Iraqi National journal of Medicine

Background: Thyroid hormones (TH) are key regulators of essential cellular processes, including proliferation, differentiation, apoptosis, and metabolism. They play an important role in the development of prostate cancer (PCa). Therefore, this study aimed to assess thyroid function tests among PCa patients in Khartoum State. Methods: The study comprised 100 male participants, including 50 PCa patients as a case study and 50 healthy men as the control group. Blood samples were collected for thyroid function test and prostate-specific antigen (PSA) using TosohTM device (China) and enzyme-linked immunosorbent assay (ELISA) using the device FortressTM. Results: Statistical analysis of the test results of the case study demonstrated mean and standard deviation (SD) ± PSA = (31.8 ± 12.5 nmol/l), triiodothyronine (T3) = (3.3 ± 1.3 nmol/l), thyroxine (T4) = (119.58 ± 46.21 nmol/l), and thyroid-stimulating hormone (TSH) = (4.6 ± 3.4 nmol/l). At P-value 0.0001, when compared to the control group, the frequencies among the case study participants for hyperthyroidism, euthyroidism, and hypothyroidism were 33 (66%), 14 (28%), and 3 (6%), respectively. Conclusions: Hyperthyroidism is the most common thyroid disorder among patients with PCa.

Background: Vitamin D3 is essential for pediatric development and normal growth. Aim: This study aims to analyze the hematological characteristics of both β-thalassemia patients and controls; their liver and renal functions; and calcium, phosphorus, and parathyroid hormone levels and their correlation with vitamin D3. Methods: Ninety teenage subjects, comprising 45 patients with β-thalassemia major (selected from the Hereditary Blood Diseases Center in Basrah during their regular checkups) and 45 apparently healthy individuals selected from relatives and friends, aged between 12 to 15 years (42.2% males and 57.8% females) were included in a 2023 case-control study at the Hereditary Blood Diseases Center. A gel tube with approximately 5 mL of blood was utilized for biochemical analyses, and a portion of the sample was transferred into a test tube for complete blood count testing. Liver and renal functions were evaluated by measuring the activities of aspartate transaminase (AST), alkaline phosphatase (ALP), alanine transaminase (ALT), blood urea, and serum creatinine. Serum concentrations of parathyroid hormone, vitamin D3, calcium, and phosphorus were also estimated. Serum ferritin and complete blood count were performed as well. The Statistical Package for the Special Science version 29 was utilized, employing several methods to assess the connection between the variables, including the Mann-Whitney U test, Pearson Chi-Square, Pearson correlation, and linear regression (to assess the correlation between the variables). A p-value of < 0.05 was considered statistically significant. Results: Regarding demographics, the only significant difference was in BMI (p = 0.0001). ALT, AST, and ALP levels were significantly higher in β-thalassemia patients compared to healthy individuals, with significant differences (p = 0.0001 for all). Blood urea and serum creatinine levels were statistically significant (p = 0.0001). A highly significant difference was found in serum levels of vitamin D3 (p = 0.0001), with PTH significantly higher in patients (p = 0.0001). Calcium levels were also significantly different (p = 0.0001), but no significant difference was found in phosphorus levels (p > 0.05). Regarding hematological indices, a highly significant association was found in Hb, RBC, HCT (p = 0.0001), and MCV (p = 0.025) levels, while MCH, MCHC, WBCs, and platelets did not have significant differences (p > 0.05). Conclusion: β-Thalassemia significantly affects hematological and biochemical markers in all patients. Vitamin D3 levels are negatively correlated with ALT, AST, serum ferritin, PTH, and calcium levels in patients

Background: Maternal mortality is a crucial community health indicator. The World Health Organization defines maternal death as “the annual number of female deaths from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes) during pregnancy and labor or within 42 days following the termination of pregnancy, irrespective of the duration and location of the pregnancy.” Aim: This study aims to calculate the maternal mortality ratio in Basra over three years, identify the causes of death, and describe the sociodemographic factors of deceased mothers. Methods: A registry-based, descriptive, and retrospective study conducted over three months. Data were collected from maternal mortality-related registries using a structured questionnaire. Results: A total of 129 maternal deaths were recorded. The primary causes of death were obstetric hemorrhage (27 cases) followed by COVID-19 infection (22 cases). Deaths were most prevalent among women aged 30–39 years, particularly among those with a primary level of education and those who were housewives. Conclusion: Unfortunately, maternal mortality remains high, with obstetric hemorrhage identified as the leading cause of maternal death

