The Medical Journal of Basrah University

Background Hemostatic agents (Ha) are essential for controlling oral hemorrhage, particularly during surgical procedures, trauma, and certain medical conditions that predispose individuals to bleeding. This review examines the various types of hemostatic agents, including absorbable and non-absorbable materials, topical agents, and biological products, highlighting their mechanisms of action, efficacy, and safety profiles. The review categorizes these agents based on their mode of action, such as platelet aggregation, clot formation enhancement, and vasoconstriction. Additionally, we discuss the clinical applications of (Ha) in dentistry, including tooth extractions, periodontal surgeries, and management of oral hemorrhaging. A comparative analysis of commonly used hemostatic products, including gelatin sponges, collagen-based agents, and fibrin sealants, is provided to assist clinicians in selecting appropriate options tailored to specific clinical scenarios. Furthermore, the review addresses potential complications and contraindications associated with the use of hemostatic agents, emphasizing the importance of individualized patient assessment. Ultimately, the effective use of (Ha) can significantly improve patient outcomes by minimizing bleeding, reducing operative time, and enhancing recovery in various dental practices. Future research directions are proposed to explore innovative hemostatic technologies and their application in oral and maxillofacial surgery; the purpose of this study is to assess the safety and effectiveness of different (Ha) used in oral surgery.

Background: Premature rupture of membranes (PROM) is the rupture of amniotic membranes before labor begins, and when membranes rupture occurs before 37 weeks of gestation, it is known as preterm PROM (PPROM). It is known to complicate around 3% of preterm pregnancies and is responsible for 40% to 75% of neonatal deaths. It is suggested that vitamin C status plays a role in reducing the incidence of PPROM. The study aims to establish the association between maternal plasma vitamin C concentration among women with PPROM and women without PPROM.
Subjects and Methods: A prospective cohort study was done at Al Basrah Teaching Hospital for maternity and children over the period from January 1st, 2023, to December 31st, 2023. The study included 34 cases of PPROM, which were matched for gestational age with 28 controls. The data were collected from women who were included in the study through a well-formed questionnaire. Then 5 cc of blood was drawn from each woman to measure the Hb, WBC, and vitamin C levels.
Results: The vitamin C level was lower among cases (7.22 ± 4.66) than controls (14.23±5.29) with a P-value of 0.001. Urinary tract infection was also higher among cases (p –value=0.001). Women with caesarean sections had a lower level of vitamin C (6.23 ± 2.8) in comparison to women with vaginal delivery (11.63 ± 6.05), and those with postpartum haemorrhage had a lower level of vitamin C (7.25 ± 4.91). however, only the mode of delivery had a statistically significant level (p-value of 0.001).
Conclusion: A lower level of vitamin C was noticed among women with PPROM in comparison to healthy women. A higher incidence of postpartum haemorrhage (PPH) and neonatal complications was noticed among those with PROM and vitamin C deficiency.

Background: Restless Legs Syndrome is a frequent neurological disorder in patients receiving hemodialysis. It causes sleep disturbance, fatigue, and reduced quality of life, yet data on its occurrence in Iraq are scarce.
Aim of the study: To determine the prevalence, severity, and associated factors of Restless Legs Syndrome among individuals undergoing chronic hemodialysis.
Subjects and Methods: A cross-sectional study was conducted from February to October 2025 at two hemodialysis centers in the Kurdistan Region of Iraq. Adult patients who had been on regular hemodialysis for at least three months were included, while those with neurological diseases or taking drugs known to trigger Restless Legs Syndrome were excluded. Diagnosis and assessment of severity followed the criteria of the 2014 International Restless Legs Syndrome Study Group. Demographic and clinical variables, including age, sex, body mass index, duration and adequacy of dialysis, and causes of kidney failure, were analyzed.
Results: Among 163 participants, 28.2 % had Restless Legs Syndrome (mean age 50.1 ± 14.2 years; 55.2 %female). The condition was more common in women, obese patients, those with dialysis duration exceeding five years, and those with inadequate dialysis. No association was found with age, frequency of dialysis, or cause of kidney disease. Of the affected patients, 11% had very severe symptoms, and 59% had moderate to severe symptoms.
Conclusion: Restless Legs Syndrome is common among hemodialysis patients, particularly women, obese individuals, and those with prolonged or insufficient dialysis. Early screening and management of risk factors may improve outcomes.

