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.

Background: It is well-established that diabetes alters the oral environment, particularly the composition and acidity of saliva, which can affect the microbial balance in the oral cavity. This study investigates the impact of oral acidity disturbances on the growth of pathogenic bacteria in diabetic patients. Saliva samples were collected and analyzed to measure pH levels, acid neutralization capacity, and microbial composition. The results indicate that: diabetic patients exhibit a lower saliva pH compared to non-diabetic individuals, creating favorable conditions for the proliferation of pathogenic bacteria such as Streptococcus mutans, Candida albicans, and Porphyromonas gingivalis. Oral acidity disturbances were positively correlated with increased bacterial colonization and a higher risk of oral infections. Conclution :These findings highlight the importance of monitoring oral health in diabetic patients and suggest that maintaining oral acid balance may play a crucial role in preventing the growth of pathogenic bacteria and their associated complications.

BACKGROUND: One of the significant causes of short stature is Growth hormone deficiency (GHD). While recombinant human growth hormone (rhGH) therapy is effective, region-specific data from Iraq is limited. This study evaluated the effect of rhGH therapy on growth velocity, insulin-like growth factor-1 (IGF-1) levels, and advancement in bone age in Iraqi children with GHD.MATERIALS AND METHODS: A retrospective cohort study was conducted on 100 children with confirmed GHD (57 males, 43 females; mean age 9.7±2.7 years) who were treated with rhGH (mean dose 0.037 mg/kg/day) at Sulaymaniyah Teaching Hospital. Growth velocity, IGF-1 standard deviation scores (SDS), and bone age were assessed at baseline and over two years of therapy. Statistical analysis employed paired t-tests, correlation analysis, and subgroup comparisons.RESULTS: Growth velocity significantly increased from a baseline of 2.51±1.44 cm/year to 4.93±1.93 cm/year at 1 year and 5.35±1.80 cm/year at 2 years (p<0.001 for all). IGF-1 SDS normalized rapidly, from -1.57±1.35 at baseline to -0.06±1.05 at 1 month and 1.04±0.71 at 1 year (p<0.001). Bone age advanced by 1.07±0.59 years in the first year (slightly faster than chronological age, p<0.001) but by only 1.46±0.81 years over two years, resulting in a favorable net advancement rate of 0.73 years per chronological year (p<0.001). A significant correlation was found between \DeltaIGF-1 SDS and \Deltagrowth velocity (r=0.300, p=0.002). Males showed a significantly better growth response than females (p=0.040).CONCLUSIONS: rhGH therapy is highly effective and safe for Iraqi children with GHD, leading to significant improvements in growth velocity and normalization of IGF-1 levels without premature acceleration of skeletal maturation. These findings provide crucial local evidence to support and optimize treatment protocols in Iraq.

Background: malnutrition in throughout early childhood remains the important health problem in Iraq and it’s a disorder which arises when a child consumes insufficient or excessive amount of one or more of the nutrients, significantly leading to health problems.Aim : To estimate the prevalence of malnutrition and its contributed socio-demographic, economic, and health-related factors among children under six years attending a major hospital outpatient department in Sulaymaniyah, Iraq. Methods: A cross-sectional study was conducted in hospital setting between March 2025 to July 2025. A systematic random sample of 420 child-caregiver pairs was selected. Information were collected using structured questionnaire and anthropometric measurements. The nutritional status was categorised based on WHO Growth Standards.Bivariate and multivariate logistic regression analyses was carried out to estimate factors associated with malnutrition .Results: Any malnutrition (stunting, wasting, or underweight) was 30.7%. Stunting was most commonly observed (14.8%), then underweight (11.7%) and wasting (7.9%). On bivariate analysis, low family income (p=0.024) was significantly associated with malnutrition (χ²=9.48). Multivariate analysis confirmed low income as the strongest predictor. Children from families earning <300,000 IQD/month (aOR=2.22, 95% CI: 1.05–4.73) and 500,000–800,000 IQD/month (aOR=2.46, 95% CI: 1.15–5.28) had significantly higher odds of malnutrition versus the highest income group .
Health and dietary factors were not significant independent predictors.Conclusion: Malnutrition is a potential public health problem in this population, with stunting being the primary concern. Socioeconomic status, not health or dietary practices, is the fundamental determinant. Effective interventions must therefore extend beyond nutritional education to include robust economic support and poverty alleviation programs to address the root causes.

