Thi-Qar Medical Journal

Background. Induction of labor (IOL) is among the most common obstetric interventions, but a meaningful minority of nulliparous women undergoing IOL ultimately deliver by cesarean. Locally relevant prediction tools, built from variables routinely available before induction, support patient counselling and protocol design. Objective. To identify independent clinical, anthropometric, and ultrasonographic predictors of failed IOL defined as cesarean delivery during an induction attempt among nulliparous women at a single tertiary center, and to compare a multivariable model with the modified Bishop score alone. Patients and methods. A retrospective cohort study was conducted at Bint al-Huda Hospital from January 2023 through December 2024 (24 months). Eligible records were those of nulliparous women with singleton, term (≥ 37 weeks), cephalic-presenting pregnancies undergoing IOL. Multiparous women, multiple pregnancies, prior cesarean delivery, intrauterine fetal death, and major fetal anomalies were excluded. The primary outcome was failed IOL. Univariable comparisons used the chi-squared, Fisher exact, or Mann–Whitney U test as appropriate. Multivariable logistic regression identified independent predictors. Discrimination was assessed by the area under the receiver operating characteristic curve (AUC). Results. Of 612 eligible inductions, 145 (23.7%) ended in cesarean delivery. Independent predictors of failed IOL were modified Bishop score ≤ 5 (adjusted odds ratio [aOR] 3.18, 95% confidence interval [CI] 2.18–4.62), pre-pregnancy body mass index (BMI) ≥ 30 kg/m² (aOR 2.55, 95% CI 1.66–3.92), sonographic cervical length ≥ 30 mm on transvaginal scan (aOR 2.11, 95% CI 1.34–3.32), maternal age ≥ 35 years (aOR 1.89, 95% CI 1.21–2.95), estimated fetal weight ≥ 3,800 g (aOR 1.96, 95% CI 1.27–3.02), hypertensive disorder of pregnancy (aOR 1.78, 95% CI 1.10–2.88), and maternal height < 155 cm (aOR 1.69, 95% CI 1.04–2.74). The combined model achieved an AUC of 0.82 (95% CI 0.78–0.86); the modified Bishop score alone achieved 0.76 (95% CI 0.71–0.80). Conclusions. Seven readily available pre-induction variables discriminated failed IOL with good performance. The combined model modestly improved on the bishop score alone and supports structured pre-induction counselling.

Background. Community-acquired pneumonia (CAP) remains the leading cause of hospitalization and a major contributor to mortality among children under five years of age globally. First-line antibiotic therapy fails in a substantial minority, with reported failure rates of 10–30% depending on definition and setting. Locally relevant predictor models that combine routine clinical variables with inflammatory biomarkers may improve early identification of children at risk of failure. Objective. To identify clinical, radiographic, and biomarker predictors of first-line antibiotic treatment failure in children hospitalized with CAP at a single tertiary center, and to develop a multivariable risk model with internal validation. Patients and methods. A prospective cohort study was conducted at Bint Al-Huda teaching hospital from January 2023 through June 2024. Eligible children were aged 2 months to 14 years admitted with World Health Organization (WHO)-defined CAP. Hospital-acquired pneumonia, immunocompromise, chronic lung disease, and aspiration were excluded. The primary outcome was treatment failure within 7 days, defined as antibiotic escalation before day 5, pediatric intensive care unit (PICU) transfer, or 30-day readmission. Univariable comparisons used the chi-squared, Fisher exact, Student t, or Mann–Whitney U test as appropriate. Multivariable logistic regression identified independent predictors; discrimination was assessed by the area under the receiver operating characteristic curve (AUC) with bootstrap internal validation. Results. Of 512 children assessed, 348 formed the analytic cohort; 74 (21.3%) experienced treatment failure. Independent predictors were procalcitonin (PCT) ≥ 1.0 ng/mL (adjusted odds ratio [aOR] 3.18, 95% confidence interval [CI] 1.86–5.43), severe acute malnutrition (aOR 2.94, 1.61–5.36), SpO₂ < 92% on room air (aOR 2.86, 1.62–5.04), C-reactive protein (CRP) ≥ 80 mg/L (aOR 2.42, 1.42–4.12), multilobar consolidation (aOR 2.21, 1.30–3.78), and pleural effusion (aOR 2.04, 1.12–3.72). The combined model achieved an AUC of 0.85 (95% CI 0.80–0.89), with bootstrap-corrected AUC of 0.83. Conclusions. Six routinely available variables three clinical, two biomarker, one radiographic discriminate first-line treatment failure in pediatric CAP with good performance. The model is suitable for institutional use after external validation