Background: The adequacy of hemodialysis is a vital indicator of treatment quality and patient survival among individuals with end-stage renal disease. In Iraq, regional disparities and inconsistent monitoring have limited the understanding of dialysis performance and its determinants.
Aim of the Study: To assess the adequacy of hemodialysis across Iraq from 2011 to 2025, focusing on regional variations, contributing factors, and related clinical outcomes.
Subjects and Method: A systematic review and meta-summary were conducted according to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eight eligible studies from Baghdad, Erbil, Karbala, Najaf, Diyala, Sulaimani, Basra, and national multicenter data were analyzed. Owing to differences in study design and reporting, data were synthesized narratively. Hemodialysis adequacy was defined as a single-pool Kt/V of at least 1.2 or a urea reduction ratio of 65 percent or higher.
Results: Adequacy rates ranged from 28.6 to 73 percent, with dialysis centers in Erbil achieving higher levels than those in other cities. Determinants of adequacy included longer session duration, higher blood flow rate, and the use of arteriovenous fistulas. Adequate dialysis was associated with higher hemoglobin levels, better biochemical and nutritional parameters, fewer hospitalizations, and improved quality of life. The mean adequacy of hemodialysis, excluding Erbil city hemodialysis centers, was 41.7%.
Conclusion: Hemodialysis adequacy in Iraq remains below international standards. Strengthening infrastructure, standardizing national protocols, and establishing a national dialysis registry are essential to improve dialysis quality and patient outcomes.

Background: Preterm labor (PTL) is the onset of uterine contractions with cervical changes before 37 weeks of gestation and remains a major cause of neonatal morbidity and mortality worldwide. Genital tract infections are strongly implicated in its pathogenesis, yet data from Iraq remain scarce.
Aim of the Study: To identify the bacteriological spectrum of genital tract infections among women presenting with active preterm labor, to guide preventive and therapeutic strategies.
Methods: A cross-sectional study was conducted at Al-Mawani Teaching Hospital for Maternity and Children in Basra, Iraq, over nine months (October 2024–July 2025). A total of 111 pregnant women (28–36 weeks) with clinically diagnosed active PTL were enrolled. Data on demographics, obstetric history, and clinical presentation were collected using a structured questionnaire. Endocervical swabs were obtained aseptically, cultured on standard media, and analyzed using Gram staining and biochemical tests.
Results: Culture positivity was 78.4%, with Staphylococcus spp. (48.6%) as the predominant isolate, followed by Streptococcus spp. (13.5%), E. coli (8.1%), and Candida spp. (5.4%). Mixed Candida + Staphylococcus infections (2.7%) were strongly associated with neonatal mortality (p <0.001). Significant predictors of positive cultures included younger maternal age (<20 years, 100%; p <0.001), low parity (p <0.001), vaginal discharge (p = 0.024), vaginal itching (p = 0.045), and prolonged symptom duration (p = 0.008). Neonatal outcomes included 55.9% NICU admissions and 10.8% mortality.
Conclusions: Genital tract infections, particularly mixed infections, represent a preventable and clinically significant determinant of PTL and adverse neonatal outcomes. Routine microbiological screening of high-risk women is recommended to improve maternal and neonatal health.

