Iraqi National journal of Medicine

Background: Laparoscopic cholecystectomy (LC) is one of the most common surgical procedures performed globally. While it is generally considered safe, there remains a risk of serious biliary injuries occurring during the procedure.


Indocyanine green (ICG) is a water-soluble, non-toxic dye that allows real-time intraoperative visualization of the extrahepatic biliary tree. Aim: This study aims to compare the bile duct injury rate, duration of surgery, conversion rate, length of hospitalization, and overall outcomes between laparoscopic cholecystectomy with and without indocyanine green (ICG). Methods: Ninety-two patients who underwent LC from October 2023 to October 2024 were included in the study; 42 of them underwent LC with ICG (group 1), and 50 did not receive it (group 2). Both groups were compared regarding intraoperative complications, duration of surgery, conversion rates, length of hospitalization, and overall outcomes. Results: The mean total operative time in minutes for group 1 was 44.6 minutes, compared to 51.1 minutes for group 2 (p-value = 0.001). No CBD or cystic duct injuries occurred in any patient in either group. Two patients were converted to open cholecystectomy in group 2, while none were converted in group 1; however, there was no statistically significant difference between the two groups (p-value = 0.174). There was no significant statistical difference in the length of hospital stay between both groups (p-value = 0.08). Conclusions: Indocyanine green (ICG) in LC allows for better visualization of the extrahepatic biliary system, leading to a significant reduction in operative time, gallbladder perforation, and bile spillage; however, there is no significant difference in bile duct injury rates, conversion rates to open surgery, or length of hospitalization in the ICG group.

Background: This is the first public study covering all cities in Anbar Province regarding the measles outbreaks occurred in 2023 and 2024. Aim: To estimate the demographic distribution of measles among infected children (age, gender, residence) in Anbar Province and to study the effectiveness of the measles vaccine for each patient on infection. Methods: A retrospective analytic cross-sectional study was conducted across all sectors of Anbar Province. The patients included those who were admitted, diagnosed, and treated in various hospitals during the measles outbreak in 2023, and 2024 years. The data was recorded in files of the Anbar Public Health Directorate, which included information on age, gender, residence, clinical manifestations, and vaccination status for each patient. Results: A total of 1,663 cases was 1663 patients with a male-to-female ratio of 1.2:1. Among the patients, 203 (12.2%) were less than one year old, 595 (35.8%) were between one to two years old, and 865 (52%)were more than two years. Of the cases, 259 (15.6%) were unvaccinated, 944 (56.8%) had received single dose of the measles vaccine, and 460 (27.6%) had received two or more doses. The most commonly reported clinical features were fever, skin rash, conjunctivitis, coryza, and cough, while lymphadenopathy was the least reported. Conclusions: A high percentage of cases were diagnosed with measles in Anbar Province, and a significant number of patients contracted the infection despite being vaccinated.

Background: Oxidative stress is implicated in male infertility, with reactive oxygen species contributing to sperm dysfunction. Among oxidative stress markers, 8-isoprostanes (8-isoP) and advanced oxidation protein products (AOPP) serve as indicators of lipid peroxidation and protein oxidation, respectively. However, their relationship with specific sperm abnormalities remains unclear. Aim: This study investigates the oxidative stress markers 8-isoprostane (8-isoP) and advanced oxidation protein products (AOPP) across different semen profiles and explores their correlation with sperm count and motility to evaluate their potential as diagnostic biomarkers in male infertility. Methods: A cross-sectional study was conducted on male partners of infertile couples between May 2024 and February 2025. Subjects were categorized into four groups based on semen analysis: normozoospermia (control), oligozoospermia, asthenozoospermia, and azoospermia. Seminal plasma levels of 8-isoP and AOPP were measured using sandwich ELISA kits, and results were compared among the groups. Results: Levels of 8-isoprostanes (8-isoP) and advanced oxidation protein products (AOPP) were significantly elevated in the asthenozoospermia group. In the azoospermia group, AOPP levels showed a significant increase, while 8-isoP exhibited a near-significant rise compared to the control. In contrast, the oligozoospermia group showed no significant increase in either marker. Conclusions: Although both markers increased in asthenozoospermia and azoospermia, AOPP showed greater sensitivity, highlighting protein oxidation’s role in severe sperm dysfunction. The oligospermic group showed no increase in both markers, indicating that isolated reduction in sperm count is unlikely to be caused by oxidative stress

