alturath Nursing Journal

Background: The host immune response plays a pivotal role in the pathogenesis and outcome of amebic infections caused by Entamoeba histolytica. Cytokines such as interleukin-2 (IL-2) and interleukin-10 (IL-10) are key regulators of immunity, with IL-2 promoting cell-mediated responses and IL-10 suppressing inflammatory reactions. Understanding how E. histolytica infection influences these cytokine levels can provide insight into disease mechanisms and potential prognostic indicators. Objective: This study evaluated the serum levels of IL-2 and IL-10 in E. histolytica-infected patients compared to uninfected healthy individuals in Tikrit, Iraq. We aimed to determine if E. histolytica infection is associated with significant changes in these cytokines, and whether such changes vary with patient age. Methods: A case-control study was conducted involving 50 patients with confirmed E. histolytica infection (diagnosed via stool exam and PCR) and 20 healthy, uninfected controls matched for age and sex. Patients were stratified into four age groups (1–15, 16–30, 31–45, 46–60 years). Serum samples were collected and IL-2 and IL-10 concentrations were measured using enzyme-linked immunosorbent assay (ELISA) kits specific for human IL-2 and IL-10. Mean cytokine levels (±SD) in each group were compared, and ANOVA with post-hoc tests was used to assess statistical significance. Results: E. histolytica-infected individuals exhibited significantly elevated cytokine levels compared to controls. IL-10 was markedly increased in all infected age groups; the highest IL-10 levels were observed in young adults (16–30 years, mean 155.2 ± 9.3 pg/mL) and middle-aged adults (31–45 years, 135.2 ± 10.3 pg/mL) versus controls (70.1 ± 4.1 pg/mL, P≤0.01). IL-2 levels were also elevated in infected patients, particularly in the 16–30 group (102.2 ± 7.4 pg/mL) compared to controls (75.1 ± 5.1 pg/mL, P<0.01). Notably, in older infected patients (46–60 years), IL-2 levels (77.0 ± 5.5 pg/mL) were not significantly different from controls, suggesting an age-related decline in the IL-2 response. Overall, statistical analysis confirmed that both IL-10 and IL-2 concentrations differed significantly among the study groups (P≤0.01 for IL-10; P<0.05 for IL-2), with infected groups showing higher levels. Conclusions: E. histolytica infection is associated with heightened systemic levels of IL-10 and IL-2, reflecting activation of both anti-inflammatory and pro-inflammatory pathways. The pronounced increase in IL-10 suggests a strong regulatory (possibly parasite-driven) immune response during amebiasis, which may help limit tissue damage but could also facilitate parasite persistence. The IL-2 response, while elevated in most patients, was blunted in older individuals, potentially indicating age-related immune senescence. These findings improve our understanding of the immunological milieu in amebic infection and point to IL-10 and IL-2 as potential biomarkers for infection severity and host response, which might inform prognosis or therapeutic interventions in amebiasis.

Background: The penile foreskin is a retractable fold of skin covering the glans and is rich in microbial flora. Circumcision, one of the most common pediatric procedures performed for cultural, religious, or medical reasons (such as pathological phimosis), removes this tissue and may alter local microbial colonization and infection risk. Post-operative wound infections remain a concern, with both Gram-positive and Gram-negative bacteria implicated This study aims to identify the bacterial species colonizing the foreskin of young children and to examine the histopathological effects of these microbes on foreskin tissue. Methods: Foreskin samples were collected from 49 boys (aged 1 day to 12 years) undergoing circumcision. Prior to excision, a sterile swab of the inner foreskin was taken and cultured on nutrient media to isolate bacteria. Isolates were identified using biochemical tests (e.g. catalase) and confirmed with an automated VITEK© system. Foreskin tissue specimens were fixed in 10% formalin, processed and embedded in paraffin, sectioned at 6 μm, and stained with hematoxylin and eosin (H&E) for histological examination. Results: Bacterial growth was obtained from 40/49 (81.6%) swabs. The most common isolates were Staphylococcus aureus (33%) and Escherichia coli (30%), followed by Klebsiella pneumoniae (15%), Pseudomonas aeruginosa (12%), and Proteus mirabilis (10%). Microscopic examination of the foreskin tissue revealed no significant age-related differences in baseline skin structure. However, samples with bacterial colonization showed notable inflammatory and degenerative changes. There was subepidermal inflammatory cell infiltration, vascular congestion, hemorrhage, and focal necrosis of the stratified squamous epithelium, along with fragmentation of the keratin layer and collagen fibers in the dermis. E. coli in particular was associated with intense dermal inflammation, edema, and accumulation of neutrophils, whereas other aerobes (e.g. S. aureus, P. mirabilis, K. pneumoniae) tended to cause milder superficial changes. These findings indicate that bacteria play a central role in post-circumcision tissue damage and inflammation. Conclusion: The foreskin of children is frequently colonized by potentially pathogenic bacteria, notably S. aureus and E. coli. Circumcision samples demonstrated histopathological evidence of inflammation and tissue injury associated with these microbes. Awareness of the common organisms and their effects on wound tissue can inform preventative strategies and prompt treatment to reduce post-circumcision infectious complications.

Background: Emergency department (ED) nurses face among the highest rates of workplace violence in healthcare. In Iraqi public hospitals, the combination of overcrowded waiting areas, intermittent security presence, and limited de-escalation training plausibly increases this risk, but multicenter prevalence and risk-factor data are limited. Aim: To estimate the 12-month prevalence and patterns of workplace violence against ED nurses in five Iraqi government teaching hospitals, characterize reporting behavior and short-term consequences, and identify modifiable risk factors. Methods: A multicenter cross-sectional survey was conducted between October 2025 and February 2026 across the EDs of five government teaching hospitals in central and northern Iraq, in line with the STROBE statement [1]. The protocol was prospectively registered (HHI-RIR-2025-22, registered 18 September 2025). The Workplace Violence in Health Care Instrument (WVHI) [2] was administered alongside a 28-item demographic, occupational, and consequence questionnaire to 318 eligible ED nurses; 287 returned complete responses (response rate 90.3%). Descriptive statistics, chi-square tests, and multivariable binary logistic regression with cluster-robust standard errors at the hospital level were used to identify independent predictors of any-violence exposure. Results: The 12-month prevalence of any workplace violence was 67.6% (95% CI 62.0–72.8). Verbal abuse affected 64.5% of nurses, physical assault 17.4%, and sexual harassment 8.0%; 14.3% had experienced both verbal and physical violence. The most common perpetrators were patients' relatives (53.1% of incidents), and the most common locations were the triage area and waiting room. Only 31.4% of incidents were formally reported, with fear of retaliation (47.4%) and a perception of no actionable response (42.3%) being the leading deterrents. Short-term consequences included sleep disturbance (52.1%), reduced job satisfaction (49.5%), at least one short-term sick day (28.6%), and intent to leave the ED (33.4%). In the adjusted model, lack of security presence on the unit (aOR 2.74, 95% CI 1.62–4.62), no prior de-escalation training (aOR 2.31, 1.43–3.74), <5 years of ED experience (aOR 2.08, 1.27–3.41), and ≥10 night shifts per month (aOR 2.36, 1.45–3.84) were the strongest independent predictors. Conclusion: Two in three Iraqi ED nurses experience workplace violence in any given year, mostly verbal and predominantly under-reported. Hospital management should prioritize visible security in triage and waiting areas, mandatory de-escalation training, simplified non-punitive reporting pathways, and structured post-incident psychological support.