Background: Klebsiella pneumoniae is a globally recognized opportunistic pathogen associated with multidrug resistance (MDR).
Objective: This study evaluated the phenotypic distribution of MDR and carbapenem resistance among K. pneumoniae isolates.
Materials and Methods: A total 200 specimens collected from four teaching hospitals in Nasiriya, Iraq(Nasiriya General Hospital, Al-Musawy, Al-Haboubi, Bint Al-Huda), between October and December 2025, from which 88 isolates were identified as K. pneumoniae using biochemical methods and the VITEK®2 system. Antimicrobial susceptibility testing was performed by the Kirby–Bauer disk diffusion method, and carbapenemase production was detected using the Modified Hodge Test (MHT).
Results: Blood samples constituted the majority of isolates (35.2%). MDR was observed in 88 isolates, with the highest resistance rates to ampicillin (68.18%) and ceftazidime (62.5%). Carbapenemase production was confirmed in 32.95% of isolates.
Conclusion: These findings indicate a high burden of MDR K. pneumoniae, underscoring the urgent need for strengthened infection control measures and rational antibiotic management in local hospitals.

Background: Multidrug-resistant (MDR) Pseudomonas aeruginosa is a serious global health concern due to the overexpression of the efflux pump system MexAB-OprM. An innovative approach to the synthesis of nanoparticles using biogenic selenium (SeNPs) has shown promising antimicrobial properties and potential for efflux pump inhibitory activity.Objective: This study focused on the synthesis of selenium nanoparticles using leaf extract from Ziziphus spina-christi and an integrated in vitro and in silico study of their activity as efflux pump inhibitors against MDR P. aeruginosa.Methods: Clinical MDR P. aeruginosa isolates were identified using 16S rRNA gene sequencing. Green-synthesized SeNPs were characterized using UV-Vis, FTIR, and SEM. MICs were determined, and antibiotic-synergy associated FIC index (FICI) calcukations and checkerboard assauys were performed. MexAB-OprM efflux pump gene expression was quantified using RT-qPCR. Molecular docking was conducted for predicting interactions of SeNPs with MexA, MexB, and OprM proteins.Results: Biogenic synthesis SeNPs showed absorption peaks between 265 and 280 nm and had a spherical shape and a dia of 20-45 nm. SeNPs exhibited a strong antibacterial effect against multi-drug resistant (MDR) P. aeruginosa and showed a synergistic effect with imipenem (FICI: 0.25-0.375) (MIC: 16-32 (μg/mL). RT-qPCR results showed a significant downregulation of mexA, mexB, and oprM genes (2.5-4.8 fold; p<0.001). In silico molecular docking studies showed that selenium compounds have a good binding affinity to distal binding pocket of MexB with a binding energy of -7.8 to -9.1 kcal/mol and good interaction with MexA and OprM proteins.Conclusion: Biogenic SeNPs produced from Z. spina-christi significantly demonstrate the inhibition of MexAB-OprM efflux pumps in MDR P. aeruginosa, thus providing a new approach in tackling the challenge of antibiotic resistance. Given the direct antimicrobial effect and the inhibition of efflux pumps, SeNPs are likely to be useful in combination therapy for the treatment of MDR pathogens.

