Annals of the College of Medicine Mosul

Background: Molecular dynamics (MD) simulations offer a practical computational method to examine protein flexibility and stability at an atomic level under physiological conditions. In structural biology, hen egg-white lysozyme (HEWL), a globular protein of known structure with 129 residues, serves as an excellent model system because it has a compact fold and a large body of experimental data.
Aim: This study aimed to evaluate the dynamic structural stability of HEWL through a 5 ns MD simulation, with focused analysis on the initial 60 ps segment using the AMBER99SB force field and the SPC/E water model.
Methods: The simulation procedure involved energy minimization, equilibration and production run. The major structural descriptors, namely root mean square deviation (RMSD), root mean square fluctuation (RMSF), and radius of gyration (Rg) were evaluated using GROMACS tools, whereas the results of conformational changes were graphically illustrated by superimposing selected frames from the simulation trajectory.
Results: The outcomes demonstrated a very stable backbone composition: RMSD stayed at ~0.015 nm, indicating minimal backbone movement; RMSF remained within the range of 0.012- 0.020 nm and indicating low residue-level fluctuation, and the radius of gyration dispersed very little (1.395- 1.402 nm), confirming persistent structural compactness. The structural overlays of the first and last frames also reinforced the numerical data since it indicated a well conserved fold with slight local deviations.
Conclusions: HEWL retains its native structure under the simulation parameters, reinforcing its status as a model protein in MD-based structural studies which involve short-timescale simulations to capture the key dynamics.

Background: Antimicrobial resistance (AMR), a dangerous health problem, is driven by excessive and incorrect usages of the antibiotics in both clinical and farming environments. Escherichia coli is an opportunistic bacteria and a sentinel species used in AMR monitoring, and it usually contains a repertoire of acquired resistance genes and chromosomal mutations.
Aim: The objective of the present work was to examine the genomic landscape of antibiotic resistance in a cache of 31 E. coli strains isolated in Iraq, Iran and Turkey and to implement a multifaceted approach based on a combination of genome-wide screening, mutational profiling and machine learning.
Methods: Assemblies of genomes were retrieved in the Bacterial and Viral Bioinformatics Resource Center (BV-BRC), and resistance genes were identified with ResFinder and ABRicate. To discover high impact mutations of major genes such as gyrA, parC, ompF, and acrR, variant calling was used. We augmented phenotypic resistance in ciprofloxacin, ampicillin, and cefotaxime and used the data with the genomic data to ensure Random Forest classifiers were trained and to determine feature importance.
Results: The most common acquired resistance genes included blaTEM-1B (87%), sul1 (77%), aadA1 (71%) and qnrS1 (65%). The frequency of mutations at gyrA S83L and parC S80I sites was more than 70% among isolates, testifying to their role in resistance to fluoroquinolone. The models of machine learning recognized aac(3)-IId, blaTEM-1B, and sul1 as the best predictors of phenotypic resistance.
Conclusions: Interaction occurs between acquired and chromosomal resistance mechanisms in E. coli landscape construction of AMR in the Middle East. Bioinformatics and machine learning would offer solid ground of resistance prediction and surveillance, and increase the need of context-sensitive plans of AMR endeavors.

Background: Septocolumellar suture is a key technique in open septorhinoplasty (SRP), serving as a functional replacement for the Pitanguy ligament and superficial muscle aponeurosis system SMAS to maintain nasal tip projection, rotation, and stability. The study intends to test the change caused by septocolumellar sutures on the rotation and projection of the nasal tip by objective examination of the facial measurements.
Methods: This is a prospective study done on 50 patients (34 females, 16 males) aged between 18 and 44 years who have been operated upon primary open SRP with tip modification. Goode's ratio was used to measure the pre and postoperative projection of the nasal tip but nasolabial angle was used to measure the rotation. A baseline, 3 and 6 months postoperative standardized photographs were taken. Paired t-tests were used to analyse the statistics.
Results: Postoperative analysis revealed a statistically significant improvement in both nasal tip projection and rotation (P < 0.001). The mean Goode’s ratio slightly decreased from 0.63 to 0.61, yet remained within the aesthetically acceptable range. The mean nasolabial angle increased by an average of 9.8°, indicating enhanced tip rotation. These changes were observed in both male and female subgroups.
Conclusion: The septocolumellar suture is an effective method for controlling and stabilizing nasal tip dynamics in SRP. It significantly improves nasal tip rotation and allows for controlled adjustments in projection, leading to better aesthetic and functional outcomes.