Background: Prenatal care is an effective health intervention for reducing the risk of maternal morbidity and mortality, the risk of which is significantly higher in Basra (or Iraq in general) due to ignorance compared to other regions who offer prenatal care. Aim: This study aimed to assess health awareness related to pregnancy among women visiting primary health care centers in Basra Methods: A descriptive cross-sectional study was conducted with a convenience sample of 100 women of reproductive age (15–49 years) attending three primary health care centers in Basra, selected by random sampling technique. Data analysis was performed utilize the statistical package for the social sciences SPSS program (V23). Chi-square test (c2) was used to detect associations between variables, with a significance value set at (p < 0.05). Results: Most women had no knowledge about food patterns that are generally considered effective in controlling or reducing nausea and vomiting during early pregnancy (66%). About 41% of participants supported exercise during pregnancy. Approximately 71% of women were aware of the reasons for blood examination during antenatal care, with 62% identifying its necessity for diagnosing anemia and 46% for diagnosing diabetes during antenatal care. The need for adequate daily rest (68%) and the harmful effects of smoking (56%) were positively associated with the level of education (p = 0.031). The awareness of the reasons for blood examination (71%) were positively associated with the level of education (p < 0.001). Conclusion: Many primary health care users lack information about the significance of antenatal procedures, such as blood examinations, although they are well-informed about the necessity of adequate nutrition and daily rest. There is a need to enhance health education through mass media and to explain the significance of the different process in antenatal care, thus allowing women to be more proactive about it.

Background: Malnutrition is a commonly encountered issue in patients with chronic kidney disease (CKD) and significantly impacts disease progression and mortality. We aimed to assess the prevalence and severity of malnutrition among Iraqi patients on a regular hemodialysis (HD) program. Aim: This study aims to evaluate the level of malnutrition among hemodialysis patients across all Iraqi centers. Methods: A cross-sectional study conducted across all Iraqi cities from January 1 to December 31, 2023, examined patients undergoing HD. A standardized questionnaire was utilized for data collection, which was centralized through governorate centers. Results: Using subjective global assessment (SGA), 3,639 patients (33.9%) in Group A (well-nourished), comprised 2,053 (19.15%) males and 1,586 females (14.79%). Group B (mild/moderately malnourished) with 4,526 patients (42.2%) included 2,399 males (22.38%) and 2,127 females (19.84%). Group C (severely malnourished) with 2,556 (23.8%) patients included 1,544 males (14.4%) and 1,012 females (9.4%). The pre-dialysis weight for males was 68.55 ± 11.37 kg, while it was 66.62 ± 11.95 kg for females. The post-dialysis weight after ultrafiltration was 66.95 ± 11.6 kg for males and 64.76 ± 12.09 kg for females. The mean height for males was 169.2 ± 7.15 cm, while females had a mean height of 155.75 ± 5.82 cm. The body mass index (BMI) among males was lower than that of females, with means of 23.18 ± 4.32 and 26.03 ± 5.12, respectively. Cholesterol levels indicated that female patients had higher levels than male patients, with mean cholesterol levels of 195.3 ± 18.24 mg/dL for males and 210.72 ± 39.55 mg/dL for females. Additionally, the serum albumin level for male patients was 3.32 ± 0.43, lower than that of female patients. Pre-dialysis renal function tests indicated blood urea levels of 182.83 ± 42.67 mg/dL for males and 182.13 ± 55.76 mg/dL for females. Serum creatinine levels were 8.8 ± 2.5 mg/dL for males and 7.2 ± 2.51 mg/dL for females. Serum calcium levels were higher among male patients, with a mean of 7.27 ± 2.1 mg/dL, while among female patients, the mean serum calcium level was 7.09 ± 1.89 mg/dL. Hematocrit (Hct) levels for male patients averaged 27.18 ± 5.07, while female patients had a mean Hct level of 27.9 ± 6.08. Conclusion: The study found that 66.1% participants exhibited some form of malnutrition, consistent with trends observed across the Middle East. Low serum albumin levels were identified, reflecting an inverse relationship between albumin levels and nutritional status. The prevalence is highlighted, attributed to factors, such as chronic inflammation, altered nutrient metabolism, and deficiencies in key nutrients.

