Health-related factors of the Iraqi adult population during the 2020 COVID-19 pandemic: physical activity, eating behavior, quality of life, general health, and mood states cross-talk.

BACKGROUND: The lockdown and social distancing caused by Coronavirus disease 2019 (COVID-19) may have changed Physical Activity Level (PAL), eating behavior, and health habits due to long-term confinement worldwide. OBJECTIVE: This study aimed to evaluate the PAL, eating behavior, Quality of Life (QoL), General Health (GH), and mood states during COVID-19 confinement in a large sample of Iraqi adults. METHODS: 3738 healthy adults (age 18-70 years) residing in Halabjeh, Iraq answered the online questionnaires including the short form of international physical activity, GH, three-factor eating (TFEQ-R18), and a short form of the profile of mood states (POMS-SF) questionnaires. Data analysis was done by Chi-square, and Spearman's correlation using SPSS statistical software at a significant level of (P < 0.05). RESULTS: The results showed unfavorable PAL, eating behavior, QoL, GH, and mood states in the total population. Low PAL was observed in 69.96% of the men and 75.99% of the women; only 3.60% of the men and 0.77% of the women had a high PAL. There was a significantly positive relationship between low PAL and the incidence of COVID-19 both in men and women (P = 0.801; r = 0.001; and P = 0.682; r = 0.011), respectively; While a significant negative relationship was observed between the moderate and high PAL and the incidence of COVID-19 in men (P = 0.011; r=-0.682 and P = 0.027, r=-0.589), and women (P = 0.001; r=-0.796 and P = 0.018, r=-0.623). No significant relationships were observed between PAL and eating behavior (men: P = 0.086; r = 0.256 and women: P = 0.365, r=-0.121); While, the results show significant positive relationships between PAL with QoL in men (P = 0.012; r = 0.623) and women (P = = 0.001; r = 0.837). based on the results, significant negative relationships between PAL with GH and mood state scores were observed in both men (P = 0.001; r=-0.837 and P = 0.001, r=-0.786) and women (P = 0.010; r=-0.652 and P = 0.001, r=-0.745), respectively. CONCLUSIONS: The Iraqi adult population showed low PAL, GH, QoL, and mood state during COVID-19 which might be due to the confinement. Also, the significant relationships between low PAL with GH, and mood state recommends physical activity as a valuable health optimizing factor during the COVID-19 pandemic.

Comparison of Antibody Levels Produced by Pfizer, AstraZeneca, and Sinopharm Vaccination in COVID-19 Patients in Erbil City-Iraq.

In this study, early adverse impacts that emerged after vaccination with each dose of these vaccines were compared from previously infected participants. Ant-SARS-CoV-2 spike-specific IgG and IgA antibodies produced by these three vaccines have been assessed using ELISA method at different time periodsꓼ including pre-vaccination, 25 days after the first shot of vaccination and 30 days after the second shot of vaccination with Pfizer-BioNTech, AstraZeneca, and Sinopharm vaccine. Overall, 150 previously infected cases were studied, 50 cases received Pfizer vaccine, 50 cases received AstraZeneca vaccine, and 50 cases received Sinopharm vaccine. The findings showed that a higher number of vaccinated participants with AstraZeneca and Pfizer vaccine had tired/fatigue/lethargy, headache, fever, and sore in arm at the first shot, but milder adverse effects, such as headaches, fever, and sore in arm, were detected in the data on the Sinopharm vaccine's adverse impacts. At the second dose, a lower number of vaccinated cases with AstraZeneca and Pfizer vaccine reported higher frequencies of the side effects. However, the results showed that the level of anti-spike-specific IgG and IgA antibodies produced by vaccinated patients with Pfizer vaccine increased compared to those who vaccinated with AstraZeneca and Sinopharm vaccine from 25 days after the first dose. From 30 days after the second dose, the IgG and IgA antibodies were significantly boosted in 97% of vaccinated patients with Pfizer vaccine compared to 92% of those who vaccinated with AstraZeneca vaccines and 60% of those who vaccinated with Sinopharm. In conclusion, these results confirmed that two doses of the Pfizer, and AstraZeneca vaccine induce a higher response of IgG and IgA antibodies than that induced by Sinopharm vaccines.