Background: Polycystic ovary syndrome (PCOS) is a widespread endocrine disorder affecting approximately 6–15% of women of reproductive age worldwide. It is characterized by hyperandrogenism, chronic anovulation, and polycystic ovarian morphology, and is often associated with metabolic disturbances, particularly insulin resistance (IR). IR is observed in 35%–80% of PCOS patients and plays a critical role in the pathogenesis of both reproductive and metabolic dysfunctions in this condition. Effective management of IR is essential to improve clinical outcomes in PCOS. Several markers have been developed to assess IR, including non-insulin-based indices such as the Triglyceride-Glucose (TyG) index, TyG index adjusted for Body Mass Index (TyG-BMI), and the triglyceride to HDL-cholesterol ratio (TG/HDL-c), in addition to insulin-based measures like the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR). Metformin, an insulin sensitizer, and finasteride, an antiandrogen, are utilized in the management of PCOS, either alone or in combination. Evaluating the effects of these therapies on IR markers is crucial for optimizing treatment strategies.
Objective: To compare the effects of metformin, finasteride, or their combination on insulin resistance markers in Iraqi women with PCOS.
Patients and method: This non randomized interventional study enrolled 150 female patients diagnosed with polycystic ovary syndrome (PCOS) according to the Rotterdam criteria (2003), with an age range of 18 to 39 years. The participants were assigned into three equal groups (n = 50). The metformin group received an initial oral dose of 500 mg once daily, which was escalated by 500 mg every 1 to 2 weeks with meals, up to a maximum dose of 2500 mg/day over a 3-month period. The finasteride group was administered 5 mg orally once daily for 3 months. The combination group received both agents at the aforementioned doses and durations. Baseline and post-treatment data were collected for age, body mass index (BMI), and insulin resistance markers for comparative evaluation.
Results: After treatment, all three modalities—metformin, finasteride, and their combination—significantly reduced mean HOMA-IR levels (p < 0.001), with metformin alone showing the greatest reduction. In addition, all treatments significantly decreased the triglyceride-glucose (TyG) index, TyG-BMI index, and TG/HDL ratio (p < 0.001), with the combination therapy demonstrating the most pronounced effect.
Conclusion: Metformin alone was more effective in reducing insulin resistance, as indicated by HOMA-IR. In contrast, the combination of metformin and finasteride produced greater improvements in insulin sensitivity, reflected by the TyG index, TyG-BMI index, and TG/HDL ratio, suggesting potential added value of the combination in managing insulin-related disturbances in women with PCOS.

Background: Electronic cigarettes have recently become more popular among young people, despite the potential risks they pose to human health.
Aim: This study aimed to evaluate the knowledge and attitudes of e-cigarettes among students at Sulaimani Technical Institute and identify their motives for using e-cigarettes.
Methods: An online-based cross-sectional study was carried out between April 15 and June 30, 2025, among students at Sulaimani Technical Institute to assess their knowledge and attitudes towards e-cigarettes. Simple random sampling was used for selecting respondents. Data were gathered using an online structured questionnaire. Chi-square and Fisher's exact tests were used to assess the relationship between categorical variables. For comparing the means, an independent sample test was used. A P-value below 0.05 was used to determine statistical significance.
Results: A total of 343 students participated, 69.4% being female and 51% studying in the medical field. The prevalence of e-cigarette use was 16.6%; this prevalence was higher in males and non-medical students (64.9% and 61.4%, respectively, P <0.05). The main motives for using e-cigarettes were to reduce emotional tension, stress and anxiety, stop smoking, and enjoy flavors of e-cigarettes (31.5%, 29.8%, and 29.8%, respectively). Social media was used by most of the participants (63.6%) as a source of information. The majority of students (79.3%) demonstrated a good knowledge, and 57.1% of them showed opposing attitudes toward e-cigarettes.
Conclusions: The majority of the students had a good knowledge and negative attitudes toward e-cigarettes. The primary source for gaining information was social media. High prevalence of e-cigarette use was observed among students, especially among males and non-medical students; the primary motives for this practice were to reduce emotional tension and stress, stop smoking, and enjoy the flavors of e-cigarettes.