Background: The gold standard test for diagnosis of neonatal sepsis is blood culture, even though no single laboratory test has 100% sensitivity and specificity. The diagnosis of sepsis cannot be made with a single test or any particular combination of testing methods. Therefore, it's necessary to identify diagnostic indicators that are both practical and affordable for every healthcare facility, while also having adequate sensitivity and specificity. This study aims to evaluate the role of platelet indices in diagnosing neonatal sepsis. Methods: A prospective, case-control study was conducted over 12 months at the Al-Kadhymiah Pediatric Hospital in Baghdad. It involves comparing 82 neonates with sepsis to 82 healthy controls. Basic investigations were sent before commencing antibiotic treatment and compared between both groups. Results: The only factor that differed significantly between the two groups was the type of pregnancy, in which 18.29% of neonates with sepsis were from multiple pregnancies compared with only 7.32% of normal neonates with such pregnancies, with a significant difference. Total platelet count was significantly lower (p=0.021) while mean platelet volume and platelet distribution width were considerably higher in the case group than in the control group (p<0.001). Blood culture was positive in 45 neonates (54.88%), and Staphylococcus aureus was the most commonly isolated bacteria. Conclusion: Neonates with sepsis have significantly lower platelet count and higher levels of the mean platelet volume and platelet distribution width. Platelet parameters are easily obtained from the complete blood count and could be used as adjuvant indices to diagnose neonatal sepsis.

Background: The first 28 days of life, known as the neonatal period, represent a critical time when infants are at the highest risk of mortality. Most neonatal deaths occur in low-income countries with inadequate healthcare systems. The World Health Organization has identified specific neonatal danger signs (NDSs) that indicate potential illness. Aim: This study aimed to assess Iraqi mothers’ understanding of neonatal risk signs in 2024 and identify factors influencing this knowledge. Method: This descriptive cross-sectional hospital-based study involved 400 mothers attending the Children’s Welfare Teaching Hospital in Baghdad from November 2023 to March 2024. Mothers who could identify at least three of the 10 NDSs were considered to have good knowledge. Results: The study found that 223 (56%) mothers had high knowledge. The most recognized NDSs were jaundice (65%), fast breathing (60%), and elevated body temperature (51.75%). The least recognized signs included Lowered temperature (0.75%), redness, foul smell, umbilical discharge, skin rash, and eye drainage (4% each). Good knowledge was significantly associated with increased prenatal care visits. Mothers who received guidance from non-health facility consultants were more knowledgeable. About 15% mothers reported seeing no warning signs in their children. Conclusion: The study conducted at the Children’s Welfare Teaching Hospital in Baghdad revealed that mothers possessed a fair understanding of NDSs, with jaundice being the most commonly recognized. Mothers who received advice from non-health facility advisers, primarily family and social media, showed significantly higher knowledge levels. Recommendations include enhancing educational programs in antenatal and postnatal care, utilizing mass media, and conducting community-based studies to improve maternal understanding of NDSs.

Background: Anxiety disorders encompass conditions characterized by excessive fear and anxiety, along with related behavioral disturbances. During epidemics, many individuals experience distress due to immediate health impacts and feelings of loneliness; however, others fear infection, death, or the loss of loved ones. The COVID-19 pandemic in Iraq, part of the global coronavirus disease 2019 outbreak, may have exacerbated anxiety disorders among patients and their families. Aim: This study aims to assess the psychological impact of the COVID-19 pandemic on the adult population in Basra. Methods: A cross-sectional community-based study was conducted using an online survey with a questionnaire available via Google Forms. The questionnaire included socio-demographic and clinical data related to COVID-19, as well as the Generalized Anxiety Disorder 7-item scale to assess anxiety severity. The survey was administered randomly to adult individuals living in Basra, and data collected from 894 participants was analyzed using 22 version of the Statistical Package for the Social Sciences. Chi-square tests were performed to assess associations between variables. Results: Approximately 56.26% of the sample experienced varying degrees of anxiety (mild, moderate, and severe) during the COVID-19 pandemic. The highest prevalence of anxiety was observed among younger residents of Basra districts aged 18–27 years, females, married individuals, and health workers. Conclusion: The study found that 56.26% of participants suffered from varying degrees of anxiety during the COVID-19 pandemic, with about 22.7% experiencing moderate to severe anxiety, indicating a need for further evaluation and management.

