Journal of the Faculty of Medicine Baghdad

Background: Hypospadias is the second most common congenital malformation and may be classified according to the anatomical site of the urethral meatus: distal, which accounts for about 70-80% of all hypospadias cases, and proximal, which is rare. There are multiple surgical options for the management of hypospadias. This study covers cases of distal hypospadias with two surgical options, which are urethral advancement and glanuloplasty, and meatal advancement and glanuloplasty.
Objectives: To compare the surgical outcome and complications between urethral advancement glanuloplasty and meatal advancement glanuloplasty.
Method: Forty-three patients with distal hypospadias were included in this study; 20 of them underwent meatal advancement and glanuloplasty, and 23 underwent urethral advancement and glanuloplasty in Ghazi Al-Hariri Hospital for Surgical Specialities during the period from April 2017 to March 2020
Results: Forty-six patients, 20 of them underwent meatal advancement and glanuloplasty, and 23 underwent urethral advancement and glanuloplasty, were followed for 6 months after the operation. The mean age of the meatal advancement and glanuloplasty group at surgery was (35.5+17.31 months, which was comparable to that of the urethral advancement glanuloplasty group (37.5+14.27 months), with no significant difference. There is no significant difference between the two groups in operative time, which was 35.16+2.9 min in urethral advancement glanuloplasty and 30.72+3.2 min in meatal advancement and glanuloplasty. Six complications were reported in this study, 4 of which (2 meatal stenoses and 2 wound dehiscences) occurred in the meatal advancement and glanuloplasty group, while 2 complications (1 meatal stenosis and 1 meatal retraction) occurred in the urethral advancement glanuloplasty group.
Conclusion: Urethral advancement glanuloplasty is a safe and good alternative surgical option in the treatment of patients with distal hypospadias, especially in those with a non-mobile meatus, with the same rate of complications

Background: Polyendocrine Metabolic Ovarian Syndrome (PMOS) typically affects women aged 15 to 50. According to recent studies, immune cells and hormonal imbalances have a role in the pathogenesis of PMOS. The causes and effects of chronic inflammation, particularly in women with PMOS, have been the focus of research.

Objectives: To better understand the immunological profile of PMOS patients through investigating the role of IL-19 blood levels as a biomarker or inflammatory mediator and examining its possible involvement in the pathophysiology of the syndrome.

Methods: This is a case-control study conducted between December 2024 and March 2025. Sixty women with PMOS were diagnosed at Kamal Al-Samarrai Specialized Hospital in Baghdad, Iraq. 30 healthy women attending private laboratories were used as a control group, matched for age (18-36) to the cases. The blood samples were centrifuged and allowed to clot at room temperature. The serum was then obtained using the enzyme-linked immunosorbent test (ELISA) for use in the human IL-19 detection method.

Results: The mean age was 26.0±4.90 years for the patients and 25.3±4.45 years for the controls. The mean Body Mass Index (BMI) of the control group was 21.9±2.01 kg/m² compared to 28.9±3.62 kg/m² for the patients in PMOS women; the mean serum IL-19 was 113.2±61.56 pg/ml, significantly higher than that of the control group (6.2±4.28 pg/ml).

Conclusion: The inflammatory environment of PMOS seems to be significantly influenced by interleukin-19. The higher blood IL-19 levels in the PMOS cases suggest that it may have a role in the pathophysiology of the syndrome, potentially connected to follicular dysfunction and insulin resistance. IL-19 may be a potential biomarker for tracking the persistent low-grade inflammation linked to PMOS, providing fresh perspectives on tailored diagnostic and treatment approaches.

