Background: The need for ongoing treatment to manage immune-mediated inflammatory diseases is a challenge for health care providers, as there is always an attempt to achieve clinical remission as much as possible. Objective: This study aimed to estimate the prevalence of non-adherence to biological drugs and factors affecting it among patients in Duhok governorate-Iraq. Patients and Methods: A cross-sectional questionnaire-based study was conducted between December 2018 to October 2019 at the specialized center of rheumatic disease and medical rehabilitation in Duhok city. One hundred forty-four patients who lived in Duhok governorate out of 216 registered cases were included, each with the established disease for at least 12 months, and had been taking biological drugs (Etanercept, Infliximab, and Adalimumab) with or without conventional drugs for at least three months were involved in this study. Disease activity scales as appropriate to each disease were used, with using a medication adherence scale to assess the adherence to medications. Results: From the total of 144 patients included in this study, 134 (93.1%) of them were nonadherent compared to only 10 (6.9%) of patients who were adherent to medication intake. Significant associations existed between adherence to the medications and different factors. These factors with the corresponding percentages of non-adherence were as follows: age between 30-39 (34.3%), illiterate/ primary education (56.0%), unemployed (64.9%), no ability to buy biologic drugs (82.1%), etanercept users (71.6%) and (56.7%) were using biological drugs for less than four years. Conclusion and recommendation: With the existence of multiple factors effect on adherence to medications and due to the inconsistency of these factors, routine measurements of adherence to medications are essential in achieving the desired therapeutic goal.

Background and Aim: Diphenhydramine is an H1-antihistamine that counteracts the toxic effects of organophosphate and carbamate insecticides that inhibit cholinesterase (ChE) activity. This meta-analysis aimed to investigate the effects of diphenhydramine on ChE inhibition induced by these insecticides in the plasma, erythrocytes, or whole brain of experimental animals. Materials and Methods: A data search was performed on erythrocyte, plasma, and brain ChE inhibition caused by organophosphate and carbamate insecticides in experimental animals (mice, rats, and chicks) treated with the antihistamine diphenhydramine in accordance with preferred reporting items for systematic reviews and meta-analysis, which was done by the two-group random-effects model meta-analysis. The meta-analysis included 18 records extracted from six studies that appeared from 1996 to 2022. Results: Using the random-effects model, a two-group meta-analysis revealed that the combined effect size (ChE inhibition) was significantly more favorable in the control group than in the diphenhydramine intervention, as shown by a forest plot. The combined effect size (standardized mean difference) was 0.67, with a standard error of 0.3, a lower limit of 0.04, and an upper limit of 1.29 (p = 0.025). The heterogeneity was moderate, as I2 of the combined effect size was 74%, with a significant Cochrane Q-test result (Q = 65, p < 0.0001). Subgroup analysis indicated that, with brain ChE inhibition, the heterogeneity (I2) became 5%, which was lower than ChE inhibition in plasma (84%) and erythrocytes (78%). No publication bias was identified using the funnel plot and Egger's test. Conclusion: This meta-analysis suggests that, in addition to its documented antidotal action against ChE-inhibiting insecticides, diphenhydramine can also reduce the extent of ChE inhibition, especially in the brain, which is the main site of toxicity of these insecticides. There is a need for additional studies to assess such enzyme inhibition in different parts of the brain.

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Background: Biological disease-modifying anti-rheumatic drugs such as infliximab are often associated with the development of anti-drug antibodies. Such a problem should be monitored in patients on these drugs. The purpose of the present study was to detect anti-infliximab antibodies and identifying factors affecting their occurrence, together with measuring infliximab concentration in the serum of patients with immune-mediated inflammatory diseases. Methods:A cross-sectional study was conducted between December 2018 to October 2019 at the Specialized Center of Rheumatic Diseases and Medical Rehabilitation in Duhok, Iraq. The included patients were of both genders, aged between 20-70 years, diagnosed with any type of immune-mediated inflammatory diseases for at least one year and had been taking infliximab with or without conventional drugs for at least 3 months. Disease activity scales specific to each disease condition were used. Anti-infliximab antibodies and infliximab concentrations in the serum were measured by using the sandwich ELISA method. Results: Anti-infliximab antibodies were detected in 19/31 (61.3%) of patients treated with infliximab, and 25/31 (80.6%) of them had an unsatisfactory infliximab concentration in the serum (< 3 μg/mL). Short duration (< 10 years) of the disease was significantly associated (p < 0.05) with positive anti-infliximab antibodies. A non-significant association (p > 0.05) was reported between the occurrence of anti-infliximab antibodies and other examined factors. High percentages of patients (57.9%) with positive anti-infliximab antibodies had moderate to high disease activity. Unsatisfactory infliximab concentration was found in 73.7% of these patients. The non-users of methotrexate and other conventional synthetic disease-modifying anti-rheumatic drugs comprised 78.9% and 68.4% of patients who had antibodies to infliximab, respectively. Conclusions: Anti-infliximab antibodies were positive in more than half of the examined patients, and most of them had unsatisfactory infliximab serum concentrations. Further efforts are needed to provide biological drugs regularly, using at least one of the conventional synthetic disease-modifying anti-rheumatic drugs to reduce the development of anti-infliximab antibodies. Regular measurement of anti-drug antibodies and biological drugs concentrations are essential to earn the goal of therapy.

Background: Diabetes mellitus is a chronic, progressive disorder that causes a variety of health problems. Adherence to medication is a major factor in the treatment outcome. The goal of this study is to translate and test the psychometric features of the Kurdish version of the Morisky Medication Adherence Scale (MMAS-8) among type 2 diabetic patients. Methods: The research used a cross-sectional approach. The researchers looked at a convenient sample of diabetic Kurdish individuals. MMAS-8 was translated into Kurdish using a normal “forward–backward” technique. It was then tested on 307 type 2 diabetic outpatients in a convenience sample. Internal consistency was checked for reliability. Convergent and known group validity were used to confirm validity. For the authentic statistical analysis, the Statistical Package for Social Sciences (SPSS) version 20 was used. Results: According to MMAS-8, 20 patients (6.5%) had a high adherence rate, 66 (21.5%) had a medium adherence rate, and 221 (72%) had a low adherence rate. There was no significant link between adherence score and gender (P = 0.055), illness duration (P = 0.251), or educational level (P = 0.12). There was a significant connection between adherence and HBA1C (P 0.001). Conclusion: The results of this validation study show that the Kurdish version of the MMAS-8 is a reliable and valid measure of medication adherence that may now be used. non-adherent. Developing patients’ treatment adherence will improve treatment managements and control.