2007 and 2011 in Erbil City, Iraq.

METHODS

This study researched 16 780 deaths registered at the statistical unit of the Directorate of Health, Irbil City. Data were reviewed and cleared for the purpose of analysis. Causes of deaths were classified according to body systems.

RESULTS

The average crude death rate was 3.1 per 1000 population with male predominance over females in all the years of study (3.5 and. 2.7, respectively). The age-specific death rates were high in the old and middle age groups in addition to the under 5 years age group. Accidents and circulatory diseases were the leading causes of deaths with rates of 65.2 and 58.3/100 000 population, respectively.

CONCLUSIONS

An accurate identification of cause of death suggests that the only use of the death certificate in Erbil is for the purpose of burial and legal issues, and therefore it is imperative for educational efforts to achieve a complete and comprehensive death registration.

Epidemiological Study of Equine Piroplasmosis (Theileria equi and Babesia caballi) by Microscopic Examination and Competitive-ELISA in Erbil Province North-Iraq

BACKGROUND

Equine piroplasmosis is a major tick-borne disease that can lead to serious health problems and economic losses in horse industry. The aim of the study is to determine the prevalence of Theileria equi and Babesia caballi in different species of Equus namely (Horse, mule, donkey and pony) by Giemsa stained blood films and competitive ELISA.

METHODS

This study was conducted at various geographic areas of Erbil governorate. A total of 349 blood samples from equine (209 horses, 62 mule, 57 donkey and 21 ponies) were collected to estimate the prevalence rate of Theileria equi and Babesia caballi by using Giemsa stained blood smear and competitive ELISA.

RESULTS

The overall prevalence rates were (10.6%) consisting of (8.3%), (1.7%) and (0.6) for T. equi, B. caballi and both infection respectively by Giemsa stained blood smears, and the rate was 38.97%, consisting of 20.9% for T. equi, 11.2% for B. caballi and 6.9% for both infection by cELISA. Seroprevalence rate of T. equi was significantly higher (P < 0.001) than that B. caballi in equids. There was also a significant difference associated between age (P < 0.01), activity (P < 0.01), management (P < 0.001) and tick infestation (P < 0.001), but neither the type of equids nor the gender was significant differences associated with prevalence rate.

CONCLUSION

The present study concluded that the equine piroplasmosis is a vital infection distributed among the equine in Erbil province North of Iraq. Thus a better control programme should be implemented to contain and control the prevalence of the disease within the area.

An An outbreak of cutaneous leishmaniasis in Erbil governorate of Iraqi Kurdistan Region in 2015

INTRODUCTION

This study aimed to identify the sociodemographic factors associated with the occurrence of an outbreak of cutaneous leishmaniasis in Erbil governorate and to determine the geographical distribution and clinical pattern of the disease during this outbreak.

METHODOLOGY

This cross-sectional study involved 234 cutaneous leishmaniasis cases from Erbil governorate. A questionnaire completed in an interview provided data on sociodemographic and clinical characteristics, risk factors, and preventive measures.

RESULTS

About 60% of participants were younger than 35 years; 59.4% were living in urban areas. Most cases (40.2%) were from Maxmur district, while 20.9% were internally displaced persons and 7.7% were refugees. Nearly 70% of the cases had a low socioeconomic status. Cases with multiple lesions constituted 65.5%. Upper limb lesions constituted 44.7%. Most lesions were 1-5 cm in size (64.7%) and were wet (63.6%). Nearly three-quarters of the cases had a history of traveling to endemic areas; most (49.7%) to Maxmur district. Around 80% reported fogging around the houses and 44.4% in the working area. The peak incidence of the cutaneous leishmaniasis cases was in December, with a total of 115 cases.

CONCLUSIONS

Cutaneous leishmaniasis was not endemic in Erbil governorate, but it became a public health challenge in 2015. Most of the cases were reported in Maxmur district and among internally displaced people and military personnel deployed there. Control and prevention activities, including fogging and spraying, face important challenges and need strengthening, especially in Maxmur district.

Heavy metals (HMs) and polycyclic aromatic hydrocarbons (PAHs) in soils of different land uses in Erbil metropolis, Kurdistan Region, Iraq

Urban soil contamination is a growing concern for the potential health impact on the increasing number of people living in these areas. In this study, the concentration, the distribution, the contamination levels, and the role of land use were investigated in Erbil metropolis, the capital of Iraqi Kurdistan. A total of 74 soil samples were collected, treated, and analyzed for their physicochemical properties, and for 7 heavy metals (As, Cd, Cr, Cu, Fe, Pb, and Zn) and 16 PAH contents. High concentrations, especially of Cd, Cu Pb, and Zn, were found. The Geoaccumulation index (I_geo), along with correlation coefficients and principal component analysis (PCA) showed that Cd, Cu, Pb, and Zn have similar behaviors and spatial distribution patterns. Heavy traffic density mainly contributed to the high concentrations of these metals. The total concentration of ∑PAHs ranged from 24.26 to 6129.14 ng/g with a mean of 2296.1 ng/g. The PAH pattern was dominated by 4- and 5-ring PAHs, while diagnostic ratios and PCA indicated that the main sources of PAHs were pyrogenic. The toxic equivalent (TEQ) values ranged from 3.26 to 362.84 ng/g, with higher values in central parts of the city. A statistically significant difference in As, Cd, Cu, Pb, Zn, and ∑PAH concentrations between different land uses was observed. The highest As concentrations were found in agricultural areas while roadside, commercial, and industrial areas had the highest Cd, Cu, Pb, Zn, and ∑PAH contents.

Contamination valuation of soil and groundwater source at anaerobic municipal solid waste landfill site

The present work aimed to determine the risks that formed landfill leachate from anaerobic Erbil Landfill Site (ELS) poses on groundwater source and to observe the effects of disposed municipal solid waste (MSW) on soil properties. The study further aims to fill the gap in studies on the effects of disposed MSW and produced leachate on the groundwater characteristics and soil quality at ELS, Iraq. Soil, leachate, and groundwater samples were collected from ELS for use as samples in this study. Unpolluted groundwater samples were collected from an area outside of the landfill. Field and laboratory experiments for the soil samples were conducted. Chemical analyses for the soil samples such as organic matter, total salts, and SO4 (=) were also performed. Raw leachate and groundwater samples were analyzed using physical and chemical experiments. The yields for sorptivity, steady-state infiltration rate, and hydraulic conductivity of the soil samples were 0.0006 m/√s, 0.00004 m/s, and 2.17 × 10(-5) m/s, respectively. The soil at ELS was found to be light brown clayey gravel with sand and light brown gravely lean clay layers with low permeability. Unprocessed leachate analysis identified the leachate as stabilized. Findings showed that the soil and groundwater at the anaerobic ELS were contaminated.