Background: Uterine fibroids are a common gynecological condition that may cause heavy menstrual bleeding, pelvic pain, and pressure on the nearby organs. Uterine artery embolization is a minimally invasive treatment that offers an alternative to myomectomy or hysterectomy. The procedure works by occluding the uterine arteries and reducing blood flow to the fibroids, which leads to ischemia and gradual shrinkage, thereby relieving the symptoms.
Objectives: To evaluate the effectiveness of uterine artery embolization in reducing the size of the uterine fibroids and alleviating the associated symptoms, and to compare treatment outcomes between International Federation of Gynaecology and Obstetrics FIGO 0–3 and 4–7 groups according to the FIGO classifications of uterine fibroids.
Methods: This prospective comparative study, conducted at the Baghdad Teaching Hospital from December 4, 2023, to December 22, 2024, involved 20 patients with symptomatic uterine fibroids who underwent uterine artery embolization. Ultrasounds were performed prior to, and three months and six months after the procedure, to evaluate the fibroid volume, the largest fibroid diameter, volume reduction rate, symptom improvement, and adverse events. The volume reduction rates of the two groups were compared based on the fibroid classification (Group A: FIGO 0-3 and Group B: FIGO 4-7) at three and six months.
Results: Of the 20 women included in the study, 90% were over the age of 35 years and 65% were obese. Following uterine artery embolization, menorrhagia decreased from 90% to 40%, intermenstrual bleeding from 45% to 5%, and dysmenorrhea from 65% to 30%. Radiologically, the mean fibroid volume reduction at six months was significantly higher in the FIGO 0–3 group (93.7%, p=0.006) compared to the FIGO 4–7 group (26.0%, p=0.002).
Conclusions: Uterine artery embolization is an effective procedure that significantly reduces fibroid size and improves its symptoms; the reduction in the largest fibroid diameter was more pronounced in the FIGO 0–3 group than in the FIGO 4–7 group.

Background: Acute kidney injury (AKI) is a frequent complication of open-heart surgery, with a reported global incidence of 20-40%. Local Iraqi data on postoperative AKI incidence and predictors remain limited despite its designation as a 2025 Iraqi Ministry of Health perioperative research priority.
Objectives: To determine the incidence, severity, independent predictors, and short-term outcomes of AKI among adult patients undergoing open-heart surgery at a tertiary cardiac center in Iraq.
Methods: This single-centre observational case-series analyzed 99 adults undergoing elective open-heart surgery at the Iraq Center for Heart Diseases, Baghdad, between January 2024 and December 2025. Patients with end-stage renal disease on dialysis or chronic kidney disease stage 4 were excluded. Preoperative renal dysfunction was defined as serum creatinine >1.1 mg/dL or estimated glomerular filtration rate <60 mL/min/1.73 m2. AKI was diagnosed and staged using KDIGO serum-creatinine criteria. Statistical analysis included Mann-Whitney U, chi-square/Fisher exact tests, and multivariable logistic regression.
Results: AKI occurred in 23/99 patients (23.2%): 19 (82.6%) were KDIGO stage 1, two (8.7%) stage 2, and two (8.7%) stage 3. One AKI patient (4.3%) required new postoperative renal-replacement therapy. In the adjusted model, male sex (adjusted OR 8.43, 95% CI 1.50-47.46, p=0.016) and impaired baseline renal function (adjusted OR 7.11, 95% CI 1.58-32.05, p=0.011) were independent predictors. CPB duration >120 minutes showed a numerically higher AKI incidence but was not statistically significant.
Conclusion: Postoperative AKI occurred in nearly one quarter of patients. Male sex and impaired baseline renal function were the only independent predictors, supporting targeted preoperative renal-risk stratification and postoperative renal surveillance in Iraqi cardiac centers.

Background: Neonatal Thrombocytopenia (NT) is defined as a platelet count of <150,000/microl and is classified as: Mild (platelet count 100,000- 149,000/microl), moderate (50,000- 99,000/microl), and Severe (<50,000/microl). It is classified according to the time of presentation as: Early NT (occurs within the first 72 hours of life) and Late NT (occurs after 72 hours).
Objectives: To study the clinical and laboratory profiles of neonatal thrombocytopenia in the Neonatal Intensive Care Unit of the Children Welfare Teaching Hospital, Baghdad.
Methods: This single-center case series observational study was conducted from 1st May 2022 to 30th April 2023, in the Neonatal Intensive Care Unit of the Children Welfare Teaching Hospital, Baghdad. Neonates with thrombocytopenia, defined as a platelet count <150,000/µl, were enrolled. Complete blood count, C-reactive protein, blood culture, and other investigations were performed as clinically indicated.
Results: Results showed a significant decrease in 25-hydroxyvitamin D in patients’ groups compared to control groups. In addition, G3 observed a significant (P-value 0.002) decrease compared to G1. While G4 showed a significant decrease compared to G2 (P-value <0.001). Results also showed a significant decrease in total Calcium levels in G3 compared to G1 (P-value <0.001), while a non-significant decrease was found in G4 compared to G2 (P-value 0.025). Results showed a significant increase in pTau217 and GFAP in G3 and G4 compared to G1 and G2 (P-value <0.001), respectively.
Conclusions: Determining vitamin D levels in Parkinson disease is important because deficiency is common and may worsen. Neonatal thrombocytopenia was found to be common in this study cohort, with sepsis being the leading associated condition. Severe cases seem to be linked to bleeding manifestations, anemia, and mortality, which highlight the importance of careful monitoring of affected neonates.