Background: Pentraxin-3 (PTX-3) and NADPH oxidase contributed to intestinal inflammation and oxidative stress pathways in Crohn’s disease (CD). However, their diagnostic performance in CD patients remains inadequately explored, especially in the Iraqi population. Aims of the study: This study aims to assess the serum PTX3 and NADPH oxidase activity in Iraqi CD patients and to determine their diagnostic utility. Materials and Methods: A case-control study was conducted at the Al-Yarmouk Teaching Hospital, Baghdad, Iraq. A total of 186 participants with an age range of 19-50 years were enrolled, including 126 CD and 60 healthy controls. PTX-3 concentrations were quantified using an enzyme-linked immunosorbent assay (ELISA), while NADPH oxidase activity was determined using the WST-8 colorimetric assay kit, with absorbance values determined using a microplate reader. Results: CD patients exhibited significantly higher levels of PTX-3 (4.5 ± 0.96 ng/mL vs. 2.5 ± 0.53 ng/mL, p < 0.001) and NADPH oxidase activity (105.7 ± 35.86 μmol/L vs. 62.8 ± 13.36 μmol/L, p < 0.001) compared to controls. PTX-3 showed high diagnostic performance with an area under the curve (AUC) of 0.97. NADPH oxidase also showed good discriminative ability with an AUC of 0.93. Furthermore, the combined biomarker model demonstrated outstanding diagnostic performance with an AUC of 0.99. The correlation analysis between PTX-3 and NADPH oxidase showed no statistically significant correlation (r = -0.039, p = 0.69). Conclusion: This study highlighted the promising role of PTX-3 and NADPH oxidase as non-invasive biomarkers that may aid in the diagnostic evaluation of CD. Future studies are required to validate their clinical applicability.

Background and Objectives: Herbal medicine use is growing globally, and pharmacists play a crucial role in ensuring its safe and effective application. This study assessed the knowledge, attitudes, and practices (KAP) of community pharmacists toward herbal medicine in Erbil City, Kurdistan Region, Iraq .
Methods: A descriptive cross-sectional study was conducted among 400 community pharmacists in both public and private pharmacies between December 2024 and February 2025. Data were collected using a validated self-administered questionnaire via Google Forms and hard copies. Statistical analysis was performed using SPSS version 27, with a p-value ≤ 0.05 considered significant.
Results: Most participants were female (69%) with an average age of 28 years; 62.5% worked in private pharmacies. Overall, 41.5% of pharmacists demonstrated fair knowledge, 30.8% poor knowledge, and 27.8% high knowledge of herbal medicine. Gender and income were significantly associated with knowledge levels (p < 0.05). Nearly half of the participants (48.3%) exhibited poor practice toward herbal medicine use, and personal use was significantly associated with better practice (p = 0.016).
Conclusion: Pharmacists in Erbil showed limited knowledge and suboptimal practice concerning herbal medicine, particularly regarding herb–drug interactions. Targeted training programs and stronger regulatory frameworks are essential to enhance pharmacists’ competence and ensure safe patient counseling.

Adolescent and young adult (AYA) women, who are between the ages of 15 and 39, are known to have breast cancer that is both clinically and biologically aggressive. This retrospective, cross-sectional study analyzed clinical records of 499 female AYA breast cancer patients treated at Hiwa Cancer Hospital between 2010 and 2025. Data included demographic characteristics, tumour biology, Histopathology, molecular subtypes (Luminal A, Luminal B, HER2-enriched, and triple-negative), surgical approaches, and survival outcomes. Statistical analyses were conducted using SPSS v26, with significance set at p<0.05. In 499 AYA breast cancer patients, with a mean age of 34.4 years. The majority resided in urban areas (68.1%) and had abnormal BMI levels (79%). hormone receptor-positive/HER2-negative was most common (55.1%), followed by triple-negative (19%), hormone receptor-positive/HER2-positive (16.8%), and hormone receptor-negative/HER2-positive (9%). Triple-negative disease was more frequent than in older women and linked to grand multiparity, while nulliparity was associated with fewer aggressive cases. High-grade tumours were mainly triple-negative or HER2-positive, and low-grade tumours were mostly hormone receptor-positive/HER2-negative. Triple-negative cancers appeared more in node-negative cases, suggesting possible hematogenous spread. Survival was poorest in ages 25–29 (30%) and best in 35–39 (51%), underscoring the need for earlier detection and targeted therapies. Breast cancer among AYA women in Sulaimani City shows high rates of aggressive subtypes, abnormal BMI, and poor survival in the youngest patients. Patterns linking parity to triple-negative disease and high-grade tumours to HER2-positive or triple-negative profiles highlight the need for targeted approaches.