Background: Caesarean section was first used to save the lives of both the mother and the babies, but the rising number of Caesarean deliveries has raised worries.
Aim of the study: To estimate the rate, indication, complications, and outcome of the Caesarean sections.
Patients and Method: A retrospective cross-sectional study was conducted in the Department of Obstetrics and Gynaecology at Basra Maternity and Child Hospital /Basra Governorate / Iraq, during the period from the 1st of October 2023 to the 1st of July 2024. All pregnant women who underwent Caesarean section during the study period were included in the current study.
Results: The number of women who were delivered by Caesarean section was 3990, with a rate of 42.45%. In 1477 (43.7%) patients, the Caesarean section was the first Caesarean section, 1107 (27.7%) had a previous Caesarean section, while 1139 (28.6%) had two or more previous Caesarean sections. The more frequent indications in the first Caesarean section versus repeated Caesarean section were failure to progress in labour (28.3% versus 24.11, P-value=0.036), fetal distress (28.2% versus 26.4%, P-value=0.310), and fetal malpresentation (29.4% versus 27.73%, P-value=0.337. The complications in the first Caesarean section versus repeated Caesarean were extension of the lower segment (0.26% versus 0.63%, P-value=0.073), intraoperative bleeding (0.22% versus 0.40, P-value=0.301), and bladder injury (0% versus 0.05%, P-value=0.289). The percentages of postoperative complications were higher in those with repeated Caesarean sections compared to those with a first Caesarean section, but the difference was not statistically significant.
Conclusion: The rate of Caesarean section was 42.45% of the total deliveries; 43.7% of these patients had the first Caesarean section. The main indication of a Caesarean section was failure to progress. The main intraoperative complications include an extension of the lower segment and intraoperative bleeding, while the postoperative complications include postpartum haemorrhage and paralytic ileus

Background: Overweight and obesity prevalence have surged globally between 1990 and 2021. One billion males and 1.11 billion females are either overweight or obese. Aim of the study: This study investigates the in vitro effect of the dual glucose-dependent insulinotropic polypeptide and Glucagon-like peptide-1 GIP/GLP-1 receptor agonist Tirzepatide on the gene expression of nuclear factor kappa B (NF-κB), a transcription factor critically involved in inflammation and carcinogenesis. Given the potential link between incretin-based therapies and cancer risk, we hypothesize that Tirzepatide might upregulate NF-κB.
Methods: Colorectal SW48 cells were treated with three concentrations of Tirzepatide (0.05, 0.5, and 5 µg/µl) for 24 hours. RNA was extracted, cDNA was synthesized, and gene expression was quantified using qPCR.
Results: Contrary to the initial hypothesis, results demonstrated a significant, dose-dependent downregulation of NF-κB gene expression. The most substantial suppression (0.03-fold change) was observed at the 0.5 µg/µl concentration, suggesting a non-linear, optimal dose-response relationship. These findings indicate that Tirzepatide exerts a direct anti-inflammatory effect by inhibiting NF-κB signaling in a controlled cellular environment. The observed suppression contrasts with clinical concerns, suggesting that any associated cancer risk may arise from secondary, systemic pathological factors rather than a direct oncogenic effect of the drug.

Background: Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting reproductive-age women, often associated with metabolic disturbances such as insulin resistance (IR), prediabetes, and type 2 diabetes (T2D).
Aims of the study: To determine the frequency of prediabetes and diabetes among women with PCOS in Basrah.
Subjects and Methods: This is a case-control study that included 100 women diagnosed with PCOS according to Rotterdam criteria and 100 age-matched control women. Fasting plasma glucose (FPG) and glycated haemoglobin (HbA1c), testosterone, and lipid profile were measured. Prediabetes and diabetes were defined according to ADA criteria.
Results: Among the PCOS group, 52% showed normoglycemia, 29% were prediabetic, while 19% were diabetic (P< 0.001). FPG (P< 0.001) and HbA1c (P< 0.01) levels were significantly higher among women with PCOS compared to controls