Background: In accordance with DSM-5-TR, Depression is a common psychiatric disorder marked by persistent sadness, loss of interest, and impairment in everyday activities. Recent evidence shows that between 22% and 45% of international student’s experience depressive symptoms. There is limited information on the prevalence of depression among international medical students at the International Campus of Tehran University of Medical Sciences.

Objectives: To investigate the prevalence of depression among international medical students at the International Campus of Tehran University of Medical Sciences and to examine related factors.

Methods: A cross-sectional study was conducted at the International Campus of Tehran University of Medical Sciences in 2022, after obtaining approval for the proposal and permission from relevant authorities. A valid questionnaire was distributed to international medical students in the International Campus of Tehran University of Medical Sciences online. A total of 215 students completed the questionnaire, and their responses were entered into SPSS version 26 for descriptive and inferential analysis. Statistical methods used included Pearson correlation coefficient analysis, student t test, and regression models.

Results: The age range of participants was 17 to 32 years, with a mean of 22.3±2.74, with 54% females and 46% males. One-third of the students were Indian (34.3%), and the remaining were Pakistanis (27.5%). Those first-born in their families were (42.8%), and most of the students' parents were still alive. Nearly half of the participants were in their first or second year of education, and (9.8%) expressed little or no interest in the field of medicine, while about 40% expressed a great deal of interest. Over one-fifth of the participants experienced mild depression, and 16.7% recorded severe depression. The regression analysis revealed that none of the examined demographic and academic variables significantly affected depression scores. Even though the period of residence in Iran and study were associated with depression scores, they did not appear as critical predictors in the regression model.

Conclusion: The current study aligns closely with global research findings, indicating a significant prevalence of moderate and severe depression among international medical students. This highlights the need for authorities to prioritize the development and implementation of programs aimed at reducing depression among them

Background: Polyendocrine Metabolic Ovarian Syndrome (PMOS) is a highly prevalent endocrine disease that affects women of reproductive age. Corin and Neprilysin are developing biochemical markers linked to the metabolic complexities of PMOS. Both are enzymes involved in the mechanisms that regulates adipose tissue metabolism.

Objective: To assess the clinical and diagnostic value of Corin and Neprilysin in a variety of phenotypic manifestations of PMOS, with a focus on their possible functions as biomarkers for illness classification and definition.

Methods: This observational case-control study was conducted on 150 women aged 18-41 years at Baghdad Teaching Hospital, Baghdad, Iraq from February to September 2025. The study groups included 50 healthy childbearing women as a control group and 100 women with PMOS, who were subdivided into four groups based on phenotype depending on Rotterdam consensus criteria to: 61 with hyperandrogenism, 15 with normal morphology by ultrasound, 14 with a normal menstrual cycle, and 10 with normal androgen levels. A spectrophotometric pathway was used to evaluate fasting blood glucose (FBG). Other markers (insulin, Neprilysin, Corin, sex hormone-binding globulin (SHBG), and total testosterone) were tested by the ELISA technique.

Results: The median value of Neprilysin in all PMOS groups was significantly higher than controls (p<0.0001), with non-significant differences among PMOS subgroups. Serum Corin levels were significantly lower in PMOS groups than controls, with non-significant differences among PMOS subgroups. There were none significant age differences between study groups, a significant positive correlation between Neprilysin and each of the following: Insulin (P = 0.027), HOMA-IR (P = 0.023), and Total Testosterone (P = 0.006), respectively.

Conclusion: Corin and Neprilysin seem to be promising biomarkers for enhancing the diagnosis and stratification of PMOS functional phenotype, offering valuable insights into personalized approaches to patient management and future research directions.