Background. Epstein-Barr virus is a herpes virus member infects many people across the world. In people of strong immune status, the infection mainly became asymptomatic and is well controlled, while in immunocompromised as hemodialysis patients, the EBV can cause severe illness due to loss of kidney function. Objective. This study objective was to detection of presence the IgG and IgM antibodies against EBV in HD patients and the suspected connection between produced antibodies and hematological parameters (CBC). Methods. During the period started from November 2025 to the end of January 2026, Blood samples obtained from 270 chronic kidney disease’s patients were collected. As 137 samples were taken from hemodialytic men, and 133 samples are obtained from women patients. The age group of patients who were chosen in the study varied from 20 to 70. Serum samples were examined for EBV-IgG/IgM antibodies. Whole blood using for analysis complete blood count (CBC) by automated hematology analyzers. Results. Levels of specific viral IgG/IgM antibodies related to EBV genome was 54.8% and 10.4% respectively. The level IgM antibodies was statistically significant and were measured higher in the age group 20-30 years to 24% than what was detected in other age groups, and lowest among those aged 51–60 years (3.4%). The availability of IgM antibodies specific for EBV indicated to their correlation with the younger age group, duration of dialysis and frequent dialysis per week. Conclusion. No statistical stratified difference between patients with EBV-IgG and age and frequency dialysis.

Background: Diabetes is a significant cause of mortality among older adults and is often misunderstood as a chronic disease. Poor management of diabetes can lead to complications like renal dysfunction. Key renal markers, such as urea and creatinine, can be affected by these complications. Additionally, Vitamin D deficiency has been linked to various health issues in diabetic patients.
Objective: To explore the correlation between Vitamin D levels and renal biochemical markers in elderly diabetic women, an area that has been under-researched. The primary goal is to measure serum levels of urea, calcium, creatinine, and Vitamin D, and assess how Vitamin D levels relate to renal function in this population.
Materials and methods: A case-control study was conducted at Nasiriyah Teaching Hospital in Thi-Qar Governorate, Iraq, from November 2024 to March 2025. The study involved 100 women aged 60 to 75, divided into two groups: 50 healthy individuals and 50 diabetic patients. Researchers measured serum levels of urea, creatinine, total calcium, and vitamin D through biochemical and immunoassay methods after collecting venous blood samples. Data analysis was performed using SPSS version 23, employing one-way ANOVA for group comparisons and Pearson's correlation coefficient to assess associations between variables. The diagnostic utility of vitamin D was evaluated using receiver operating characteristic (ROC) curve analysis.
Results: compared to the control group, diabetic patients exhibited considerably greater serum urea [(47.8 ± 11.5 mg/dL)] and creatinine [(1.48 ± 0.33 mg/dL)] levels than the control group [(31.5 ± 7.2 mg/dL and 0.96 ± 0.17 mg/dL, respectively; p < 0.001)] ; p < 0.001]. Diabetic patients had lower serum vitamin D levels [(16.2 ± 5.8 ng/mL)] than the control group [(28.1 ± 6.6 ng/mL; p < 0.00001)]. Serum calcium levels were statistically similar in both groups. Vitamin D had statistically significant negative correlations with serum creatinine [(r = –0.42, p = 0.004)] and urea [(r = –0.32, p = 0.012)], and a positive correlation with total calcium [(r = +0.36, p = 0.007)]. Vitamin D had a good diagnostic accuracy (AUC = 0.82) at a cut-off value of 20 ng/mL based on the ROC analysis.
Conclusions: Elderly women with diabetes mellitus show notable renal biochemical disturbances and significant vitamin D deficiency. There is a close relationship between vitamin D status and renal impairment, evidenced by a negative correlation between kidney performance markers and vitamin D levels. These findings suggest that measuring vitamin D alongside traditional renal biomarkers could improve early detection and treatment of renal issues in diabetic patients.