Background: Hepatitis B remains a serious global health issue, with healthcare workers at higher risk because of frequent contact with blood and body fluids in their work.
Aim: The assessment of knowledge ,attitude, and practice of health staff in the Raparin independent administration area toward hepatitis B prevention.
Methods: This cross-sectional study involved 513 health care workers from health facilities in Raparin independent administrative area and conducted between October 2024 and July 2025 using a multistage sampling method . Data were gathered through a self-administered questionnaire to assess participants' demographic details and their knowledge, attitudes, and practices regarding hepatitis B. The data were analyzed in SPSS v27 using both descriptive and inferential statistics.
Results: Out of 513 health care workers, 70.8% had good knowledge. Most participants were aware of how the hepatitis B virus spreads; however, only 38.2% knew about the presence of post-exposure prophylaxis, and just 9.2% were knew of the type of vaccine, 88.1% had a positive attitude. While 51.3% demonstrated good practice, only 51% had completed all three vaccine doses. Better knowledge was significantly associated with age, marital status, profession, education level, work unit, and years of experience. Younger, single, doctors, those with higher certification degrees, and dental staff tended to score higher in knowledge.
Conclusion: Overall, healthcare workers demonstrated good knowledge with a median score of 75% (IQR: 15), positive attitudes with a median score of 88.9% (IQR: 22), and good practices with a median score of 70% (IQR: 30).

Background: cardiovascular diseases (CVD) are significantly increased by dyslipidemia, while statins, especially atorvastatin, efficiently lower low-density lipoprotein (LDL) cholesterol levels, and decrease the risk of cardiovascular diseases. However, there are raising concern about the potential role of statins in inducing diabetes.
Aim: to highlight the impact of atorvastatin on glucose homeostasis, focusing on the mechanisms through which atorvastatin influences glucose metabolism.
Method: An extensive literature search has been conducted on various electronic databases such as PubMed, Scopus, Web of Science, and Science Direct. The review reported the effect of atorvastatin on main organs that are related to glucose homeostasis such as liver, adipose tissue and skeletal muscle. The mechanisms that underlie the atorvastatin-induced glucose intolerance effects include decreased insulin signaling in both muscle and adipose tissues, increased hepatic gluconeogenesis, and suppression of the mevalonate pathway.
Conclusions: The present knowledge regarding the impact of atorvastatin on glucose metabolism has been improved but several molecular/cellular signaling pathways are yet to be determined.

Objectives: To determine whether the family's history of colonic, uterine, breast, or other malignancies raises the risk of developing cancer of the endometrium in women in Nineveh Province, northern Iraq.
Subjects and Methods: A case-control study included 300 female participants: 100 with endometrial cancer and 200 age-matched controls. The researcher identified and selected cases from the medical records of the Oncology and Nuclear Medicine Hospital and its departments, then contacted them directly via phone. For the controls, the data were obtained during direct interviews with participants who were attending the local hospitals in Nineveh Province for non-neoplastic and non-gynecological conditions.
Results: The associations between familial history of colonic, uterine, or breast cancer in the first degree and the occurrence of cancer of the endometrium in the study sample groups revealed a risky association with a statistically significant difference (OR = 29.74, 95% CI = 3.83; 230.87, P > 0.001); (OR = 6.38, 95% CI = 2.71; 15.01, P > 0.001); (OR = 3.92, 95% CI = 1.83; 8.39, P = 0.002), respectively. However, no statistically significant difference exists between the occurrence of endometrial cancer and other forms of cancer. Furthermore, there is no statistically significant association between the family's history of cancer and menopausal status.
Conclusion: According to the study, a first-degree relative's family history of colonic, uterine, or breast cancer is significantly associated with an elevated risk of endometrial cancer. However, other malignancies and menopausal status have non-significant associations.