Background: Central obesity is a critical predictor of cardiometabolic risk, yet universally applicable waist circumference cut-offs are confounded by ethnic discrepancies
Objectives: To determine the optimal WC cut-off points for identifying central obesity in the Iraqi population and evaluate associated sociodemographic risk factors.
Methods: A retrospective record review was conducted utilizing data from 3,924 participants (1,600 males, 2,324 females) who underwent anthropometric assessment in the National Iraqi STEPWISE Survey of non-communicable disease risk factors. Central obesity was referenced against the WHO Body Mass Index criteria, BMI (30kg/m2). Receiver Operating Characteristic (ROC) curves and the Youden index determined optimal Waist Circumference cut-offs. Multivariable logistic regression identified independent sociodemographic predictors.
Results: The optimal Waist Circumference cut-off points were established at> 91.75 cm for males (AUC: 0.900, 95% CI: 0.884–0.916; prevalence: 56.3%) and> 91.05 cm for females (AUC: 0.882, 95% CI: 0.865–0.899; prevalence: 60.8%). Multivariable analysis revealed that the 18–39 age group had significantly lower odds of having central obesity in both males (OR: 0.404, 95% CI: 0.222–0.735) and females (OR: 0.287, 95% CI: 0.177–0.464). Conversely, central obesity was independently elevated in males who were government employees (OR: 2.581, 95% CI: 1.447–4.604) or unemployed with an income (OR: 2.431, 95% CI: 1.341–4.407), and in females with no formal schooling (OR: 1.892, 95% CI: 1.062–3.373).
Conclusions: The Iraqi population exhibits distinct Waist Circumference thresholds that differ substantially from traditional international metrics, with the odds of central obesity significantly influenced by specific sociodemographic characteristics.

Background: Small cell lung cancer and non-small cell lung cancer are the two main types of lung cancer and major causes of cancer-related death worldwide.
Objectives: To compare serum cytotoxic T-lymphocyte-associated antigen 4 levels between treated and untreated patients with small cell lung cancer and non-small cell lung cancer, and healthy controls.
Methods: This case-control study was conducted at the Oncology Teaching Hospital, Baghdad, Iraq, from December 2024 to June 2025. The study included 180 participants: 24 patients with small cell lung cancer, 96 with non-small cell lung cancer, and 60 healthy controls. Serum cytotoxic T-lymphocyte-associated antigen 4 levels were measured using enzyme-linked immunosorbent assay, and complete blood count parameters were measured using an automated hematology analyzer.
Results: Cytotoxic T-lymphocyte-associated antigen 4 levels differed significantly among the control, small cell lung cancer, and non-small cell lung cancer groups (p = 0.02), with higher levels in small cell lung cancer and lower levels in non-small cell lung cancer than controls. No significant differences were observed between treated and untreated patients in either group. Cytotoxic T-lymphocyte-associated antigen 4 levels were significantly associated with Programmed death-ligand 1 categories in treated non-small cell lung cancer patients (p = 0.01), but not in untreated patients (p = 0.12). Complete blood count parameters differed significantly among the study groups, suggesting systemic inflammatory changes. Serum cytotoxic T-lymphocyte-associated antigen 4 showed limited diagnostic performance.
Conclusion: Cytotoxic T-lymphocyte-associated antigen 4 levels were significantly associated with Programmed death-ligand 1 expression in treated patients. Complete blood count, cytotoxic T-lymphocyte-associated antigen 4, and Programmed death-ligand 1 may provide useful information on the inflammatory and immunological status of lung cancer patients, but further studies are needed to confirm their clinical significance.