Background. Cytomegalovirus (CMV), a member of the Herpesviridae family (subfamily Betaherpesvirinae), is highly prevalent worldwide (seroprevalence 45-100%) and can cause severe disease in immunocompromised hosts. Obsessive-compulsive disorder (OCD) is a chronic psychiatric disorder affecting at least 2% of the population, in which immune dysregulation has been implicated.
Objective. To investigate the association between CMV infection and OCD using serological, cytokine, and molecular markers.
Methods. Ninety Iraqi participants were enrolled: 60 OCD patients (40 females, 20 males) and 30 healthy controls, aged 20-60 years. CMV-specific IgG, IgM, PP65 antigen, IL-6, and TNF-α were measured by ELISA, and CMV DNA was detected by real-time PCR of the UL83 (PP65) gene.
Results. OCD patients showed significantly higher positivity than controls for CMV IgG (96.67% vs 56.67%), IgM (75.00% vs 20.00%), and PP65 antigen (90.00% vs 16.67%) (P = 0.000). IL-6 (191.28 ± 74.03 vs 14.33 ± 8.22) and TNF-α (581.26 ± 90.01 vs 45.10 ± 16.10) were markedly elevated, and CMV DNA was detected in 45% of patients versus none of the controls (P = 0.000). No significant associations were found with gender or occupation.
Conclusions. CMV infection and the accompanying immune activation are significantly associated with OCD, consistent with Khanna et al. (1997), suggesting that CMV-induced immune dysregulation may contribute to OCD pathogenesis.

Background: Type I Tympanoplasty is a commonly performed operation in the ENT department that aims to repair a defect in the tympanic membranes, to improve hearing to a serviceable level, and to minimize the occurrence of complications.
Aim of the study: To evaluate the impact of tympanic membrane perforation size on graft take and on hearing improvement in type I tympanoplasty.
Methods: This prospective study was carried out at Al-Shaheed Ghazi Al-Hariri teaching hospital for specialized surgeries in the period between 1st July 2016 to 1st January 2018, in which 50 patients with tympanic membrane perforation underwent type I Tympanoplasty using an underlay temporalis fascia graft. Preoperative and postoperative examination of the patients was carried out by clinical and audiological assessment.
Result: The graft success rate was 84%. Significant predictors of failure included smoking and perforation size >50%. For successful takes, hearing improvement showed a direct correlation with perforation size; the mean air-bone gap (ABG) reduction was 5.25 dB, 14.05 dB, 21.24 dB, and 20.63 dB for small, medium, large, and subtotal perforations, respectively.
Conclusions: The size of tympanic membrane perforation is an important factor affecting graft taking. Hearing loss was associated proportionally with the size of tympanic membrane perforation. Postoperative hearing gain for graft success cases was directly related to the preoperative size of the tympanic membrane perforations.

Varicocele is a common and correctable cause of male infertility, which this study was aimed to ascertain the impacts of microsurgical varicocelectomy with regard to the parameters of semen, as well as to contrast them with the precise scrotal ultrasound values. A cross-sectional, prospective study of 108 infertile men having palpable varicoceles (mean age 31.5 +/- 5.8 years; Grade 82.4 left; Grades I-III) was carried out. Standardized subinguinal varicocelectomy of the micro-surgeries was performed on all the patients. The outcome was semen analysis (WHO 6th edition) and scrotal ultrasound/Doppler parameters (venous diameter, reflux, testicular volume, and parenchyma echotexture) between baseline (preoperative) and 12-month follow-up. All semen parameters improved statistically at 12 months; concentration improved from 18.5 x10⁶/mL to 29.7 x10⁶/mL, progressive motility from 22.4 to 33.5x, and total motile sperm count (TMSC) from 23.1 to 52.3 x10. On the whole, 86.3 percent of patients demonstrated an improvement in 1 or more semen parameters. At the same time, the ultrasound showed a high level of anatomical correction: the mean venous diameter decreased (3.5 mm to 1.8 mm), the volume of the left testicle increased (14.8 to 16.1 mL), and parenchymal heterogeneity was decreased. At one year, the natural pregnancy rate of couples who tried was 35.9%. Microsurgical varicocelectomy produces considerable and statistically significant increases in semen quality and scrotal ultrasound parameters. Anatomical correction recorded by ultrasound, namely, volume increase of testicles and decrease of the venous diameter, is also a powerful objective correlate of the improved spermatogenic function.