Background: Malnutrition accounts for sixty percent of annual deaths among children under five years in developing countries, attributed to inappropriate feeding practices, including non-diverse and insufficient feeding. Improving the nutrition of children under five is a top priority for human development in these regions. Caregivers’ knowledge, attitudes, and practice of young child feeding are essential factors for child health and growth. Aim: The primary aim of this study was to assess infants and young children feeding practice among mothers attending primary health care centers in Basrah. Methods: A cross-sectional study was conducted involving 250 mothers attending five primary health care centers in Basrah. Data were collected through face-to-face interviews with participants by the investigators, using a specially prepared questionnaire. Results: The study included 250 children under the age of two years, with 76% of the children being less than one year old. Only 100 (40%) of the mothers breastfed their last child at the time of the study. Among the 250 mother-child pairs who participated, 101 (63.9%) mothers exclusively breastfed. Among 86 mothers with children aged 12-24 months, 63 (73.3%) of them continued breastfeeding. The initiation of complementary feeding (CF) was ideal in only 32.5% of the respondents, with the majority initiating CF before six months. Conclusions: Infant and young child feeding practices were poor in this study. There is a need to promote optimal feeding practices during postnatal care and to utilize mass media to emphasize the importance of complementary feeding practices, especially for mothers with lower educational status.

Background: Red blood cell distribution width (RDW) reflects anisocytosis, which is the variability in erythrocyte size. This parameter is commonly used in the differential diagnosis of various types of anemia Mean platelet volume (MPV) demonstrates platelet size and serves as an indirect marker of platelet activation. Both RDW and MPV have been proposed as potential markers for cardiovascular disease severity and prognosis. Aim: To evaluate the role of RDW, MPV, and the MPV/PLT ratio as supporting indicators in the diagnosis and severity assessment of acute coronary syndrome (ACS). Methods: This cross-sectional hospital-based study included 104 patients diagnosed with ACS (ST-elevation myocardial infarction, non-ST elevation myocardial infarction, unstable angina) admitted to the coronary care unit between October and December 2023. A control group of 181 healthy individuals was used to establish reference values. Data analysis was conducted using IBM SPSS. Results: Platelet count, MPV, and the MPV/PLT ratio were significantly associated with ACS. However, RDW showed no association with ACS in this study. Conclusions: This study evaluated the role of hematological parameters in acute coronary syndrome. To the best of our knowledge, this is the first study in Basrah demonstrating that the PLT count, MPV, and MPV /PLT ratio are significantly associated with ACS. In this study, RDW was not related to ACS. Given that a complete blood count (CBC) is a simple, cost-effective, and widely available test, we propose that these hematological indices may serve as supportive tools in the risk assessment of ACS patients.

Background: Helicobacter pylori is a Gram-negative, spiral-shaped, motile bacterium that represents one of the most widespread chronic infections in humans, affecting nearly half of the global population. Iron is a vital micronutrient required for almost all living organisms, including H. pylori, which relies on iron to establish colonization. Although several studies have indicated an association between iron deficiency (ID) or iron deficiency anemia (IDA) and H. pylori infection, the precise mechanisms remain incompletely understood. Aim: To assess the serum iron profile among Sudanese patients with H. pylori infection. Methods: Analytical case‑control hospital-based study was conducted at Bahri Hospital, Khartoum state during the period from December 2018 to April 2019. Eighty subjects were involved; forty patients with H. pylori and forty healthy individuals as a control group. Serum total iron and Total Iron Binding Capacity (TIBC) concentrations were estimated using the colorimetric method with a Mindray Analyzer. Serum total ferritin concentrations were estimated using an ELISA kit method with a TOSOH Analyzer. Results: The mean ± SD of serum iron, TIBC, and ferritin in the case groups were 92.80±34.38, 304.65±50.19, and 159.73±80.58, respectively. In the controls, the corresponding values were 109.00±22.51, 323.75±32.14, and 200.95±45.09, respectively. These parameters were significantly lower in cases compared with controls (p<0.05). Conclusions: Sudanese patients with H. pylori infection exhibited significantly lower serum iron, TIBC, and ferritin levels compared with controls. No significant association was detected between iron profile parameters and patient age.