Background: Polycystic ovary syndrome (PCOS) is a common hormonal disorder that affects women of reproductive age, which is characterized by hyperandrogenism, leading to ovarian dysfunction and hyperinsulinemia. Elevated homocysteine (Hcy) levels have been linked to PCOS.
Aims of the study: To determine Hcy levels among women with PCOS.
Subjects and Methods: This study is a case-control study conducted from January 2024 through April 2024 and involved 200 participants, 100 as patients with PCOS, and 100 women as the control group, who appeared healthy. Blood pressure (BP), body mass index (BMI), waist circumference (WC), plasma Hcy, testosterone, total cholesterol (TC), triglycerides (TG), high-density lipoprotein-cholesterol (HDL-C), and low-density lipoprotein-cholesterol (LDL-C) were measured in all participants.

Background: Disagreement exists regarding the proper management of gestation known to involve meconium-stained
amniotic fluid, and additional fetal, obstetrical, and ultrasonic assessments may be indicated.
Patients and method: A Prospective cohort study was conducted at Al-Elwiya Maternity Teaching Hospital (2022 – 2023).
One hundred sixty-eight pregnant women at term with decreased fetal movement were recruited. All were subjected to
abdominal ultrasonography to determine the echogenic pattern throughout the amniotic cavity. According to meconium-stained
AF (MSAF) observed at the moment of membrane rupture, participants were classified into two groups: Group 1 (positive),
88 women, and Group 2 (negative), 80 women. The sensitivity, specificity, and accuracy of ultrasound in the detection of
echogenic AF were calculated. Furthermore, the potential impact of MSAF on the fetal outcomes and emergency cesarean
section (C/S) was assessed

Background: Premature rupture of membranes (PROM) is the rupture of amniotic membranes before labor begins, and when membranes rupture occurs before 37 weeks of gestation, it is known as preterm PROM (PPROM). It is known to complicate around 3% of preterm pregnancies and is responsible for 40% to 75% of neonatal deaths. It is suggested that vitamin C status plays a role in reducing the incidence of PPROM. The study aims to establish the association between maternal plasma vitamin C concentration among women with PPROM and women without PPROM.
Subjects and Methods: A prospective cohort study was done at Al Basrah Teaching Hospital for maternity and children over the period from January 1st, 2023, to December 31st, 2023. The study included 34 cases of PPROM, which were matched for gestational age with 28 controls. The data were collected from women who were included in the study through a well-formed questionnaire. Then 5 cc of blood was drawn from each woman to measure the Hb, WBC, and vitamin C levels.
Results: The vitamin C level was lower among cases (7.22 ± 4.66) than controls (14.23±5.29) with a P-value of 0.001. Urinary tract infection was also higher among cases (p –value=0.001). Women with caesarean sections had a lower level of vitamin C (6.23 ± 2.8) in comparison to women with vaginal delivery (11.63 ± 6.05), and those with postpartum haemorrhage had a lower level of vitamin C (7.25 ± 4.91). however, only the mode of delivery had a statistically significant level (p-value of 0.001).

Background: Homocysteine (Hcy) is thought to increase the risk of developing cardiovascular disease (CVD). Several data indicate that there may be a relationship between hyperhomocysteinemia (HHcy) and insulin resistance (IR), which is a clinical substitute of metabolic syndrome (MetS).
Objective: To determine plasma Homocysteine level, insulin resistance, and β-cell function among patients with type 2 diabetes (T2D) and metabolic syndrome (MetS).
Methods: The study included 150 patients with T2D (75 patients with T2D and MetS, and 75 patients with T2D without MetS) and 75 apparently healthy control subjects. The diagnosis of MetS was confirmed by the updated ATPIII criteria for the definition of MetS. Blood pressure (BP), Body Mass Index (BMI), and Waist circumference (WC), plasma Homocysteine, fasting blood glucose (FBG), and insulin were determined in all participants. In addition, IR and ß- cell function were determined by Homeostatic model assessment (HOMA-IR and HOMA-B) equations, respectively