Background: Coverage of extensive defects of the thumb, with exposure of tendon and/or bone, presents challenging reconstructive problems. Aim: The aim of this study is to evaluate the versatility, applicability, and patient satisfaction with the first dorsal metacarpal artery flap for thumb reconstruction. Methods: This prospective case series study was conducted over approximately four years (June 2017–September 2022) in the Plastic Surgery Department at Rizgary Teaching Hospital in Erbil. Twelve patients with complex soft tissue thumb defects exposing vital structures were included and treated with first dorsal metacarpal artery island flaps. Results: Twelve patients participated in the study. Their mean age (SD) was 33.7 (14) years, with an age range of 9-57 years. The majority (75%) were males. Nine flaps survived, two cases experienced partial necrosis, and one case resulted in total loss. Overall, sensory function of the flap area was satisfactory for 8 patients (66.6%) and unsatisfactory for 4 cases (33.3%). Conclusion: The first dorsal metacarpal perforator artery flap is versatile, with a reliable vascular supply, providing satisfactory functional and aesthetic restoration. This makes it an appealing choice for addressing various soft tissue defects.

Background: Diabetes mellitus (DM) is a metabolic disease that can affect pregnant women; if diabetic mothers are not well controlled, newborns may face higher risks of serious problems during pregnancy and at birth. Methods: This study was a cohort follow-up study that assessed the outcome of infants born to diabetic mothers (IDM). It involved two groups: a study group of 77 IDM (45 males and 32 females) born at Basra maternity and Children Hospital during the set six-month period (January 1 to June 30, 2018) and a control group of 137 infants born to non-diabetic mothers (69 males and 68 females) during the same period. Both groups were followed up to 28 days of life (the neonatal period). Results: The study results showed that the rates of preterm birth, macrosomia, respiratory distress syndrome, and hyperbilirubinemia were significantly higher among IDM (14.3%, 41.6%, 13%, and 10.4%, respectively) than among infants of non-diabetic mothers (5.1%, 5.8%, 0.7%, and 0.7%, respectively), with a p-value of <0.05. Additionally, a p-value rate of congenital malformations among IDM was higher than that among non-diabetic mothers (6.5% vs. 0.7%). The study also revealed that the most common metabolic disorder affecting IDM was hypoglycemia, which affected 40.3%, while neonatal death among IDM was 4%, compared to 0.77% for infants of non-diabetic mothers (causes of death included two due to preterm birth and one due to congenital heart disease). Conclusion: The results of the present study suggest that preterm birth, macrosomia, respiratory distress syndrome, hyperbilirubinemia, and hypoglycemia are significantly associated with diabetes during pregnancy. Hence, family planning, preconception counseling, and special antenatal care are recommended for diabetic mothers to reduce the risk of infant morbidity and mortality.

Background: The peritoneal cavity, a region of the abdomen, receives dialysate, a cleansing solution, via a catheter tube. The dialysate removes waste from blood vessels in the peritoneum; subsequently, the fluid is removed from the body and disposed of. Benefits of chronic PD include reduced costs, home-based therapy, single access, a decreased need for highly skilled workers and large infrastructure. Aim: This study aimed to assess the prevalence and outcomes of acute and chronic PD in the Iraqi population Methods: We have gathered data regarding every patient who received acute and chronic peritoneal dialysis in Iraq in period between 2016-2024 to know the prevalence and mortality rate.450 patients with end stage renal disease undergo chronic peritoneal dialysis in AL-Najaf center. 950,459,74,23 patients have acute peritoneal dialysis in children welfare teaching hospital. Mosul,AL-Nasyrea and AL-Basra centers respectively. Results: Among the subjects, 450 patients underwent chronic dialysis at the Al-Najaf center, with a mortality rate of 41%. Sepsis and cardiac disease were the most common causes of death. Four percent underwent kidney transplant, and 18% were transferred to hemodialysis. Regarding acute pediatric PD, a high rate of complete recovery was observed at the Children Welfare Teaching Hospital and Mosul, Al-Nasyrea, and Al-Basra centers, with rates of 72%, 83%, 70%, and 48%, respectively. The death rates in these centers were 25.7%, 16.7%, 29.7%, and 26%, respectively. Conclusions: The findings demonstrate that infection and cardiovascular diseases are the most common causes of death in adult CAPD patients; a high recovery rate can be achieved from acute peritoneal dialysis in children; and limited access to CAPD solutions complicates practice.