Background: Doxorubicin is widely used as a chemotherapeutic drug. It has several serious side effects, including cardiotoxicity. Valsartan is an angiotensin II receptor blocker that plays a cardioprotective role against doxorubicin-induced cardiotoxicity. Aim: The aim of our study is to evaluate whether the combination of valsartan and doxorubicin affects the therapeutic efficacy of doxorubicin in treating cancer using an in vitro breast cancer cell line (MCF-7). Methods: Different concentrations of doxorubicin, valsartan, and their combination were tested to detect their cytotoxic effects on the cell line using MTT colorimetric assay method. Three duplicates of each concentration and control were made. Results: Valsartan had a mild cytotoxic effect only at higher concentrations, with an estimated IC50 value of 125.8 μg/ml, while doxorubicin, had more potent cytotoxicity, with an estimated IC50 value of 87.43 μg/ml. The IC50 of the doxorubicin-valsartan combination was lower than the IC50 of both drugs when used alone, with a DRI more than 1 (3.56) and an IAI less than 1 (0.94). Conclusions: There is synergism between doxorubicin and valsartan on MCF-7 breast cancer cells, suggesting a potential role for the combination in cancer treatment. The combination induces cytotoxicity in lower doses than when doxorubicin used alone.

Background: A precise estimate of gestational age (GA) is essential for providing optimal maternity care and determining the labor date. Aim: This study aimed to determine gestational age between the 14th and 40th weeks for Sudanese pregnant women by measuring the normal fetal kidney width using ultrasound. Methods: The study was designed as a descriptive cross-sectional study in Khartoum and Gezira states, Sudan, from June 2016 to May 2017. Three hundred ninety healthy pregnant women aged between 15 and 45 years were assessed by ultrasound, with overall normal well-being fetuses. Linear regression models for estimating gestational age were developed based on biometric markers and kidney width. Stepwise regression models were created to determine the most effective model for measuring gestational age that occur between 14 and 40 weeks. Comparisons were subsequently made between the models' effectiveness in identifying gestational age. Results: The most accurate variable parameter assessed in this study was kidney width, with a standard error (SE) of 0.02 days, followed by kidney length (SE = 0.04 days), biparietal diameter (BPD) (SE = 0.10 days), and femur length (FL) (SE = 0.13 days). The abdominal circumference was the least accurate, with an SE of 1.35 days. There was a strong association between GA and kidney width (R = 0.72, P < 0.002). Conclusions: The kidney width (KW) is easy to identify and measure. It is the most accurate parameter for estimating GA compared to other biometric indices in the late second and third trimesters and could be easily incorporated into models for estimating GA.

Background: The COVID-19 pandemic is associated with prothrombotic complications, leading to increased morbidity and mortality. D-dimer, a fibrin degradation product, serves as a biomarker for coagulation abnormalities. This study evaluates the role of D-dimer in predicting disease severity and hospitalization in COVID-19 patients. Aim: To assess correlations between D-dimer levels and age, gender, comorbidities, disease severity, and hospitalization needs in COVID-19 patients. Methods: A retrospective analysis of 78 COVID-19-positive patients admitted to an outpatient clinic was conducted. Data on demographics, comorbidities, vaccination status, disease severity, and admission D-dimer levels were analyzed using statistical tests (t-tests, chi-square, Mann-Whitney U). Results: The mean age of participants was 49 years, with 56.4% males and 43.6% females. Approximately 52% of patients had a comorbid disease, primarily hypertension and diabetes. Older patients and those with coexisting diseases had significantly higher D-dimer levels (p-values 0.017 and 0.045, respectively), with non-significant differences between males and females (p-value 0.648). Older patients had a significantly higher need for hospitalization during acute COVID-19 infection (p-value 0.002). Additionally, patients with elevated admission D-dimer levels showed a greater prevalence of severe disease (p-value 0.01) and a higher need for hospitalization (p-value 0.028). Conclusions: Elevated admission D-dimer levels are strongly linked to severe COVID-19 outcomes and hospitalization, highlighting their utility as an early prognostic marker. Clinical management of COVID-19 patients may be guided by D-dimer assessment, which may help predict disease severity.