Associated effects of clinical characteristics, risk factors, and comorbidity on disease severity and mortality among patients with COVID-19 in Sulaimani City/ Kurdistan Region of Iraq.

The effects of clinical symptoms, laboratory indicators, and comorbidity status of SARS-CoV-2-infected patients on the severity of disease and the risk of death were investigated. Questionnaires and electronic medical records of 371 hospitalized COVID-19 patients were used for data collection (demographics, clinical manifestation, comorbidities, laboratory data). Association among categorical variables was determined using Kolmogorov-Smirnov test (P-value ≤0.05). Median age of study population (249 males, 122 females) was 65 years. Roc curves analysis found that age ≥64 years and age ≥67 years are significant cut-offs identifying patients with more severe disease and mortality at 30 days. CRP values at cut-off ≥80.7 and ≥95.8 significantly identify patients with more severe disease and mortality. Patients with more severe disease and risk of death were significantly identified with platelet value at the cut-off ≤160,000, hemoglobin value at the cut-off ≤11.7, D-Dimer values ≥1383 and ≥1270, and with values of neutrophil granulocytes (≥8.2 and ≤2) and lymphocytes (≤2 and ≤2.4). Detailed clinical investigation suggests granulocytes together with lymphopenia may be a potential indicator for diagnosis. Older age, several comorbidities (cancer, cardiovascular diseases, hypertension) and more laboratory abnormalities (CRP, D-Dimer, platelets, hemoglobin) were associated with development of more severity and mortality among COVID-19 patients.

Assessment of the implementation of preventive measures by Iraqis people to reduce the spread of coviD-19 pandemic.

BACKGROUND AND AIM: The new outbreak "Coronavirus disease 2019 (COVID-19)" happened in china is caused by severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2). Consequently, it spreads across the globe and is affecting wellbeing frameworks and the global economy. This pandemic disease places a heavy burden on governments in general, so individuals must adhere to WHO's instructions to limit its spread. The current study was applied to find out the extent of commitment among the Iraqi people to the standards of prevention measures against the coronavirus. MATERIALS AND METHODS: A cross sectional study was conducted with 1153 respondents widely in all governorates of Iraq to identify the commitment of the Iraqis to the preventive measures against COVID-19 in Iraq. This study covered the Iraqis in three main regions (Southern, middle, and Northern) for data collection. It was conducted between the 17th and 25th of March 2020, and Iraqis were administered with a structured questionnaire comprising of three domains. RESULTS: The results showed that the majority of the respondents (52%) were female, and most of them (42.3%) were observed between the age group of 31-40 years. About 82% of the respondents were residents of urban areas. CONCLUSION: This study reveals the excellent implementation of preventive measures by the population. It is observed that the application of prevention standards in the countryside is less than in the city.

Prevalence and determinants of anxiety and stress in the general population during COVID-19 pandemic in Iraq: A cross-sectional study.

BACKGROUND: The COVID-19 pandemic and its prevention and control measures, such as social distancing, self-isolation, and quarantine, have a negative impact on the population's mental health. This study aimed to determine the prevalence of anxiety and stress among the general population during the outbreak of COVID-19 and assess their associated factors. METHODS: We carried out a cross-sectional study in Erbil governorate, Iraqi Kurdistan Region, from July 18 to September 12, 2020. We used an online survey questionnaire to collect data from a sample of Erbil population. The 10-items Perceived Stress Scale and the 7-item Generalized Anxiety Disorder scale were used to measure the levels of stress and anxiety. RESULTS: A total of 851 persons responded to the survey. The prevalence of moderate and high perceived stress was 59.6% and 16.6%, respectively. The prevalence of moderate and severe anxiety was 24.7% and 22.7%, respectively. Age, gender, economic level, having contact with COVID-19 patients, and following COVID-19 news were independent variables significantly associated with stress levels. Age, gender, economic level, employment status, having symptoms of COVID-19, having contact with COVID-19 patients, and following COVID-19 news were independent variables significantly associated with anxiety levels. CONCLUSION: A high proportion of people experienced stress and anxiety during the COVID-19 outbreak in Erbil, Iraqi Kurdistan Region. Females, younger age, poor, and unemployed reported significantly higher stress and anxiety levels. There is a need to establish mechanisms at the population level to decrease the stress and anxiety risks and provide mental health coping measures in times of crisis, such as education about positive thinking, stress management programs, and the role of social support.