Background: Parkinson's disease is a neurological condition that strikes an individual and gradually progresses, resulting in both motor and non-motor symptoms. The severity and progression of can be predicted by biochemical biomarkers, such as glial fibrillary acidic protein and degradation products, which are released into the cerebrospinal fluid and serum when astrocytes are injured. Accumulating evidence suggests that Tau protein plays a major role in the pathological mechanisms of Parkinson’s disease.
Objectives: This study aimed to evaluate the levels of Tau and human glial fibrillary acidic protein GFAP in patients with Parkinson's disease PD and subsequently compare them with those in the control group.
Methods: This case-control study included 80 participants. This included 40 patients and 40 normal healthy controls with their gender distribution. Subsequently, the 80 participants were divided into four categories: G1, Control Male n=20; G2, Control Female n=20; G3, Parkinson Male patients n=20; and G4, Parkinson Female patients n=20. An enzyme-linked immunosorbent assay was used to ascertain the quantities of pTau217 and GFAP. Total calcium is measured more often because it is easier and widely available, whereas ionised calcium requires special handling and equipment. Total calcium levels were measured using automated clinical chemistry analyzers. Statistical significance was defined as a P-value of 0.05 or less. Receiver operating characteristic (ROC) experiments were conducted on pTau217 and GFAP.
Results: Results showed a significant decrease in 25-hydroxyvitamin D in the patient groups compared to the control groups. In addition, G3 showed a significant decrease compared to G1. G4 showed a significant decrease compared to G2 . The results also showed a significant decrease in total calcium levels in G3 compared to G1, while a non-significant decrease was found in G4 compared to G2 . A significant increase in pTau217 and GFAP in G3 and G4 compared to G1 and G2.
Conclusions: Determining vitamin D levels in patients with Parkinson’s disease is important because deficiency is common and may worsen bone health, muscle strength, balance, and overall function. Testing allows appropriate supplementation and prevention of complications, particularly falls and fractures. The pTau217 and GFAP biomarkers could open new prospects for early diagnosis, monitoring the course of the disease, and personalized treatment strategies.

Background: Polyendocrine metabolic ovarian syndrome (PMOS) is a common condition that affects women of reproductive age. It is usually associated with hormonal and metabolic disorders. However, the precise relationship between these derangements and the development of PMOS is unclear.
Objectives: To evaluate the circulatory levels of Glucagon-Like Peptide-1 (GLP-1) and Advanced Glycation End-products (AGEs) in PMOS and to explore the possible application of these factors as potential diagnostic biomarkers.
Methods: A case-control study was conducted at the College of Science, University of Baghdad, between Nov. 2024 and Feb. 2025. The study involved 90 Iraqi women aged 18-45 years, divided into two groups: 50 women who had recently been diagnosed with PMOS and 40 healthy women as controls. Hormonal profiles and metabolic parameters (GLP-1 and AGEs) were measured in all participants.
Results: Women with PMOS had an elevated hormonal profile, characterized by higher concentrations of LH, an LH/FSH ratio, testosterone, and Anti-Müllerian Hormone (AMH), along with a considerable drop in FSH compared to the control group. They also showed significant elevations in metabolic parameters (AGEs and GLP-1) compared to the control group. GLP-1 and AGEs had an area under the curve (AUC) of 1.000, with 100% sensitivity and 100% specificity, indicating their diagnostic value.
Conclusions: The increase in GLP-1 and AGEs reveals hormonal-metabolic dysregulation, indicating a high degree of correlation in the complexity and progression of the disease. The high diagnostic accuracy of GLP-1 and AGEs in PMOS, may suggest that they are potential biomarkers for diagnosing the disease.

Background: While endometriosis has a high prevalence among women during their reproductive years, appendiceal endometriosis is an uncommon clinical condition that affects women, and it is mostly presented as acute appendicitis, and or similar to several other gynecological disorders.
​Case Presentation: A thirty-four years old female presented with symptoms of a one-day of acute right lower quadrant (RLQ) pain as well as a chronic history of abdominal pain and chronic recurrent pelvic pain. The physical and clinical assessment referred for laboratory, the findings suggested acute appendicitis, then admitted to Baghdad teaching hospital for Laparoscopic appendectomy, and the specimen was sent for histopathological examination, where it revealed endometrial glands and stroma embedded in the muscularis propria of the appendix.
​Conclusion: Although rare, appendiceal endometriosis should be considered in the differential diagnosis of RLQ pain in reproductive-age women. This case indicates the necessity of routine histopathological examination of all appendectomy specimens to ensure accurate diagnosis and appropriate follow-up.