Background: Urinary tract infection UTI is one of the most common bacterial infection , predominantly caused by E.Coli this case control study aimed to evaluate demographic characteristic ,hematological parameters ,serum interleukin IL-6 and associated of TLR4 gene polymorphism (rs4986790 and rs4986791) with susceptibility to UTI Aim:To evaluated demographic characteristics inflammatory and hematological parameters ,serum ;IL-6 levels and the association of TLR4 gene polymorphism (rs 4986790 and rs 4986791). Methods:A total of 66 UTI patients and 55 healthy control were enrolled demographic data ,complete blood count , C–reactive protein CRP , urine analysis finding and serum IL-6 level were measured .TLR4 polymorphism were determining using PCR-RFLP , and Statistical analysis including odds ratios , 95% confidences intervals and effect size estimation .Results: No significant differences were found between patients and control healthy age or sex distribution (p > 0.05). UTI patients exhibited significantly elevate white blood cell counts, urinary red blood, neutrophil percentages, CRP levels, cells, and pus cells compared to controls (p < 0.001). Hemoglobin levels were lower in patients; however, this difference was not statistically significant (p = 0.08). serum IL-6 were markedly increased in UTI patients (47.9 ± 17.6 pg/mL) .compared with control (10.4 ± 4.8 pg/mL), indicated strong statistical significant p < 0.001 and a large effect size (Cohen’s d = 2.65). Genotype and allele distributions of TLR4 rs4986790 (Asp299Gly) and rs4986791 (Thr399Ile) did not demonstrate statistically significant associations with UTI susceptibility (p > 0.05) .Conclusion: UTI patients showed significant systemic and local inflammatory responses compared to healthy controls. TLR4 polymorphisms (rs4986790 and rs4986791) were not significantly associated with UTI susceptibility. These results highlight the diagnostic value of inflammatory markers, particularly IL-6, and suggest further studies on host genetic factors.

Inhibition of Dipeptidyl Peptidase-4 (DPP-4) is an established therapeutic target for type II diabetes control, having potential for potentiating endogenously produced insulin by maintaining stability of incretin hormones. The current study extensively analyzes molecular modeling, pharmacokinetics, toxicity, and insulin secretory efficacy of Quercetin, Celecoxib, Doxycyline, Atorvastatine, Omeprazole, and Furosemide, a set of six different compounds, for DPP-4 inhibition, which is an established therapeutic target for diabetes control by potentiating endogenously secreted insulin by maintaining stability of incretin secretion. Using InstaDock v1.1 for molecular modeling, binding affinity, as well as Ligand Efficiency, of Quercetin, Celecoxib, Doxycyline, Atorvastatine, Omeprazole, and Furosemide have been calculated, of which Quercetin showed maximum binding affinity of -8.2 kcal/mol, respectively. The pharmacokinetics, target binding, as well as toxicity (LD50) of candidate compounds, have also been predicted using SwissADME, Swiss-TargetPrediction, respectively, in combination, ascertaining anti-toxicity (Gusar on Way2Drug). One-way ANOVA, further followed by t-tests, has also been used to check for significant differences between compounds to identify better treatments for augmenting functions of secreted hormones to stimulate pancreatic insulin secretion. The current scientific study is ethically justifiable for computational procedures, providing concrete scientific inputs for future studies in preparing optimized therapeutic agents for repurposed intervention in commonly prevalent metabolic.

BACKGROUND. Post-burn scar contractures restrict joint mobility and are a leading indication for reconstructive surgery. Z-plasty and full-thickness skin grafting (FTSG) are both established release techniques, but comparative evidence on long-term recurrence and functional recovery is limited. We compared range-of-motion (ROM) gain and recurrence between them. METHODS. In this prospective comparative study, 62 patients with post-burn contractures of the axilla, elbow, neck and other sites were allocated by morphology to Z-plasty (n=32) or FTSG (n=30). Goniometric ROM was recorded pre-operatively and at 3, 6 and 12 months; recurrence was loss of corrected ROM or a tethering band requiring revision. RESULTS. Mean ROM gain was 72.5 degrees after Z-plasty versus 86.5 degrees after FTSG (p<0.001). Recurrence was 6.2 versus 13.3 percent (Fisher exact p=0.418) over a mean follow-up of 16.3 months. Complications and aesthetic outcomes were comparable, with donor-site morbidity confined to the graft group. Both techniques restored meaningful joint excursion, supporting a morphology-driven approach: Z-plasty for linear bands and FTSG for broad planar defects.