The epidemiological pattern of seasonal influenza in four sentinel sites in Iraq.

Introduction: Influenza is an acute viral infection with significant morbidity and mortality. It occurs annually each winter, which is called seasonal influenza, and is preventable through safe vaccine. Aim: The aim of this work is to know the epidemiological pattern of patients with seasonal influenza in Iraqi sentinel sites. Methods: A cross-sectional study was carried out on records of patients who attended four sentinel sites and registered to have influenza-like illness (ILI) or severe acute respiratory infection (SARI), and laboratory investigated. Results: The total number of cases was 1124; 36.2% of them aged 19-39 years; 53.9% were female; 74.9% lived in urban areas; 64.3% diagnosed as ILI; and 35.7% as SARI; 15.9% had diabetes, 12.7% had heart disease, 4.8% had asthma, 3% had a chronic lung disease, and 2% had hematological disease; 94.6% did not get influenza vaccine. About COVID-19 vaccine, 69.4% were not vaccinated, 3.5% got only one dose, and 27.1% completed two doses. Only the SARI cases needed admission; among them, 95.7% were cured. 6.5% were diagnosed with influenza-A virus, 26.1% had COVID-19, and 67.5% were negative. Among those with influenza, 97.3% had H3N2 subtype and 2.7% had H1N1 pdm09. Conclusions: The percentage of influenza virus in Iraq is relatively small. The age, classification of case (ILI or SARI), having diabetes, heart disease, or immunological disease, and taking COVID-19 vaccine have a significant association with influenza. Recommendations: It is needed for similar sentinel sites in other health directorates and for rising health education about seasonal influenza and its vaccine.

Molecular Study of ACE2 Gene Polymorphism of COVID-19 Infection among the Kurdish Population in Kurdistan Region- Iraq.

Coronavirus Disease 2019 (COVID-19) is a current pandemic infection of the human respiratory system, which is caused by which caused by Sever Acute respiratory syndrome virus 2 (SARS-CoV-2). The infection was classified by World Health Organization (WHO) as a universal pandemic in February 2020; there have been 494.587.638 confirmed cases and 6.170.283 deaths. The present study investigated the molecular genetics of the Angiotensin Converting Enzyme 2 (ACE2) gene in correlation to COVID-19 patients in the Kurdish population. Eighty-six individuals were clinically diagnosed with COVID-19 and control groups. After the genomic DNA extraction these participants the target 1, 2 and 8 exons of the ACE2 gene were amplified using the PCR technique, and then the Sanger sequencing technique was performed to analyze genetic variants of the ACE2 gene in 70 DNA samples of COVID-19 hospital patients at Emergency Hospital in Erbil city, Sarchnar Hospital in Sulaymaniyah city, Lalav Hospital in Duhok city and Wafa Hospital in Halabja city from Kurdistan Region of Iraq. The current study was designed into two groups control group and a patient group. The patient group was divided into two subgroups, severe and mild patients of different ages and genders. As a result, there were no mutations at the positions 1, 2 and 8 exons sequences, while single nucleotide polymorphisms (SNPs) were detected and identified three different types of mutation at intron position: twenty-six of c.12405 del T, two of c.12407 T>G, and two of c.12406 G>A in a total 86 participants. This result shows that genetic difference does not impact the COVID-19 infection severity among the Kurdish population regarding ACE2 gene polymorphism.