Background: Gastric cancer is a significant health issue worldwide; it ranks fourth among cancers, following those of the lung, breast, and colon. Tumor markers can be utilized as screening and diagnostic tests for neoplastic diseases. Aim: This study aims to evaluate value and the efficacy of tumor markers (CA242, CA19-9, CEA) in patients with gastric carcinoma and to investigate the utility of single and combined tumor markers for the diagnosis of gastric carcinoma. Methods: The serum level of CA242, CA19-9, and CEA were measured in 40 patients with gastric carcinoma, using the ELISA technique, compared with 20 patients with benign gastric conditions and 20 healthy controls. Chi-square tests and F-test were employed for statistical analysis. Results: The mean age of patients with gastric cancer was 54.7 ± 12.8 years, with a male-to-female ratio of approximately 1.2:1. Serological data indicated that 60%, 37.5%, and 50% of these patients had positive results for CA242, CA19-9, and CEA, respectively. A statistically significant difference was observed in the mean serum level of CA19-9 between gastric cancer patients and controls. Additionally, CA242 demonstrated the best sensitivity (CA242 71%), while CA19-9 exhibited the highest specificity. The combination of tumor markers (CA19-9 and CEA), (CA242 and CEA), and (CEA and CA19-9) increased specificity to 97%. Conclusion: The novel tumor marker CA242 was the most sensitive for gastric cancer while CA19-9 was the most specific. Furthermore, a significant increase in serum CA19-9 levels was of diagnostic value. The combination of two tumor markers enhanced the specificity of the test.

Background: Early recognition of neonatal sepsis is challenging due to its subtle and nonspecific symptoms. Failure to recognize or delays in diagnosis can result in significant mortality and morbidity. Laboratory sepsis markers complement clinical signs and risk factors in diagnosing sepsis. The current approach for early recognition of sepsis combines clinical presentation, biomarkers, and blood culture. Aims: This study aims to assess the effectiveness of C-reactive protein and basic hematological indices, such as neutropenia, leukopenia, and thrombocytopenia, in diagnosing sepsis, measuring the sensitivity of each test, and evaluating the outcomes of the studied sample. Methods: This study consisted of 90 patients with clinical suspicion of sepsis who were admitted to the neonatal care unit at Central Child Teaching Hospital in Baghdad. Patients were classified according to the age at which symptoms began into early onset and late onset sepsis. All patients underwent blood culture and sensitivity testing, complete blood count, and serial C-reactive protein measurements. Results: late onset sepsis was more common than early onset sepsis, and males outnumbered females. The sensitivity of C-reactive protein was 84%, with a specificity of 13%. The positive predictive value (PPV) and negative predictive value (NPV) were 21% and 75%, respectively. Total leukocyte count (TLC) demonstrated a sensitivity of 42%, specificity of 77%, PPV of 33%, and NPV of 83%. Absolute neutrophil count (ANC) showed a sensitivity of 5%, specificity of 97%, PPV of 33%, and NPV of 79%. Thrombocytopenia exhibited a sensitivity of 32%, specificity of 85%, PPV of 35%, and NPV of 82%. Conclusion: C-reactive protein had the highest sensitivity, while ANC had the highest specificity. Complete blood count showed little correlation with sepsis, and thrombocytopenia was a late finding associated with increased mortality. All tests utilizing the hematological profile can be employed using hematological profile can be used on primary health center level, with results obtainable within hours.

Background: Carbapenems are the drugs of choice for serious hospital-acquired infections and for patients in intensive care unit affected by multidrug-resistant microorganisms, particularly Acinetobacter baumannii. Carbapenem-resistant Acinetobacter baumannii (CRAB) poses a significant threat to public health. Aim: The study aims to focus the distribution of carbapenemase-encoding genes belonging to classes A and B (blaGES, blaKPC, and blaNDM) among CRAB isolated from various clinical specimens. Methods: A total of 55 bacterial isolates were collected from different clinical specimens and underwent identification using Chrom agar and the Vitek 2 compact (ID) system. The checkerboard technique, modified Hodge test, and Vitek 2 compact (AST) system were employed to detect CRAB. PCR techniques were used to identify the presence of blaGES, blaKPC, and blaNDM. Results: Of the 55 isolates, 43 (78.1%) were identified as A. baumannii, with 39 (90.6%) of these being CRAB. All CRAB isolates could produce carbapenemase. The percentages of CRAB isolates possessing blaGES, blaKPC, and blaNDM were 28.2%, 15.4%, and 48.7%, respectively. In contrast, 25%a percentage of non-CRAB isolates possessing blaKPC and blaNDM had 25% of each. Conclusion: A high prevalence of CRAB capable of producing carbapenemase and harboring blaGES, blaKPC, and blaNDM genes belonging to classes A and B was observed among various infections in Al Najaf hospitals.