Background: Acute coronary syndrome (ACS) is a subcategory of coronary artery disease (CAD) that encompasses a range of thrombotic cardiovascular events and remains a significant cause of morbidity and mortality worldwide. The clinical characteristics and outcomes of ACS patients can vary significantly based on geographical location, healthcare facilities, and population demographics. These variations highlight the importance of region-specific studies to better understand the presentation, management, and outcomes of ACS in diverse populations. Aim: This study aimed to evaluate the demographic profile, cardiovascular risk factors, seasonal variations, clinical presentations, and in-hospital outcomes of ACS patients admitted to Slemani Cardiac Hospital. Methods: A retrospective cross-sectional study was conducted on 375 ACS patients admitted between June 2021 and January 2022. Data on demographics, comorbidities, lifestyle risk factors, past cardiovascular history, ACS subtype, seasonal variation, management, and complications were collected from medical records and analyzed using SPSS. Results: The mean age was 63.3 ± 6.7 years, with a 60% male predominance. Hypertension (57.3%) was the most common risk factor, followed by diabetes mellitus (43.2%), smoking (31.7%), and prior coronary artery disease (29.9%). Unstable angina was the most frequent presentation (51.2%), followed by STEMI (27.7%) and NSTEMI (21.1%). Younger patients (48–57 years) were more likely to present with STEMI, while NSTEMI predominated in older groups (70–78 years). ACS admissions were significantly higher in winter than in summer (p = 0.030), with notable seasonal differences in risk factor distribution. Coronary angiography was performed in 24.8% of cases, PCI in 16%, and CABG in 2.9%. The most common complication was heart failure (20%), with STEMI associated with higher rates of arrhythmia, cardiogenic shock, stroke, and in-hospital mortality (25% within the STEMI group). Conclusions: ACS in this region predominantly affects older males, with hypertension and diabetes as the leading modifiable risk factors. Seasonal variation influences ACS incidence, with higher rates in winter. Tailored prevention strategies—particularly targeting blood pressure control, diabetes management, and smoking cessation—are essential to reduce the ACS burden.

Background: Vitamin D deficiency is a common health issue worldwide. Clinical observations have shown that most healthy individuals living in Iraq and the Middle East are vitamin D deficient. This study aimed to establish the true cut-off value for vitamin D deficiency (25(OH)D) in Basrah, Iraq, by analyzing the value at which parathyroid hormone (PTH) begins to rise above its reference range. Aim: This study sought to determine the true cut-off value for vitamin D deficiency (25(OH)D) in Basrah, Iraq by analyzing the value at which PTH starts to exceed its reference range. Methods: A cross-sectional study was conducted involving 874 apparently healthy subjects from Basrah, Iraq. Serum calcium, creatinine, vitamin D and PTH levels were measured for each participant. Individuals with impaired renal function and primary hyperparathyroidism were excluded from the study. The association between serum 25(OH)D and PTH was examined using multiple logistic regression analysis. The best cut-off value of serum 25(OH)D to predict elevated PTH was determined using receiver operating characteristic (ROC) analysis. Results: The mean values of 25(OH)D and PTH were 16.9 ± 14.9 ng/ml and 129.1 ± 110.5 pg/ml, respectively. If the universal cut-off values were applied, 25-hydroxyvitamin D deficiency was identified in 599 subjects (68.5%) and was inversely related to PTH. Only 139 subjects (15.9%) had optimal 25(OH)D levels. Secondary hyperparathyroidism was found in 487 subjects (45.7%). Using ROC analysis, a serum 25(OH)D value of 12.5 ng/ml was identified as the best cut-off point to predict secondary hyperparathyroidism in the population (sensitivity: 88.2%, specificity: 53.6%). The number of subjects classified as vitamin D deficient decreased to 461 (52.7%) when the new cut-off value was applied. Conclusions: The cut-off value for vitamin D deficiency needs to be redefined in areas where the disease is unexpectedly prevalent. A single cut-off value cannot be universally applied worldwide due to genetic and environmental variations. The new cut-off value is lower than that used globally. Further studies are required to establish new cut-off values.

Background: Precise quantification of platelet counts is a fundamental aspect of clinical hematology, pivotal in diagnosing and managing conditions such as thrombocytopenia and thrombocytosis. However, inconsistencies in platelet measurements across various automated hematology analyzers present significant challenges, potentially compromising the reliability of results. This variability is especially critical when platelet counts inform urgent clinical interventions, including the administration of platelet transfusions. Aim: The present study evaluated the accuracy of Sysmex XN-350 and Mindray in comparison to flow cytometry, the gold standard for platelet counting. Methods: 120 blood samples were categorized into thrombocytopenic, thrombocytosis, and normal groups. Platelet counts were measured using Sysmex XN-350, Mindray BC-720, and flow cytometry. Statistical analyses, including correlation coefficients, Bland-Altman plots, and repeated measures ANOVA, were employed to assess agreement and differences among the methods. Results: The study revealed significant discrepancies in platelet counts among the devices. Sysmex XN-350 consistently overestimated platelet counts compared to flow cytometry, particularly at higher counts, with a mean difference of 176.76 ± 358.51. Mindray BC-720 demonstrated greater agreement with flow cytometry, with a mean difference of 60.062 ± 119.67 and a stronger correlation (r = 0.972). Bland-Altman analysis showed that Sysmex exhibited substantial overestimation at higher platelet counts, while Mindray maintained consistency within clinically relevant ranges. Conclusions: Mindray BC-720 outperformed Sysmex XN-350 in terms of agreement with flow cytometry, especially in the thrombocytopenic and normal ranges. These findings highlight the importance of validating automated hematology analyzers against advanced techniques like flow cytometry to ensure precision in platelet enumeration.