Background: Placental grading and thickness measures still underutilized in routine clinical practice in spite of their effects on fetal growth and their potential prognostic values .
This study aimed to establish the effects of placental maturity grading and thickness on the estimated fetal weight at term pregnancy.
Patients and method: A prospective , cross-sectional study on (150 ) pregnant , who attended the radiology outpatient clinic for routine obstetric ultrasound in, Thi-Qar Province, Iraq.
The average gestational age and the fetal weight are calculated using Hadlock formula .The placental maturity graded in to four grades according to homogeneity, calcification and chorionic plate undulation and the thickness is measured at the site of the umbilical cord insertion in millimeters .
Results: The mean placental thickness was 35.31 mm. Most placentas were grade 2 maturity (66%). there was a statistically significant association between placental maturity grade and fetal weight (p -value < 0.04), with Grade 2 showing higher fetal weights. while at 40 weeks, the association was not significant (p-value = 0.624) .There was a significant positive correlation between placental thickness and fetal weight at 37, 38, and 39 weeks (p-value = 0.001). The strongest correlation was observed at 39 weeks.
Conclusion: This study concludes that measurement of placental thickness and grading of placental maturity during routine antenatal obstetric ultrasound assessment can help to predict the estimated fetal weight and can be used as complementary measures besides other parameters to determine fetal well-being and outcome.

Background. The negative appendectomy rate (NAR) the proportion of appendectomies in which the removed appendix is histologically normal is a recognized quality indicator in emergency general surgery. Despite the increasing availability of preoperative imaging, NAR remains variable, and selective rather than universal imaging strategies leave a residual burden of unnecessary operations, particularly in women of childbearing age. Objective. To determine the NAR at a single tertiary center in the era of selective preoperative imaging, to characterize NAR across clinically relevant subgroups, and to identify independent predictors of negative appendectomy using histopathology as the reference standard. Patients and methods. A retrospective single-center cohort study was conducted at Nasiriyah teaching hospital, Thi-Qar province, Iraq from October 2024 through February 2026 and reported in accordance with the STROBE statement. Patients aged 16 years or older undergoing appendectomy for suspected acute appendicitis with a retrievable histopathology report were included. Negative appendectomy was defined as the absence of histological inflammatory changes in the resected appendix. Multivariable logistic regression identified independent predictors; discrimination was assessed by the area under the receiver operating characteristic curve (AUC). Results. Of 712 appendectomies screened, 583 formed the analytic cohort; 96 (16.5%, 95% CI 13.6–19.7%) were negative. NAR was 9.4% in men and 27.8% in women, rising to 33.6% in women aged 16–45 years. NAR was 6.8% when CT was performed versus 27.1% with no preoperative imaging. Independent predictors of negative appendectomy were female sex aged 16–45 years (adjusted odds ratio [aOR] 3.42, 95% CI 2.06–5.68), absence of preoperative imaging (aOR 2.98, 95% CI 1.79–4.96), Alvarado score below 7 (aOR 2.61, 95% CI 1.58–4.31), and normal white-cell count (aOR 3.05, 95% CI 1.83–5.08). The predictive model achieved an AUC of 0.81 (95% CI 0.76–0.86). Conclusions. NAR remained substantial under a selective-imaging strategy and was concentrated in young women and in patients operated without imaging. Wider preoperative imaging in selected high-risk subgroups may reduce unnecessary appendectomy.

Background. Computed tomography pulmonary angiography (CTPA) is the diagnostic reference standard for acute pulmonary embolism (PE), but overuse exposes patients to ionising radiation and iodinated contrast and increases service demand. Guidance recommends pretest-probability assessment (Wells score) and age-adjusted D-dimer testing before CTPA; the Royal College of Radiologists (RCR) considers a diagnostic yield of 15–35% acceptable. Objective. To determine the diagnostic yield and negative rate of CTPA for clinically suspected acute PE at a single tertiary centre and to identify independent predictors of a negative scan. Methods. A retrospective single-centre observational audit (January 2022 through December 2024, 36 months) was reported in accordance with the STROBE statement. Adults aged 18 years or older undergoing CTPA for suspected acute PE were included; the final CTPA report served as the reference standard. Multivariable logistic regression identified independent predictors of a negative scan. Results. Of 1,184 studies screened, 948 formed the analytic cohort; 162 (17.1%, 95% CI 14.8–19.7%) were positive, giving a negative rate of 82.9%. Independent predictors of a negative CTPA were D-dimer below the age-adjusted threshold (aOR 9.42), absence of all PERC criteria in patients younger than 50 (aOR 5.71), Wells ≤ 4 (aOR 3.18), pre-existing COPD (aOR 2.34), and outpatient origin (aOR 2.05). The Wells score was documented in only 31.8% of requests. Conclusions. The CTPA yield lay at the lower end of the RCR acceptable range and concentrated in patients investigated below the discriminatory pretest-probability and D-dimer thresholds, identifying actionable targets for a structured request-pathway intervention.