Background: Obstetrical brachial plexus paralysis (OBPP) refers to an injury to all or part of the brachial plexus occurring at the time of delivery. Injuries associated with the upper brachial plexus are termed Erb’s palsy, while those associated with the lower brachial plexus are referred to as Klumpke palsy. Obstetrical brachial plexus injuries are often associated with large birth weight and shoulder dystocia. Aim: This study aims to evaluate the outcomes of different secondary reconstructive surgical options for the treatment of OBPP Methods: This prospective study was conducted at Basra General Hospital from October 2022 to November 2023. Sixty-eight patients (43 males and 25 females) were included, with 49 patients experiencing right-side involvement and 19 with left-side involvement. All patients had Grade 2 OBPP according to the modified Mallet score. Secondary reconstruction involved subscapularis release for 48 patients, derotation osteotomy for 12 patients with fixation using plates and screws, and tendon transfer for eight patients in the form of trapezius transfer to the upper humerus. Results: In the subscapularis release group, 42 out of 48 patients (87.5%) reported satisfaction with the surgical outcome, noting improvements in their ability to eat and drink. In the derotation osteotomy group, 11 out of 12 patients (81.7%) were satisfied with the result of surgery, while the trapezius transfer group expressed dissatisfaction with the surgical outcome. Conclusion: Subscapularis release surgery is suitable for early and flexible OBPP, yielding satisfactory results, while derotation osteotomy is appropriate for fixed OBPP in toddlers and older children, also demonstrating good results. Trapezius tendon transfer showed unsatisfactory outcomes.

Background: Cataract is the most common elective and ambulatory procedure globally, and its incidence continues to rise, leading to an increasing number of cataract surgeries aimed at eliminating the burden of cataract blindness in the aging population. Cataract surgery is safe, predictable, and cost-effective. Aim: This study aimed to evaluate the surgical visual outcomes and factors influencing vision in patients who underwent cataract surgery in the Al-Zubair district, Basrah, Iraq. Methods: A cross-sectional prospective study was conducted on cataract surgeries of all ages performed at Al-Zubair General Hospital between October 2014 and November 2022. Data based on demographic characteristics, preoperative risk factors, visual acuity, postoperative visual acuity, and surgical complications were collected, along with a review of the factors influencing vision after cataract surgery. The postoperative visual status was assessed and compared with the World Health Organization’s (WHO) categories of Visual Impairment and Blindness. Standard parameters for assessing the outcomes of cataract surgery and WHO criteria for grading these outcomes were utilized. Evaluations of the outcomes over the years of the study were carried out. Results: A total of 2,710 eyes from 2,358 patients who underwent cataract surgery during the study period were studies. About 1,293 were included, with 1,293 females and 1,065 males. The mean age at the time of surgery was 62.74 ± 13.8 years. The primary surgical technique was phacoemulsification (1,786 eyes, 68.3%), followed by extra capsular cataract extraction (ECCE) (884 eyes, 31.6%), both with intraocular lens implantation. Significant improvement was observed throughout the study period, with 80.8% of eyes achieving good postoperative vision (Best Corrected Visual Acuity [BCVA] 6/6-6/18). Approximately 15.84% of the operative eyes had borderline outcomes (BCVA 6/24-6/60), while poor outcomes were observed in 34% of the eyes. Poor visual outcomes were significantly higher in patients with diabetic retinopathy and corneal Diseases glaucoma. Intraoperative and postoperative complications occurred in 9.88% of cases, with rupture of the posterior capsule, vitreous loss, and corneal edema being the major causes. Conclusions: Visual outcomes after cataract surgery (whether phacoemulsification or ECCE) are generally good, even in patients with risk factors. Patients with visually significant cataracts should be encouraged to undergo cataract surgery despite the potential for intraoperative and postoperative complications.