Background: Recently, there has been an increasing interest towards the metabolic and clinical effects of vitamin D deficiency. Vitamin D has been suggested to impact glucose homeostasis and, thus, metabolic syndrome and type 2 diabetes mellitus (T2DM) seem to be linked to vitamin D deficiency.
Aim: To study serum “25-hydroxy vitamin D” levels in a group of T2DM patients and to investigate its possible influence on the degree of glycemic control and lipid metabolism.
Methods: This is a case- control study which enrolled 65 known cases of T2DM and 65 non- diabetic subjects. Blood levels of vitamin D, glycosylated hemoglobin (HbA1c), fasting serum lipids and plasma glucose (FPG) were measured. The impact of vitamin D levels on the extent of glycemic control and serum lipids was investigated.
Results: The mean serum level of vitamin D was significantly lower among T2DM patients compared to controls (p<0.0001). Vitamin D was significantly and inversely correlated with HbA1c and FPG values in diabetic patients (r= -0.54 and -0.578 respectively, p<0.0001). In addition, vitamin D showed negative correlations with serum triglycerides, total cholesterol, VLDL- cholesterol and low density lipoprotein cholesterol (LDL- c), but significant positive correlation with high density lipoprotein cholesterol (HDL- c).
Conclusions: Patients with T2DM frequently have vitamin D deficiency. Vitamin D insufficiency may be linked to poor glycemic control and dyslipidemia in T2DM patients. Vitamin D therapy may, thus, improve glycemic control in type 2 diabetes mellitus and ameliorate metabolic derangements.

Background: Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease with diverse clinical manifestations. Nasal septal perforation is a rare complication, typically occurring during active disease phases or in established cases. Its presentation as the initial symptom is exceedingly uncommon.
Case Presentation: Authors report a 35-year-old male presenting with recurrent mild nasal bleeding, nasal discomfort, fullness, and intermittent nasal obstruction. Nasal endoscopy revealed a large septal perforation. The patient also exhibited joint pain, stiffness, a mild butterfly rash, photosensitivity, and malaise that preceded nasal symptoms. Laboratory tests showed strongly positive antinuclear antibody (ANA) and IgM anticardiolipin antibodies, with normal urinalysis. Histopathology of nasal mucosa indicated mild lymphomononuclear infiltrate. Based on clinical and laboratory findings, diagnosis of Systemic Lupus Erythematosus (SLE) was established by the rheumatologist.
Conclusion: This case highlights nasal septal perforation as the initial manifestation of SLE, emphasizing the importance of considering autoimmune aetiologies in unexplained nasal perforations. Early recognition can facilitate prompt diagnosis and management of systemic disease.

Background: Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system that encompasses long-term usage of disease-modifying therapy (DMTs). In Mosul city, the availability, distribution, prescription patterns, and accessibility of such therapies is not fully explored.
Objective: To describe the current treatment landscape for MS patients at Mosul Neurology Center, including DMT usage patterns, common adverse effects reasons for therapy switching, age and gender distribution of patients, local drug availability and cost, patient satisfaction, and infrastructure conditions at the local biological therapy unit.
Methods: This descriptive cross-sectional study analyzed a random sample of 108 medical records drawn from a total cohort of 592 registered MS patients at Ibn-Sina Neurology Center. Collected data included age, gender, current DMT, prior treatment history, therapy switching, and relevant laboratory findings. The annual treatment cost of each drug class was assessed. Additionally, a structured patient questionnaire was performed in the biological therapy unit. Drug usage patterns were compared with UK and other global benchmarks.
Results: Eight drugs are currently used in the treatment spectrum of 592 registered MS patients. The pattern is coherent with international standards, but there is relatively high utilization of betaferon (21% of patients), and lack of other more useful options, like dimethyl fumarate. Fingolimod is associated with high rate of leukopenia, and betaferon is the most commonly discontinued drug. Treatment pattern is consistent with induction strategy, and analysis of annual cost shows that natalizumab is the most expensive, yet, valuable drug, followed by ocrelizumab and betaferon. Generally, 60% of patients receiving biological treatment are completely satisfied with their treatment.
Conclusion: The available DMTs landscape is fairly good, including the usage of multiple treatment options and continuous monitoring of adverse reactions. Yet, it can still be improved by reallocating resources from high-cost, lower-efficacy interferons to introducing oral agents like dimethyl fumarate.