Background: Smoking is a significant global cause of preventable morbidity and mortality, resulting in six million deaths worldwide each year. Electronic cigarettes are becoming increasingly popular among adolescents and young adults globally. Aim: This study aims to determine the prevalence of electronic smoking and awareness among Al-Nahrain undergraduate medical students. Methods: A cross-sectional study was conducted at the College of Medicine, Al-Nahrain University, Baghdad, Iraq. Data were collected during March and April, 2022. A total of 474 undergraduate students completed a modified standard questionnaire. Statistical analysis was performed using SPSS-26. Results: The prevalence of electronic smoking was found to be 12% of the total sample. Of the students surveyed, 350 (73.8%) were aware of electronic cigarettes. A significant association was observed (P-Value < 0.05) between smoking and being male, having history of smoking among friends or relatives, and a lack of awareness that electronic cigarettes are similar traditional cigarette smoking. Conclusions: More than one-tenth of the sample reported history of electronic smoking, and they were generally aware of most information regarding it. The usage is a significant public health issue; therefore, it is crucial to implement strict laws and policies to minimize the sale of these products to the younger population. Health promotion strategies should be developed to reduce the usage of electronic cigarettes.

Background: Tonsillectomy is a very common surgery in children and it is the most routinely performed surgical operation worldwide. It is indicated for recurrent tonsillitis, chronic tonsillitis, peritonsillar abscess, suspicion of malignant diseases, and tonsillar hypertrophy causing obstructive sleep apnea. Various techniques can be employed for tonsillectomy, including cold dissection, electrocautery, bipolar diathermy dissection, radiofrequency, coblation, laser, and harmonic scalpel. Coblation is one of the most recent techniques used for tonsillectomy, which can ablate tissue by generating a field of ionized sodium molecules using a bipolar radiofrequency energy, which ablates and coagulates soft tissue into an ionized plasma layer, creating sufficient energy to break molecular bonds which result in molecular dissociation. Aim: To evaluate the efficacy of the coblation technique in decreasing the complications associated with tonsillectomy. Methods: A prospective study was conducted at Al-Moosawi Private Hospital in Basrah over a period of five years, between April 2018 to April 2023. A total of 466 patients (266 male and 240 female), aged 4 to 54 years, were included. All patients underwent coblation tonsillectomy either due to recurrent tonsillitis or tonsillar hypertrophy causing obstructive sleep apnea, or both. Several operative and postoperative parameters were evaluated, including operative time, hospital stay, postoperative bleeding, postoperative pain, and time to resume a normal diet. Results: The surgery was most commonly indicated due to recurrent tonsillitis in 411 patients (88%), while only 5 patients (1%) underwent surgery for tonsillar hypertrophy causing obstructive sleep apnea. The operative time ranged from 6 to 15 minutes in the majority of patients, constituting 413 (88.6%). Of the patients, 396 patients (85%) stayed in hospital for 6 hours postoperatively, while 44 patients (9.5%) stayed for 12 hours, and only 26 patients (5.5%) required an overnight stay. Among the 466 patients, only 8 (1.7%) patients experienced postoperative bleeding. The bleeding was primary in 3 (0.65%) and secondary in 5 (1.05%) patients. The mean VAS in the first postoperative day was 2.5±1.4, increasing to 4±1.4 on the third postoperative day, and decreasing to 3.5±1.7 by the 7th postoperative day. Most patients (311, or 66.7%) resumed a normal diet on the first postoperative day, while only 12 (2.5%) delayed resuming their diet to the seventh postoperative day. Conclusions: Based on our findings and clinical outcomes, the coblation technique is an effective, reliable, and safe method for tonsillectomy, with negligible complications. We recommend its wider adoption among otolaryngologists and pediatric ENT surgeons.