Background: The progressive and permanent damage associated with chronic kidney disease (CKD) makes it a major global health concern. Hemodialysis (HD) is a vital renal replacement therapy; however, its prevalence and adequacy remain understudied in Iraq. Aim: This study aims to assess the current situation of HD in Iraq, focusing on the prevalence and causes of CKD. Patients and Methods: This cross-sectional study included all Iraqi cities and examined patients receiving HD from January 1 to December 31, 2023. Data was collected through a structured questionnaire at governorate centers across Iraq. Results: A total of 10,721 HD patients from various regions of Iraq were included in the study, revealing a male-to-female ratio of 1.27:1. Baghdad had the highest patient population undergoing HD (27.0%), followed by Basra (10.5%), Karbala (8.1%), Erbil (6.4%), Dohuk (3.2%), Salah-al-Din (2.0%), Anbar (4.4%), Diyala (4.5%), Wasit (3.6%),3.2%), Najaf (2.8%), Maysan (3.2%), Al-Muthanna (2.3%), Nasiriyah (3.9%), Ninawa (6.2%), Kerkuk (3.8%), Babil (4.1%), and Diwaniyah (2.2%). Sulaymaniyah had the least number of patients undergoing HD (1.8%). A total of 7,918 (73.9%) were married, comprising 4,234 (39.49%) males and 3,684 (34.36%) females. Meanwhile, 2,803 (26.1%) were single, comprising 1762 (16.44%) males and 1041 (9.71%) females. A total of 7,695 (71.8%) patients received two HD sessions each week, comprising 4,378 (40.84%) males and 3,317 (30.94%) females. A total of 3,026 (28.2%) had three sessions per week, comprising 1,618 (15.09%) males and 1,408 (13.13%) females. Assessment of the etiological factors leading to renal disease among patients undergoing HD revealed that 3,467 (32.3%) patients had diabetes mellitus. Among them, 1,834 (17.1%) were males and 1,633 (15.2%) were females. Patients with hypertension comprised 4,317 (40.3%) individuals—2,389 (22.3%) males and 1,928 (18%) females. A total of 271 (2.6%) patients had polycystic kidney disease—125 (1.2%) males and 146 (1.4%) females. Glomerulonephritis was identified in 164 (1.5%) patients—88 (0.8%) males and 76 (0.7%) females. Patients with other etiological factors contributing to kidney disease totaled 2,502 (23.3%)—1,560 (14.6%) males and 942 (8.8%) females. Conclusion: The study underscores the burden of end-stage renal disease (ESRD) in Iraq and emphasizes the critical need for access to renal replacement therapies. Regional disparities in HD prevalence call for targeted interventions to address healthcare infrastructure, disease management, and awareness. Additionally, gender-related differences in CKD risk factors and management warrant further investigation to enhance patient outcomes and resource allocation.

Background: Elevated tricuspid regurgitation jet velocity (TRV) is a key indicator of pulmonary hypertension (PHT) in sickle cell disease (SCD) patients, with SCD occurring frequently in both adults and children. Aim: This study aimed to estimate TRV through echocardiography and assess the presence of comorbidities in SCD patients at the Center of Hereditary Blood Diseases. It further aimed to determine the percentage of elevated TRV and its relationship to various SCD-related variables. Methods: A cross-sectional, descriptive study was conducted to assess TRV in children and adolescents with SCD registered at the Center of Hereditary Blood Diseases from October 1, 2021 to October 1, 2022. A specialized data collection form was designed to gather socio-demographic and disease-related variables, and echocardiography was performed on all patients. Results: A total of 142 SCD patients were included in the study. Their ages ranged from 10 months to 18 years, with a mean age of 8.48 ± 3.51 years and a male-to-female ratio of 1.36:1. Sickle cell anemia was the most common type of SCD (62.7%), followed by sickle/β-thalassemia. The study found that most patients (74.7%) had normal TRV values (< 250 cm/sec), while 25.3% exhibited elevated TRV (≥ 250 cm/sec), with a total mean of 209.50 ± 44.44 cm/sec. A significant difference was observed in the frequency of PHT symptoms between patients with elevated and normal TRV, with a p-value < 0.001. Conclusion: Elevated TRV is an alarming sign that necessitates early screening for PHT.