Identification of SARS CoV-2 Omicron BA.1 and a novel Delta lineage by rapid methods and partial spike protein sequences in Sulaymaniyah Province, Iraq.

BACKGROUND: Five variants of concern (VOCs) of severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) have been globally recorded including Alpha, Beta, Gamma, Delta, and Omicron. The Omicron variant has outcompeted the other variants including the Delta variant. Molecular screenings of VOCs are important for surveillance, treatment, and vaccination programs. This study aimed to identify VOCs by using rapid inexpensive methods and partial sequencing of the virus's spike gene. METHODS: Mutation-specific rRT PCR probes were used for both D614G and K417N mutations to potentially discriminate between Delta and Omicron variants. These were followed by sequencing of a fragment of spike gene (748 nucleotides), which covers the most notable VOC mutations in the receptor binding domain of SARS CoV-2. RESULTS: Rapid methods showed that out of 24 SARS CoV-2 positive samples, 19 carried the N417 mutation, which is present in the Omicron variant. Furthermore, 3 samples carried K417 wildtype, which is present in the Delta variant. Additionally, 2 samples containing both K417 and N417 suggested mixed infections between the two variants. The D614G mutation was present in all samples. Among the 4 samples sequenced, 3 samples carried 13 mutations, which are present in Omicron BA.1. The fourth sample contained the two common mutations (T478K and L452R) present in Delta, in addition to two more rare mutations (F456L and F490S), which are not commonly seen in Delta. Our data suggested that both Omicron variant BA.1 and a novel Delta variant might have circulated in this region that needs further investigations.

Identification of DNA methylation change in TCF7L2 gene in the blood of type 2 diabetes mellitus as a predictive biomarker in Iraq Kurdistan region by using methylation-specific PCR.

Objective. Nowadays, type 2 diabetes mellitus (T2D) is the most common chronic endocrine disorder affecting an estimated 5-10% of adults worldwide, and this disease also rapidly increased among the population in the Kurdistan region. This research aims to identify DNA methylation change in the TCF7L2 gene as a possible predictive T2D biomarker. Methods. One hundred and thirteen participants were divided into three groups: diabetic (47), prediabetic (36), and control (30). The study was carried out in patients who visited the private clinical sector between August and December 2021 in Koya city (Iraq Kurdistan region) to determine DNA methylation status using a methylation-specific PCR (MSP) with paired primers for each methylated and non-methylated region. In addition, the X2 Kruskal-Wallis statistical and Wilcoxon signed-rank tests were used, p<0.05 was considered significant. Results. The results showed hypermethylation of DNA in the promoter region in diabetic and prediabetic groups compared to the healthy controls. Different factors affected the DNA methylation level, including body max index, alcohol consumption, family history, and physical activity with the positive Coronavirus. Conclusion. The results obtained indicate that DNA methylation changes in the TCF7L2 promoter region may be used as a potential predictive biomarker of the T2D diagnosis. However, the findings obtained in this study should be supported by additional data.

The association of ABO blood group distribution and clinical characteristics in patients with SARS-CoV-2.

INTRODUCTION: SARS-COV-2, the novel severe acute respiratory syndrome coronavirus, has become a life-threatening public health crisis. This kind of pandemic is frightening the world with clinical, psychological, and emotional distress and leading to an economic slowdown. To explore any association between the ABO blood type and the susceptibility to coronavirus disease 2019 (COVID-19), we compared ABO blood group distribution among 671 COVID-19 patients with the local control population. METHODOLOGY: The study was conducted in Blood Bank Hospital in Erbil, Kurdistan Region, Iraq. The ABO-typed blood samples were obtained from 671 patients infected with SARS-CoV-2 between February and June 2021. RESULTS: Our results demonstrated that the risk of SARS-COV-2 was higher for patients with blood group A than those with not-A blood type patients. Of the 671 patients with COVID-19, 301 had type A (44.86%), 232 had type B (34.58%), 53 had type AB blood (7.9%), and 85 had type O (12.67%). CONCLUSIONS: We concluded that the Rh-negative blood type has a protective effect on SARS-COV-2. Our results also indicate that the decreased susceptibility of individuals with blood group O and the increased susceptibility of individuals with blood group A to COVID-19 could be linked to the presence of natural anti-blood group antibodies, particularly anti-A antibody, in the blood. However, there might be other mechanisms that require further study.