Background: Acute lymphoblastic leukemia (ALL) is a cancer characterized by the rapid and uncontrolled growth of immature lymphoid cells. Among its subtypes, B-lineage ALL in children represents the most frequently diagnosed malignancy in the pediatric population. Despite high survival rates, relapsed or refractory cases remain challenging. Minimal Residual Disease (MRD), detected by flow cytometry, is a strong prognostic marker that guides the intensity of post-induction therapy. Aim: This study aims to evaluate the correlation between post-induction MRD, measured by multicolor flow cytometry, and the initial clinical and laboratory parameters in pediatric patients with B-ALL. Methods: A retrospective cross-sectional study was conducted at the Children’s Specialty Hospital in Basrah, including 51 pediatric B-ALL patients (aged 1–14 years) treated between April 2023 and August 2024. All patients successfully completed the induction phase of chemotherapy, and their MRD status was subsequently evaluated. Results: MRD was negative in 60.78% and positive in 39.22% of patients. The majority of patients in both MRD groups were under 10 years old, with no significant age-related difference (P = 0.732). Patients with positive MRD had significantly higher mean white blood cell (WBC) counts (58.62 ± 86.9 vs. 11.44 ± 13.04) and blast cell percentages (87.1% ± 7.6% vs. 76.6% ± 16%) compared to those with negative MRD (P = 0.004 and 0.008, respectively). No significant associations were found between MRD and hemoglobin levels, platelet counts, or National Cancer Institute (NCI) risk classification. Conclusions: Flow cytometric MRD detection is a valuable prognostic tool in pediatric B-ALL. Higher WBC counts and blast percentages at presentation are associated with positive MRD, while MRD was not significantly linked to age, hemoglobin, platelet count, or risk stratification

Background: Periorbital oedema following septorhinoplasty is one of the major complications. Various measures have been advocated to alleviate this issue, including the use of a variety of chemical and/or physical materials, such as Aescin. Aim: This study aims to evaluate the role of Aescin in reducing peri-orbital oedema following septorhinoplasty. Methods: Fifty-four patients underwent primary septorhinoplasty at both Syaab and Saddar Teaching Hospitals in Basrah, Iraq, from September 2023 to September 2024. This randomized prospective interventional study collected data from patients using a designed form during the initial interview. The study population was divided into two groups randomly, group A received Aescin in the form of Aescin Diethylamine Salicylate (Reparil 40 mg oral tablet once daily for 10 days), while Group B did not receive Aescin; each group consisted of 27 patients. Patients in both groups were followed regularly on the 1st, 3rd, 7th and 1 month post operatively. Results: Of the total 54, 25 patients were males and 29 were females, representing 46.3% and 53.7%, respectively. Female to male ratio was 1.16:1. Patients' ages ranged from 17 to 42 years, with the majority (57%) in the 20-30 years age group. Eighty-seven percent of the studied patients developed peri-orbital oedema post-operatively. In Group A, 85% developed peri-orbital oedema, of which 73% resolved on the first post-operative day with the use of Aescin (Reparil 40 mg tablet). Conclusions: Aescin Diethylamine Salicylate can effectively reduce peri-orbital oedema following septorhinoplasty.

Background: Breast cancer is a heterogeneous disease comprising molecular subtypes such as Luminal A, Luminal B, Human Epidermal Growth Factor 2 (HER-2)-Enriched, and Triple Negative, each with distinct clinical, molecular, and immunological features. Immunological markers play a critical role in modulating tumor behavior, angiogenesis, and immune evasion. Aim: This study aimed to identify key immunological markers that correlate with the molecular (intrinsic) subtypes of breast cancer and to explore their potential as prognostic factors. Methods: Serum samples from 180 breast cancer patients (56 untreated and 74 treated) were analyzed using Enzyme-Linked Immunosorbent Assay (ELISA) to determine the levels of four immunological biomarkers, including Cellular Communication Network Factor 6/WNT 1 Inducible Signaling Pathway Protein (CCN6/WISP3), Vascular Endothelial Growth Factor A (VEGF-A), Nuclear Factor Kappa B (NF-κB p65), and Cancer Antigen CA15-3. Demographic data and clinical parameters were collected using questionnaires. Results: Compared to the controls, patients with breast cancer exhibited significantly elevated levels of VEGF-A, NF-κB p65, and CA15-3, alongside decreased CCN6 levels (P < 0.05). At the molecular subtype level, HER2-enriched tumors showed the highest concentrations of CCN6 and VEGF-A, while elevated NF-κB p65 and CA15-3 levels were noted in Luminal B tumors, indicating the lowest CCN6 concentration in triple-negative tumors. Conclusions: This study demonstrates the roles of CCN6, VEGF, NF-κB p65, and CA15-3 as reliable biomarkers for distinguishing between molecular subtypes and suggests their potential as prognostic indicators.