Abstract
Angiotensin converting enzyme 2 receptor is an entry point for COVID-19 infections into body cells. The review's primary objective is to provide readers with an in-depth comprehension of the potential impact of COVID-19 on the reproductive systems of both sexes. We have demonstrated that SARS-CoV-2 can impact on the urogenital tract as well. This indicates that it should be carefully considered while treating infected males who are of reproductive age. Two crucial physical barriers in males are the blood-epididymis (BEB) and the blood-testis barrier (BTB). Studies revealed that various viruses remain able to intrude through these defenses and then malfunction the testicles, even though they play a major role in male reproductive function. Consequently, this brief overview emphasizes the function of ACE2 receptors. Additionally, due to the indirect cytopathic consequences of viral replication and dissemination in the testis, coronaviruses may have a negative impact on male fertility. Most existing data indicate that SARS-CoV-2 has no impact on female reproduction. Cytokines and inflammation associated with nervous system injury could be a secondary mechanism by which the virus influences sex hormone levels. Angiotensin converting enzyme 2 down-regulation may be the cause of menstrual issues among infected women with SARS-CoV-2, irregular hormone levels, medications, and stress. The parameters have not changed significantly in vitro fertilization or the quality of ovarian follicles between the prior to and post-COVID-19 immunization groups

Background: Perforated duodenal ulcer disease is a surgical emergency that has undergone significant changes in its management over recent decades. The identification of Helicobacter pylori and its link to the development of peptic ulcers, the introduction of proton pump inhibitors, and the application of laparoscopy in conjunction with endoscopy have all significantly influenced new management strategies for peptic ulcer disease. However, despite these advancements, the frequency of ulcer perforations requiring surgery has not decreased as dramatically as the worldwide incidence of peptic ulcer disease has; thus, emergency surgery remains a common practice for addressing complications associated with peptic ulcer disease.
Aim: To compare the outcomes of patients who underwent laparoscopic and open repair for perforated duodenal ulcers regarding operative and postoperative factors.
Patients and Methods: A prospective observational study was carried out in Al- Sader teaching hospital and Al-Saadi private hospital in Basrah from February 2020 to April 2023 to compare the outcomes of patients who underwent laparoscopic and open repair for perforated duodenal ulcers regarding operative and post-operative factors, a total of 43 patients (27 males/ 16 females) with age range of (31-66) years divided into two groups, open method group (24 cases) and laparoscopic method group(19 cases) were included in the study. The statistical analysis was done using SPSS spreadsheet version 26, and the level of statistical significance was set to 0.05.

Background: Reproductive health includes responsible, satisfying, and reproductive well-being. It's a crucial component of
general health and reflects well-being during adolescence and adulthood. The more aware individuals are of reproductive
health issues, the more stable families can be formed, capable of building a better future.
Objectives: Assessing the knowledge and attitude of female college students regarding reproductive health and to determine
the social and demographic factors of the female students that may be associated with their knowledge and attitude.
Methodology: A descriptive study was conducted to assess the level of knowledge about reproductive health among 387
female college students from five colleges in Al-Basrah city. The data was collected by direct interview using a constructed
questionnaire to obtain socio-demographic characteristics and the level of knowledge related to reproductive health.

Background: Depression is common among infertile women, partly due to social stigma and marital pressures. Data remains scarce in low-resource settings like Al-Basra. The study aims to estimate the prevalence of depression among infertile women and examine factors linked to its severity.
Methods: This pilot case–control study recruited 100 infertile women (cases) and 100 fertile women (controls) at the IVF and gynecology clinics of Al-Basra Hospital for Women and Children from August–November 2022. Participants completed the General Health Questionnaire (GHQ-30) and Beck’s Depression Inventory-II (BDI-II). Sociodemographic data (e.g., marriage order, family psychiatric history) were collected.