A cross-sectional analysis of the predictors of COVID-19 vaccine uptake and vaccine hesitancy in Iraq.

BACKGROUND: Vaccine hesitancy poses a significant risk to global recovery from COVID-19. To date however, there is little research exploring the psychological factors associated with vaccine acceptability and hesitancy in Iraq. AIM: To explore attitudes towards COVID-19 vaccination in Iraq. To establish the predictors of vaccine uptake and vaccine hesitancy in an Iraqi population. METHODS: Using a cross-sectional design, 7,778 participants completed an online questionnaire exploring their vaccination status, likelihood of infection, perceived severity infection, benefits of vaccine, barriers to vaccine, anticipated regret, subjective norms, and trust in government. FINDINGS: Vaccination rates increased with age and were greater in males, those who were married, divorced or widowed, those with children and those with underlying conditions. Vaccine hesitancy was widespread with 61.40% of unvaccinated individuals reported an unwillingness to receive a COVID-19 vaccine. In unvaccinated groups, vaccine hesitancy was associated with lower trust in the government, more negative social norms, greater perceived barriers to vaccination and reduced perceived benefits. CONCLUSIONS: There is significant COVID-19 vaccine hesitancy in Iraq. Public health institutions should be aware of the influence of demographic factors, as well as personal beliefs and social norms, on individuals' decisions to vaccinate. Public health messaging should therefore aim to be tailored to address the concerns of citizens.

CORRELATION BETWEEN HEPCIDIN AND PROCALCITONIN AND THEIR DIAGNOSTIC ROLE IN PATIENTS WITH COVID-19.

OBJECTIVE: The aim: The purpose of this study is to find out the association between procalcitonin and hepcidin in patients with COVID-19, in addition to their role as diagnostic markers. PATIENTS AND METHODS: Materials and methods: A total of 75 patients infected with coronavirus were included in the current study, their age is ranging between 20 to 78 years. Those patients was hospitalized in Al-Sadr Teaching Hospital in Najaf, in Iraq. This study also included 50 healthy subjects which are volunteers and considered as a (control group). Biomarker (procalcitonin and hepcidin) measurements were achieved by electrochemiluminescent immunoassay (ECLIA) in the Elecsys immunoassay system. RESULTS: Results: The present study showed a significant increase the serum cencentration of hepcidin and procalcitonin in patients with COVID-19 as compared tohealthy subjects. There was a highly significant increasing(p < 0.01) in hepcidin and PCT level in patients with severe infection comparing to other catgaries.The current study also revealed that the sensitivity values of the markers were: 0.88%, 0.85 for procalcitonin and hepcidin respectively, which indicate high diagnostic power. CONCLUSION: Conclusions: Serum levels of hepcidin and procalcitonin are increased as inflammatory markers in COVID-19 patients with relatively high sensitivity. It seems that these imflammatory markers obviously elevate in the severe cases COVID-19dusease.

Analysis of Proinflammatory Cytokines in COVID-19 Patients in Baghdad, Iraq.