Background: The correlation between hepatitis B virus (HBV) and nephropathy presents a significant public health issue in Iraq. Aim: This study systematically investigates the association between hepatitis B surface antigen (HBsAg) serology and chronic kidney disease among residents of Baghdad, Iraq. Methods: We evaluated the clinical characteristics and serologic profiles of 609 patients with adult-onset HBV-related membranous nephropathy. Results: Individuals who are HBsAg (+) have a slightly increased risk of developing eGFR < 60 ml/min/1.73m2 or proteinuria compared to HBsAg (-) individuals. Conclusion: The study emphasizes the substantial impact of HBV on chronic kidney disease, independent of viral replication or inflammation. The findings underscore the importance of understanding the epidemiology and clinical implications of HBV infection in the context of renal complications, revealing potential immunological and pathological mechanisms. Further studies are recommended to elucidate the complex relationship between HBV infection and kidney impairment.

Background: Divorce has been linked to increased psychiatric morbidity; however, studies in regions such as Iraq remain sparse. Despite the known mental health challenges that often follow divorce, the impact within the Iraqi context—shaped by unique cultural changes—demands focused exploration. Aim: This study aimed to estimate the prevalence of psychiatric morbidity among divorced individuals, identify psychiatric disorders post-divorce, and assess the impact of various sociodemographic variables on psychiatric morbidity in this population. Methods: Employing a case-control design, this study was conducted in collaboration with local courts and psychiatric clinics in Basrah. A total of 154 participants, divided equally between divorced individuals (cases) and married controls, were selected. Data were collected using the General Health Questionnaire (GHQ) and semi-structured interviews, followed by statistical analysis to evaluate the association between divorce and psychiatric disorders. Results: The study revealed a significant prevalence of psychiatric disorders among divorced individuals compared to controls. A notable increase in depressive symptoms was observed in 68% of cases versus 55% of controls. Generalized Anxiety Disorder (GAD) was present in 42% of cases, compared to 22.2% of controls. Substance abuse was reported at 8% in cases but was not present in controls. A history of psychiatric illness before divorce was significantly associated with post-divorce psychiatric morbidity (P<0.05). The analysis highlighted a marked difference in the psychological impact of divorce, underscoring the intensified risk of psychiatric disorders among the divorced population. Conclusions: The findings underscore the heightened vulnerability of divorced individuals to psychiatric disorders, emphasizing the need for targeted mental health support and interventions. This study contributes to the growing body of evidence on the mental health repercussions of divorce and underscores the importance of comprehensive support systems for this population.

Background: Depression is the most common mental disorder in community settings and a major cause of disability worldwide. In 1999, it was the fourth most common cause of disability globally, and by 2020, it is projected to become the second most common cause. Doctors, as the primary workforce in hospitals, endure significant emotional and physical stress, which may have been exacerbated by the COVID-19 pandemic. Aim: This study aimed to estimate the prevalence of depression among doctors during the COVID-19 pandemic and its risk factors. Methods: This descriptive cross-sectional study was conducted from February 1 to June 1, 2021. The study population comprised 327 doctors working in seven general hospitals in Basra city center. An online questionnaire was utilized, and the responses were analyzed using SPSS program version 26. Results: The study included 48.9% males and 51.1% females, with participants aged between 24 and 67 years. Most participants were married (70.6%), and nearly half had children, with years of service being less than five. A total of 73% of doctors exhibited depressive symptoms, with mild depressive episode was the most common (36.4%), occurring more frequently in females (75.4%) than in males (70.6%). The most significant risk factors identified were exposure to violence and the presence of comorbid physical conditions. Conclusions: The high prevalence of depression was particularly noted among doctors who work in AL-Basra Teaching Hospital for Maternity and Children, with pediatricians being the most affected specialty.

Background: Colorectal cancer (CRC) has traditionally been considered a disease of older adults; however, recent evidence shows an increasing incidence among younger patients. Understanding the differences in clinicopathological features between young and older individuals is essential for improving early diagnosis, treatment strategies, and outcomes. Aim: The primary objective of this study is to compare the demographic profiles and clinicopathological characteristics of younger patients (aged <40 years) with those of older patients (aged ≥40 years) diagnosed with colorectal cancer. Methods: Eighty-five consecutive patients admitted to our hospital were prospectively followed for their entire hospital stay or up to 7 days, whichever came first. Each patient's blood glucose measurement was recorded according to ward protocol. Indices included total blood glucose per ward, per patient-day, or patient stay, and percentage blood glucose levels per predefined cut points to assess the incidence of hypo-, eu-, and hyperglycemia. The trial registration number at Clinicaltrials.org is NCT04800861. Results: Total data consisted of 645 blood glucose tests from 85 patients and 284 patient-day results, with an average of 2.27 tests per patient-day and 7.59 measurements per patient stay. The percentage of blood glucose in the range (80–180 mg/dL) varied by model, with patient-day showing the highest results at 48.24%, while the percentage of patients with hypoglycemia (blood glucose <60 mg/dL) was highest per patient stay at 1.18%. Conclusions: Younger colorectal cancer patients in this study presented more frequently with rectal tumors, poor differentiation, and advanced disease stages. Despite similar symptom profiles, delayed diagnosis may contribute to worse pathological features. These findings support the need for greater awareness and consideration of earlier screening in younger populations.