Background: Hemophilia A is a rare X-linked congenital bleeding disorder characterized by a tendency to bleed. This is the primary tendency of the disorder, with most of the bleeding occurring internally into the joints. A significant complication of hemophilia treatment is the development of neutralizing antibodies against factor VIII replacement therapy, known as inhibitors. Aim: This study aimed to investigate the demography of pediatric hemophilia A patients at the Basra Center for Hereditary Blood Diseases and assess the annual incidence of positive inhibitors and their associated risk factors. Methods: A descriptive, retrospective, registry-based study was conducted for hemophilia A patients registered at the Basra Center for Hereditary Blood Diseases from October 2018 to October 2023. A total of 110 males aged < 1 year to £ 15 years, with a median age of 8.7 ± 3.8 years, were included in this study. Patient Information collected included the date of birth, age at diagnosis, severity of disease, symptoms at diagnosis, quantitative inhibitor levels, and risk factors for inhibitor development. Results: In this study, 46 patients (42%) were ≥10 years old, and 53 patients (48.1%) were diagnosed between 1–5 years. Among the hemophilia A patients, between one year and five years, 48 (43.7%) had moderate severity. The primary symptom at diagnosis was postoperative bleeding in 29 patients (26.3%), followed by mucocutaneous bleeding in 26 patients (23.7%). A total of 22 out of 110 (20%) patients developed inhibitors, with 21 of these (95.5%) classified as high-titer, predominantly in severe hemophilia A patients with factor VIII levels < 1 (12/22 patients, 54.5%). The annual incidence of inhibitors decreased over the last five years from 46 to 13 (registered patients/year) and from 18 to 2.7 (examined patients/year). Severity of disease, family history of positive inhibitors, age at first exposure to factor VIII therapy, history of intensive factor VIII treatment, and type of factor VIII replacement were statistically significant correlates of inhibitor development. Conclusions: The annual incidence of inhibitor development has decreased over the last five years. Severity of disease, family history of positive inhibitors, age at first exposure to factor VIII therapy, history of intensive factor VIII treatment, and type of factor VIII replacement are significant risk factors for inhibitor development.

Background: Hemodialysis is a treatment for advanced renal failure; however, various complications can arise following the procedure. Aim: This study aimed to investigate the incidence of adverse side effects during hemodialysis in patients with chronic renal failure. Methods: This descriptive hospital-based study was conducted on 105 patients treated with hemodialysis between November 2020 and January 2021 at the Kassala Dialysis Center in Kassala City, Kassala State, Sudan. Data were collected through interviews using a questionnaire designed to address the research questions. The data were analyzed using the software Statistical Package for the Social Sciences version 16. Results: The findings indicated that 61% of this study group were male and 39% were female. The disease duration ranged from 1 to 5 years in 56 patients (53.3%). The age group ranged from 10 to 80 years, with approximately half of the study population in the age groups of 31–40 and 41–50 years. Regarding educational level, the majority were illiterate, representing 45 patients (42.9%). The most common symptoms mentioned by patients included joint pain (56 patients, 53.3%), sleeping problems (34 patients, 32.4%), and muscle cramps (33 patients, 31.4%). The most frequently used medication for symptom relief was paracetamol (46 patients, 43.8%), followed by diclofenac sodium (14 patients, 13.3%). Conclusion: The most common adverse effects of hemodialysis are joint pain, sleeping problems, and muscle cramps. Addressing the adverse effect of hemodialysis could lead to comprehensive managing the patients with end-stage chronic renal disease ultimately improving the patient outcome and efficiency of health car delivery.

Estrogen receptor-positive breast cancer is a heterogeneous disease characterized by its dependence on estrogen for growth and progression. Although hormonal therapy remains the cornerstone of treatment, many patients eventually develop resistance, leading to recurrence and disease progression. This case report describes a durable response to a rechallenge with Anastrozole (Arimidex) in combination with Everolimus (Afinitor), an mTOR inhibitor, in a patient with advanced (stage IV) ER+ metastatic breast cancer.

Anatomical variations of the aortic arch branches have been documented; however, the occurrence of five branches arising directly from the aortic arch is rare. During the dissection of a 35-year-old male cadaver‘s thorax and neck region for undergraduate students in the academic year 2022–2023 at the Department of Anatomy, Faculty of Medicine, Delta College of Science and Technology, Omdurman City, Sudan, the aortic arch exhibited five direct branches: the left subclavian, left common carotid, left vertebral, right common carotid, and right subclavian arteries. Understanding such variations and their anatomical courses prior to surgical procedures holds significant clinical value.