Due to the pandemic of COVID -19 disease and the fact that the effective variables in the severity and control of the disease have not been established, numerous factors have been investigated, including the study of inflammatory factors. A cross-sectional study was carried out to investigate the proinflammatory cytokines in patients with COVID -19, conducted in Baghdad, Iraq. The age of the patients was above > (15) years old, with confirmed infection documented by polymerase chain reaction (PCR). The subjects were 132 patients, 69 (52.3%) males, and 63 (47.7%) females. Patients were divided into three pathological groups: mild patients (45), moderate patients (34), and severe patients (53), each group was divided into four weeks according to symptoms onset date. The most common clinical symptoms were cough, fever, and headache, while sore throat, gastrointestinal symptoms, chest pain, and loss of taste and smell were less common in COVID -19 patients. Sandwich-Enzyme-Linked Immunosorbent Assay kits were used to evaluate levels of proinflammatory cytokines, including IL-1ß, IL-6, IL-8, and TNF-α. The results IL-6 and TNF-α were significantly elevated in mild during the four weeks with (P=0.0071) and (0.0266) respectively, levels of IL-1ß were increased with highly significant differences (P=0.0001) while levels of IL-8 were decreased with highly significant differences (P=0.0001) during the four weeks. In moderate patients, levels of (IL-1ß, IL-6, and IL-8) increased without significance (P=0.661, 0.074, 0.0651), respectively; in contrast, the levels of TNF-α increased with significant (P=0.0452) across four weeks. Severe COVID-19 patients showed significantly increased differences in levels of (IL-6, IL-8, and TNFα) (P=0.0438, 0.0348, 0.0447), respectively, while no significant differences in the level of IL-1ß (P=0.0774). This study showed that investigating inflammatory factors in the COVID-19 pandemic is crucial in controlling and treating.

Danger Zone or Newfound Freedoms: Exploring Women and Girls' Experiences in the Virtual Space during COVID-19 in Iraq.

During the COVID-19 pandemic, women and girls across the globe faced increased reliance on the digital space to access education, social support, and health and gender-based violence (GBV) services. While research from the last three years has explored how women and girls navigated and responded to their new virtual reality, minimal evidence has been generated from low-resource settings where access to technology may be limited. Further, no studies to date have examined these dynamics in Iraq, where women and girls already face numerous threats to safety due to various forms of structural violence and patriarchal family structures. This qualitative study aimed to examine women and girls' experiences in the digital space during COVID-19 in Iraq, including the benefits and risks of engagement as well as how access to the digital space was controlled. Data for the present analysis come from the authors' larger multi-country study investigating women and girls' safety and access to GBV services in the context of the COVID-19 pandemic and related public health measures employed to control the spread of the virus. In Iraq, semi-structured key informant interviews were conducted virtually with fifteen GBV service providers. Following the translation and transcription of interviews, the thematic analysis highlighted several benefits and challenges women and girls experienced as they tried to access and utilize technology for schooling, support services, and obtaining and spreading information. While many women and girls increasingly and successfully relied on social media to spread awareness of GBV cases, key informants noted that women and girls also faced increased risks of experiencing electronic blackmail. In addition to a substantial digital divide in this context-which manifested as differential access to technology by gender, rural/urban status, and socioeconomic status-intrahousehold control of girls' access to and use of technology left many adolescent girls unable to continue schooling and contributed to their further marginalization and consequent decline in well-being. Implications for women's safety and mitigation strategies are also discussed.

SARS-CoV-2 Omicron Variant Genomic and Phylogenetic Analysis in Iraqi Kurdistan Region.

Omicron variants have been classified as Variants of Concern (VOC) by the World Health Organization (WHO) ever since they first emerged as a result of a significant mutation in this variant, which showed to have an impact on transmissibility and virulence of the virus, as evidenced by the ongoing modifications in the SARS-CoV-2 virus. As a global pandemic, the Omicron variant also spread among the Kurdish population. This study aimed to analyze different strains from different cities of the Kurdistan region of Iraq to show the risk of infection and the impact of the various mutations on immune responses and vaccination. A total of 175 nasopharyngeal/oropharyngeal specimens were collected at West Erbil Emergency Hospital and confirmed for SARS-CoV-2 infection by RT-PCR. The genomes of the samples were sequenced using the Illumina COVID-Seq Method. The genome analysis was established based on previously published data in the GISAID database and compared to previously detected mutations in the Omicron variants, and that they belong to the BA.1 lineage and include most variations determined in other studies related to transmissibility, high infectivity and immune escape. Most of the mutations were found in the RBD (receptor binding domain), the region related to the escape from humoral immunity. Remarkably, these point mutations (G339D, S371L, S373P, S375F, T547K, D614G, H655Y, N679K and N969K) were also determined in this study, which were unique, and their impact should be addressed more. Overall, the Omicron variants were more contagious than other variants. However, the mortality rate was low, and most infectious cases were asymptomatic. The next step should address the potential of Omicron variants to develop the next-generation COVID-19 vaccine.