Background: Metabolic syndrome is a complex of heart disease and type two diabetes mellitus. Its diagnostic criteria vary between organizations such as American Diabetes Association (ADA) and World Health Organization (WHO). Lifestyle modifications are the cornerstone of its management.
Objective: The primary aim is to detect frequency of metabolic syndrome in patients diagnosed with coronary heart diseases.
Methods: Case series descriptive study. Patients who had acute coronary syndromes are qualified to be admitted to the cardiac care unit of Ibn-Sena Teaching Hospital. The individuals ranged in age from 17 to 88 years. The study conducted between March 1st, 2023 and September 1st, 2023. The study includs 61 patients (40 males and 21 females). Data were gathered and analyzed with Google Sheets and JASP 0.17.3 featured 18 variables (9 continuous and 9 categorical). Analysis performed by using and Fisher\'s, Chi-Square and Mann-Whitney U test.
Results: In this study, (73.8%) of study patients had metabolic syndrome. Individuals aged 50 to 65 years had the highest frequency of metabolic syndrome cases, accounting for 60% of all patients diagnosed with metabolic syndrome. The frequency of metabolic syndrome in patients with acute coronary syndrome was lower in males than in females. Among ACS patients with metabolic syndrome, 51.1% were unemployed and 48.9% employed, indicating no significant association between employment status and the presence of metabolic syndrome (p = 0.613). It has been found that the highest prevalence of metabolic syndrome (60%) among ACS patients aged 50–65. In contrast, other age groups under 35, 35–50, 65–80, and over 80 had more patients without metabolic syndrome, indicating an age-specific distribution pattern.
Conclusion: Metabolic syndrome was highly prevalent (73.8%) among ACS patients, reflecting global patterns and highlighting key demographic influences. These findings stress the need for early, person-centered prevention of cardiovascular risk.

Background: Chronic Myeloid Leukemia (CML) shows a diverse clinical presentation, and its prognosis is affected by a combination of demographic and laboratory factors. Although global studies have identified several prognostic markers, detailed information specific to the Iraqi population remains limited. Understanding how local demographic trends and easily accessible laboratory measures influence treatment response is essential for customizing care in this region.
Aim: To determine the influence of demographic characteristics (age, sex), disease-related factors (phase, duration), and baseline laboratory parameters ( WBC, HGB, and PLT) on treatment response and prognosis in AL-Diwaniya Iraqi patients with CML
Methods: A retrospective study was conducted using routinely collected clinical data from 51 CML patients managed at Al-Diwaniya Teaching Hospital in the hematology clinic from September 2024 to March 2025. Response was mainly determined by Molecular Response, which was defined as a reduction in BCR-ABL transcript levels, as measured by RT-PCR every 3-6 months. Multivariable regression models were used to assess the independent associations between each predictor and treatment response while controlling for potential confounders.
Results: PLT (Platelet count) demonstrated statistically significant associations with treatment response among the variables examined. Age, sex, disease phase, disease duration, WBC, and HGB did not reach statistical significance in this study.
Conclusion: This study highlights platelet count as a significant prognostic marker, suggesting its potential utility in personalising treatment strategies and enhancing patient outcomes in limited-resource countries and as a primary assessment tool. However, the study's findings must be interpreted with caution due to limitations such as missing data and a small sample size and factors such as baseline disease burden and treatment duration, which can substantially influence response dynamics and overall outcomes, which may impact the generalisability of the results. This work provides locally relevant evidence to guide clinical practice and national policy development, contributing to better outcomes in CML management across similar healthcare contexts.