Background: Acute flaccid paralysis surveillance forms the basis for poliovirus eradication efforts and provides useful data on non-polio enteroviruses, which are significant causes of acute flaccid paralysis in polio-free countries. Non-polio enteroviruses were the most common isolates from acute flaccid paralysis cases at this time, indicating sensitivity of surveillance and continued circulation of enteroviruses.
Objectives: This study aimed to determine the prevalence, epidemiologic trends and clinical features of non- polio enteroviruses among children with acute flaccid paralysis in Iraq, from 2018 to 2024, for improving surveillance sensitivity and complementary evidence-based public health measures.
Methods: The data was gathered from the acute flaccid paralysis surveillance system in Iraq. Stool specimens were analyzed at the National Polio Laboratory according to the World Health Organization guidelines. Suspensions of stool were prepared and inoculated into the Rhabdomyosarcoma cell line and genetically modified mouse L cells expressing the human poliovirus receptor. Isolates were subjected for real-time polymerase chain reaction, whereas cultures were checked for cytopathic effect. Isolates negative for poliovirus but positive in Rhabdomyosarcoma cells were classified as non-polio enteroviruses. Demographics and clinical findings were analyzed using appropriate statistical tests.
Results: Non-polio enteroviruses were reported in 10.5% of the cases; the prevalence being highest in children 1 to 2 years. They appeared to be two peaks; one in January and another in May, and cases were particularly low in September. Non-polio enteroviruses were associated with residual weakness and lower mortality.
Conclusions: Non-polio enterovirus detection declined during 2020–2023 with recovery in 2024. Positivity was significantly higher in younger children and demonstrated clear seasonal peaks. Non-polio enterovirus infection was associated with residual weakness but not with gender, fever, or mortality.

Background: Obsessive-compulsive disorders (OCD) is a common mental health condition where a person has obsessive thoughts and compulsive behaviors. The worldwide prevalence of OCD is approximately 2% of the general population.
Objective: To assess prevalence of obsessive-compulsive disorder symptoms in a sample of medical students in Iraq.
Methods: A cross-sectional study design with a convenience sampling method, was conducted on 414 Iraqi medical students during
the period from 1st November, 2022 to 28th February, 2023. Data were collected using a structured questionnaire submitted online. The questionnaire consisted of two parts: The first included socio-demographic characteristics (age, gender, college year, residence, marital status) and risk factors, whereas the second part consisted of 20 items from the Revised Arabic Scale of Obsession-Compulsion.
Results: It was found that (38.9%) of participants had OCD symptoms. The overall weighted mean and standard deviation, was 2.13 ± 0.599, so any mean equal to or exceeding this value was highly indicative of OCDthe cut-off point). Significant associations were found between positive family history of OCD, age, college year, and OCD symptom score.
Conclusion: OCD symptoms were found in over one third of the Iraqi medical students included in the study. A positive family history of OCD, younger age, and early college years seem to be associated with higher OCD symptom scores.

Background: Polyendocrine metabolic ovarian syndrome (PMOS) is a common condition that affects women of reproductive age. It is usually associated with hormonal and metabolic disorders. However, the precise relationship between these derangements and the development of PMOS is unclear.
Objectives: To evaluate the circulatory levels of Glucagon-Like Peptide-1 (GLP-1) and Advanced Glycation End-products (AGEs) in PMOS and to explore the possible application of these factors as potential diagnostic biomarkers.
Methods: A case-control study was conducted at the College of Science, University of Baghdad, between Nov. 2024 and Feb. 2025. The study involved 90 Iraqi women aged 18-45 years, divided into two groups: 50 women who had recently been diagnosed with PMOS and 40 healthy women as controls. Hormonal profiles and metabolic parameters (GLP-1 and AGEs) were measured in all participants.
Results: Women with PMOS had an elevated hormonal profile, characterized by higher concentrations of LH, an LH/FSH ratio, testosterone, and Anti-Müllerian Hormone (AMH), along with a considerable drop in FSH compared to the control group. They also showed significant elevations in metabolic parameters (AGEs and GLP-1) compared to the control group. GLP-1 and AGEs had an area under the curve (AUC) of 1.000, with 100% sensitivity and 100% specificity, indicating their diagnostic value.
Conclusions: The increase in GLP-1 and AGEs reveals hormonal-metabolic dysregulation, indicating a high degree of correlation in the complexity and progression of the disease. The high diagnostic accuracy of GLP-1 and AGEs in PMOS, may suggest that they are potential biomarkers for diagnosing the disease.