Although reported in children, acquired and acute-onset isolated unilateral palatal palsy is a clinically rare condition. It is typically caused by involvement of the pharyngeal branch of the vagus nerve, with presenting symptoms primarily including acute-onset hypernasal speech and ipsilateral nasal regurgitation of fluids. While the etiology is often considered idiopathic, several pathologies, such as infections, trauma, tumors, and brainstem lesions, must be excluded, as direct associations have been established in literatures. We report a case of a 13-year-old girl who developed acute-onset left sided isolated palatal palsy following mild rhinitis with non-conclusive neuroimaging and negative routine serology. Complete recovery was achieved within two weeks with a tapering course of oral corticosteroids. The patient was closely monitored for three months to exclude recurrence and the possibility of other underlying pathologies.

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Post-publication Author Correction


Following publication of the above article, the Editorial Office of the Iraqi National Journal of Medicine (IqNJM) received a formal request on 7 July 2025 from Dr. Assad Faisal Al-Kuheli requesting a correction to the authorship of the article, including removal of one author and rearrangement of the author sequence.


Upon receipt of this request, the Editor-in-Chief initiated a formal investigation in accordance with the journal’s bylaws and authorship correction policy. As part of this process, Dr. Weal Al-Shehaby and the Editor-in-Chief contacted all originally listed authors as well as the newly proposed author, both directly by telephone and officially via email.


The communications and documentation provided to the Editorial Board demonstrated clear evidence that Dr. Saifali Jabbar Al-Jabran does not fulfill the authorship requirements as defined by the International Committee of Medical Journal Editors (ICMJE) criteria. In contrast, the investigation confirmed that Dr. Jawad K. Atiya fulfills all ICMJE authorship criteria and should be included as an author of the article.


All authors involved submitted a signed covering letter confirming their agreement with the proposed authorship changes and revised author sequence.


Based on the findings of the investigation and following discussion during the regular meeting of the Editorial Board held on 11 January 2026, the Board approved a formal correction to the authorship of the article. Accordingly, a Corrigendum is issued to reflect the corrected authorship information and will be published in Volume 8, Issue 1 of the Iraqi National Journal of Medicine.


The authorship correction does not affect the scientific content, results, or conclusions of the article.


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Background: Plasma cell disorders encompass a spectrum of diseases ranging from benign to malignant. Among malignant plasma cell disorders, multiple myeloma is the most common and well-recognized entity. Aim: To identify the pattern of immunoglobulin production in secretory myeloma in Basra and correlate findings with hematological and clinical data. Methods: A retrospective study of 143 patients with plasma cell disorders was conducted at the Department of Pathology, Basrah Oncology Center, Iraq. Clinical data, relevant laboratory parameters (erythrocyte sedimentation rate, renal function tests, and serum calcium), bone marrow examination findings, radiological findings of bony lesions, and results from serum/urine protein electrophoresis and immunofixation or flow cytometric immunophenotyping were analyzed in conjunction with medical records. Results: Abnormal urine protein electrophoresis was found in 93.4% of patients, with most M bands located in the gamma region. The most prevalent subtype was IgG kappa, accounting for 68% of cases. This was followed by IgG lambda (17%), IgM lambda (6.5%), IgM kappa (3.2%), IgA kappa (1.3%), and free light chains (1.3%). Laboratory parameters showed wide variability, with a median hemoglobin of 9.1 g/dL, serum calcium of 9.9 mg/dL, and erythrocyte sedimentation rate of 80 mm/hr. Significant associations were found between immunofixation electrophoresis subtypes and erythrocyte sedimentation rate, serum calcium, and urea. Notably, the IgA kappa group had higher serum calcium (mean 12.45 mg/dL, p = 0.020). Radiological findings revealed multiple bony lesions in the majority of patients. Conclusions: Serum protein electrophoresis is a useful initial screening tool for detecting paraproteinemia, but it lacks sensitivity for accurately characterizing monoclonal proteins. Immunofixation, by contrast, provides higher sensitivity and allows precise identification of monoclonal immunoglobulin subtypes. In our cohort, IgG kappa was the predominant subtype, aligning with global trends, whereas patients with the IgA isotype exhibited more severe laboratory abnormalities.