Background: Endoscopic transsellar approaches effectively access skull base lesions but risk cerebrospinal fluid leaks. Three-layer grafting techniques reliably reinforce dural closure, reducing complications and supporting optimal healing.
Aim: Assessment of the efficacy and safety of the modified protocol for skull base reconstruction which is done by utilizing a three-layer grafting technique (Facia-Fat-Facia) for the patients who developed intraoperative CSF leak necessitating an immediate repair regardless the degree of the leak at time of repair.
Methods: A prospective study had been conducted at Skull Base Center and Neurosurgical Department of Ghazi Al-Hariri Martyr Hospital for Surgical Specialties, Medical City Complex of Baghdad through a period of 18 months, between January 2022 and June 2023, during which 43 patients with different pathologies underwent pure endoscopic endonasal sellar approach. Intra-operative CSF leaks were classified into four grades according to Esposito et al. Sellar reconstruction was performed by utilizing a three-layer grafting technique (Facia-Fat-Facia) for all patients regardless the degree of the leak at time of repair. Authors did not use any vascularized flaps or tissue glues and did not include any procedures of CSF diversions such as lumbar drainage.
Results: Among the 43 (29 adenomatous pathology and 14 non-adenomatous), CSF leak was 34.88% Grade I, 41.86 Grade II and 23.26 Grade III. A minimum of 18 months follow-up showed development of two postoperative CSF leaks (4.65%), one pneumocephalus (2.32%) and one bacterial meningitis (2.32%) cases.
Conclusion: Utilizing autologous facia lata and fat grafting in this modified three layered fashion is effective, reliable and safe procedure for reconstructing skull base defects regardless the CSF leak grading and severity, taking in consideration its tissue compatibility, availability and the ease of harvesting with negligible donor site morbidity, flexibility in size of the graft needed, it’s a good substitute for vascularized regional flaps in cases of unavailability of difficult to be harvested and lastly, it’s adding no cost on the patient when compared to other synthetic and artificial grafting substitutes avoiding the use of highly costed tissue glues and other synthetic sealant agents in most of cases.

Background: Iron deficiency anemia (IDA) is a widespread hematologic condition characterized by low hemoglobin levels. Intravenous (IV) iron is used for replenishing iron stores. Iron sucrose is administered in multiple low-dose infusions and recognized for its favourable safety and efficacy profile. Ferric carboxymaltose (FCM), a newer IV formulation, permits higher iron doses in a single infusion and may improve patient adherence. However, FCM is linked to a high incidence of adverse effects.
Aims: To compare the efficacy of IV FCM and iron sucrose in improving hemoglobin levels in patients with IDA and the number of hospital visits, and to assess the safety of ferric carboxymaltose
Method: In this study, 30 patients diagnosed with IDA at Aldiwaniay Teaching Hospital. 15 patients received iron sucrose, and 15 received FCM. Hematologic response was evaluated via complete blood count performed before treatment and two weeks following the final infusion.
Result: Iron sucrose produced a modest yet statistically significant improvement in hemoglobin levels compared to FCM. Nevertheless, FCM was associated with fewer hospital visits, offering a benefit in terms of treatment convenience. Notably, the FCM group experienced a high adverse event.
Conclusion: While iron sucrose demonstrated slightly superior hematologic efficacy, FCM remains an alternative, particularly in settings where resource optimization and patient accessibility are central considerations.

Background: Lymphoma is a malignant lymphoid cell tumors at varying stages of maturity and it is the most common hematological malignancy. Lymphoma is classified mainly into non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma (HL). Cluster of Differentiation 47(CD47) is cell surface protein, expressed by approximately all cells in the body in addition to different tumor cell types such as lymphoma. It mediates immune homeostasis, cell proliferation, phagocytosis, migration and apoptosis.
Objectives: To evaluate the expression of CD47 in B-cells lymphoma in addition to study the relation of expression of CD47 with some clinicopathological parameters such as site , age and gender.
Methods: A retrospective and prospective case series study of 51 cases of B-cell lymphoma, which were collected from histopathological departments of governmental and private labs over six months extending from September 2024 to February 2025.Assessment of IHC expression of CD47 expression on B-cell lymphoma.
Results: A total of 51 patients, 53% were HL , while 47% were NHL. The age of the patients under 60 years was 45% while at 60 years and above 55%, 64.7% were nodal presentation and 35.3% were extranodal ,51% were males while 49% were females.64.71% were high CD47 expression while 35.29% were low CD47 expression group.
Conclusions: high CD47 expression was associated with female gender and younger age patients, however, long term follows up studies on larger sample is recommended.