Abortion is the termination of a pregnancy, either spontaneously (miscarriage) or intentionally (induced abortion). or it is define a spontaneous loss of pregnancy before 20 weeks. Intentional abortion ends 6 out of 10 unintended pregnancies. Approximately 97% of unsafe abortions occur in developing nations, accounting for Several bacteria are associated with abortion, most notably Listeria monocytogenes, Chlamydia trachomatis, Mycoplasma hominis, and infections linked to bacterial vaginosis(BV) which Characterized by a reduction in beneficial Lactobacillus species and an overgrowth of anaerobes like Gardnerella vaginalis, These pathogens can disrupt pregnancy by causing uterine infection, sepsis, or altering the vaginal microbiome. The maternal infections that are transmissible from mother to fetus are caused by many pathogens.

Uterine artery Doppler velocimetry has been widely adopted as a non-invasive tool to evaluate uteroplacental hemodynamics and is already used clinically, particularly in first-trimester preeclampsia screening, second-trimester risk stratification for adverse pregnancy outcomes, infertility assessment and monitoring of twin pregnancies. This systematic review combines evidence from 31 empirically validated studies until 2026. Longitudinal cohort study of 476 low-risk pregnancies [1] established normative uterine artery pulsatility index reference ranges highlighting progressive decline from first to third trimester. Uterine artery pulsatility index was shown to have a meta-analysis of 81,673 patients moderate sensitivity of 0.586 and high specificity at 0.879 for predicting preeclampsia [2]. In fact, research undertaken in the field of unexplained infertility showed that there are strikingly higher levels of uterine artery pulsatility index in women with unexplained infertility compared to fertile controls [3]. In a prospective longitudinal study of 538 women, they found that history of previous Cesarean delivery does not have independent effect on uterine artery Doppler values through pregnancy[4]; Sex differences between fetuses in uterine artery Doppler [5] were identified, with a more rapid deterioration of uteroplacental perfusion and associated greater incidence of fetal compromise higher in male fetuses than female fetuses in complicated pregnancies. Randomized controlled trials of aspirin prophylaxis in high-risk women defined by Doppler imaging have shown mixed results with one trial showing benefit and another showing no effect on the incidence of preeclampsia [6,7]. In a prospective study of 106 patients, uterine artery pulsatility index > the 95th centile was strongly associated with preeclampsia and small for gestational age whereas isolated diastolic notch showed no significant association [8]. With this review, we aim to offer evidence-based clinical guidelines on the incorporation of uterine artery Doppler into clinical practice.The purpose of this systematic review was to determine if reference ranges established for the assessment of uterine artery Doppler parameters can be extrapolated into groups not used for their establishment.

BACKGROUND: Superficial serosal uterine varicosity (SSUV) is a rare anomaly commonly seen in non-pregnant individuals, and its presence in pregnancy is seldom reported. Here we present a case of SSUV that was accidentally discovered during an elective Cesarean delivery, causing unexpected bleeding. CASE PRESENTATION: A 30-year-old pregnant woman at 37 weeks of gestation with three previous Cesarean deliveries attended our clinic for an elective appointment; her past medical and surgical history was unremarkable. Laboratory investigations were normal, and Doppler ultrasound showed a fundo-anterior placenta, normally situated, with no signs of placenta accreta. During an otherwise uneventful surgery, a brisk haemorrhage occurred near the incision site following complete placental delivery. A dilated tortuous vein was identified as the bleeding source, and hemostasis was secured by ligation and oxytocic drugs. CONCLUSION: SSUV is an uncommon cause of bleeding during Cesarean delivery; as it escapes antenatal imaging, it imposes diagnostic challenges and increases bleeding and transfusion demands.