D-dimer and HbA1c levels findings in COVID-19 Iraqi patients.

On March 11, 2020, the World Health Organization (WHO) declared a new coronavirus infection caused by the SARS-CoV-2 virus as a pandemic, making it the 11th pandemic of the 20th and 21st centuries. This study investigated the clinical and laboratory results (D-dimer, conventional coagulation, and HbA1c biomarker concentrations) of 150 patients (75 male and 75 female) with confirmed COVID-19 pneumonia and 50 controls (25 male and 25 female). For disease diagnosis, all COVID-19 patients were given a Real-Time Reverse Transcription Polymerase Chain Reaction Assay (RT-PCR). The findings revealed that D-dimer and HbA1c levels in COVID-19 patients were significantly higher (P 0.001) at the time of admission; In COVID-19 patients, there was also a strong correlation between D-dimer levels and HbA1c levels (P 0.001). In conclusion, COVID-19 patients are more likely to have a poor prognosis if their D-dimer and HbA1c levels remain uncontrolled over a lengthy period. To lower the likelihood of a bad prognosis in COVID-19, patients with higher levels of D-dimer and HbA1c should be continuously monitored.

Study of some immunological signatures and their association with COVID-19 in a sample of recovered Iraqi patients.

Since its emergence about two years ago, the novel coronavirus has continued to be a challenge and threat to public health, struck most parts of the world, leaving more than half a billion cases of infection and more than five million deaths. Immune response abnormalities post-infection with SARS-CoV-2 have been reported, and the mechanisms that lead to them are still ambiguous. This study was conducted to evaluate some immunological markers in the serum samples of COVID-19 convalescent patients and investigate the association of these immunological signatures with their age and sex. The serum levels of immunoglobulin G, interleukin-1 beta, and interferon lambda-1 of 75 patients and 50 healthy control group members were measured, with 55 % males and 45 % females participating and ages ranging from 20 to 80 years. The measurement of the immunological signatures was performed using the enzyme-linked immunosorbent assay (ELISA). The result revealed highly significant elevated levels of the serum immunological signatures of the convalescent group in comparison to the control group, with P-values of 0.00001 for each signature. Moreover, age was observed to have an association with an elevated level of the immunological signatures as it increased in the elderly, whereas no association with sex was detected. The findings strongly suggest that COVID-19 infection results in a persistent inflammatory response, which leads to prolonged post-recovery symptoms. Post-COVID-19 syndrome necessitates additional research to clarify its pathophysiology, pathogenesis, and long-term implications.

Orphans in Syria and Iraq Juggling Balls: Wars, COVID-19, and the NGO's financial crisis.

The COVID-19 pandemic's impact varies between and within nations, causing new forms of inequality. Refugee and orphan children in conflicted areas are more likely to suffer due to poverty, vulnerability, and limited access to essential services including reduction in donor funding. This qualitative study is the first to assess the effects of the COVID-19 pandemic and the financial crisis on Iraqi and Syrian orphaned children and their mothers. The Modified Grounded Theory was used for the preliminary analysis to expand the range of themes. This study has identified five major themes: financial crisis, low educational attainment, child labour, mental health issues, violence, and social problems. The impact of COVID-19 children and adolescents' mental health is of great concern. These multiple crises may significantly impact orphan children and adolescents' cognitive, mental health, and physical development. It is critical to address mental health issues during the current crisis and to plan for possible future pandemics and their intersecting outcomes. A Holistic approach requires providers to be aware of their clients' intersecting circumstances and needs using a range of lenses, including the person in the environment, family dynamics, culture, politics, and structural challenges. Offering food, medical supplies, and housing are considered basic needs.