Background: The CYP1B1 gene is typically associated with congenital glaucoma and certain cancers, but its role in metabolic regulation remains less understood. We report a case that suggests a possible new connection between CYP1B1 mutations and pancreatic islet cell hyperplasia.
Case Presentation: Our patient, a 12-year-old boy with a known history of congenital glaucoma and familial Mediterranean fever (FMF), presented with recurrent hypoglycemic episodes initially thought to be seizures due to epilepsy. Further workup revealed high insulin levels during these episodes. A PET/CT scan eventually identified a lesion in the pancreas, and surgery confirmed islet cell hyperplasia. Following resection, his hypoglycemic episodes resolved. Genetic testing revealed a homozygous mutation in CYP1B1, along with a known MEFV variant linked to FMF.
Discussion: This appears to be the first reported case linking a CYP1B1 mutation to islet cell hyperplasia. One theory is that the gene’s role in hormone and lipid metabolism, as well as oxidative stress regulation, may influence β-cell activity. Chronic inflammation from FMF could have also contributed to pancreatic stress or compensatory hyperplasia.
Conclusion: This unusual case raises important questions about the metabolic roles of CYP1B1. It also highlights the value of genetic testing in unexplained cases of hyperinsulinemic hypoglycemia, especially in patients with complex medical histories.

Background: In spite of the fact that the oral congenital teratomas are rare, they may be identified throughout the ultrasonic examination. The radiologists must be oriented to identify the imaging characteristics to facilitate the best prognosis. Generally, these anomalies are benign, however, breathing difficulties are encountered, causing fetal distress and poor progress of labor beside the difficult feeding postnatally.
Aim: To make an insight into the rare cases of oral congenital teratomas.
Methods: In this case report, a cystic mass was nominated incidentally by two-dimensional transabdominal ultrasonic examination in the oral cavity of a second-trimester fetus in a 30-year-old patient. Upon arrival to the hospital, a sonographic detection was accomplished via a Samsung HS40 convex prob with 2-8 megahertz.
Results: Sonography showed a 24 weeks + gestation fetus with 11.5 x 6 x 6.7 cm complex cystic mass (volume was equal to 257 ml ) protruded from the fetal oral cavity (Figures 1,2, and 3) with otherwise normal anatomy. In addition, the amniotic fluid index was over 25 cm with deepest pocket of amniotic fluid was 7 cm which indicates the polyhydramnios.
Conclusion: The radiologists must be oriented to identify the imaging characteristics to facilitate the best prognosis. In fact, the professionality of the radiologist to detect these teratomas and their physiological complication precisely could substantially contribute on the improvement of the perinatal treatment.

Background: obesity generates a substantial worldwide health threat as it is being widely prevalent across the globe, including in Iraq, with notably among Baghdadi women. This rising prevalence of obesity has been associated with an increased incidence of various respiratory conditions.
Aim: This review highlights the special effect of obesity on respiratory parameters in healthy lung individuals and in individual with common pulmonary disease.
Method: This review was conducted through a comprehensive search of many literatures using electronic database.
Result: Literatures were selected based on effect of obesity on respiratory function in normal and respiratory diseased subjects.
Conclusion: Obesity primarily causes restrictive lung problems, but it can give rise to a slight obstructive difficulty, as exacerbation preexistent asthma. Pulmonary function is probably more directly impacted by central obesity. Forced vital capacity improves more in males than females after decreasing weight.

X-ray were discovered in 1895, the explosion of research that occurred shortly thereafter paved the way for much of the diagnostic imaging that we have today not just in medicine, but also in industrial and even scientific uses of these powerful technologies. Originally employed for examining the skeletal system, x-rays have become an integral part of modern medicine, which aids in different pathological conditions like fractures and tumors along with playing a vital role in treatment, as in the case of radiotherapy. Exploring various imaging methods such as conventional radiography, computed tomography (CT), and digital radiography suggests an ongoing pursuit to improve image quality while minimizing radiation exposure but with the risk of increasing radiation dose. Although X-rays are effective, radiation safety issues continue to arise, especially since ionizing radiation is associated with an increased risk of cancer later in life. Rapid maturity in radiology and the advent of sophisticated technologies like artificial intelligence and digital modeling systems have further redefined the radiology space and its impact in diagnostic accuracy and workflow efficiency. With the advancement of the field, an in-depth knowledge of the ethical considerations, regulatory requirements, and patient safety measures is of utmost importance. This review summarizes the historical development, the underlying concepts, and the current applications of X-ray technology and outlines the need for further investigations to develop solutions to minimize potential harms while enhancing its clinical applications. X-ray imaging is an essential diagnostic tool widely used in healthcare settings; however, translation into clinical practice is fraught with challenges that, if left untreated, can inhibit improvement of patient care and radiological safety.