The Iraqi National Journal of Medicine (IqNJM) is a peer-reviewed, biannual publication, dedicated to advancing the field of medical research. Published by the Iraqi Association for Medical Research and Studies (IAMRS), the journal aims to support the research community by promoting high-standard scientific research in Iraq and the surrounding region. IqNJM is committed to facilitating the growth of medical research, education, and health services. By adopting an open access policy, the journal provides authors with the opportunity to share their work with a global audience, ensuring that their research is widely disseminated and accessible.
Iraqi Association for Medical Research and Studies (IAMRS)
Research Integrity Risk Index (RI²) and Iraqi Universities
Copyright (c) 2025 Dhurgham A. Abdulwahid https://creativecommons.org/licenses/by-nd/4.0
Central cervical cleft: A very rare case of cervical congenital malformation
Central cervical cleft is an rare congenital midline anomaly of the neck, typically presenting as a vertically oriented skin defect accompanied by a subcutaneous fibrous band and, in many cases, an associated skin tag. This case report presents a case involving a five-year-old female who exhibited a midline cervical lesion with intermittent clear discharge but no associated pain or functional impairment. Clinical examination identified a characteristic cutaneous defect with a prominent skin tag in the midline of the anterior neck. Radiological evaluation, including ultrasound and CT scan, confirmed the localized nature of the anomaly and excluded deeper structural involvement. After appropriate counseling and reassurance of the benign nature of the lesion, surgical management was undertaken under general anesthesia. The excision was followed by multilayered wound closure incorporating multiple Z-plasty incisions to optimize healing and minimize scar formation. The postoperative course was uneventful, and the cosmetic outcome was further enhanced through regular follow-up and scar management using silicone gel. This case highlights the importance of early recognition and surgical correction of central cervical cleft to prevent potential functional limitations and achieve superior aesthetic results. Z-plasty remains a valuable reconstructive technique in such congenital neck anomalies, particularly in pediatric patients.
Copyright (c) 2025 Wael j. Alshihaby https://creativecommons.org/licenses/by-nd/4.0
Reviewing of radical radiotherapy to the mediastinum in patients with lymphoma
Background: Historically and clinically, lymphomas are categorized into two major groups: Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL). Over the years, radiotherapy techniques have advanced from extended-field to involved-field and more recently to involved-site/involved node radiation therapy (RT) (ISRT/INRT). Aim: This study aimed to evaluate the efficacy of mediastinal radiotherapy in lymphoma patients in Iraq. Methods: A prospective study was conducted to assess clinical and dosimetric changes in various radiotherapy planes and dosimetry between January 2023 and December 2023. The data collected included The data collected included patient demographics, medical history, treatment details, lymphoma characteristics, staging, radiotherapy plans, dose/fraction, and organ doses. Results: The study included 30 lymphoma patients (19 HL and 11 NHL cases) with a mean age of 31.3 ± 9.11 years. The non-coplanar group demonstrated superior mean PTV coverage compared to the coplanar volumetric modulated arc therapy (VMAT) group (P = 0.005). Additionally, the mean heart dose in the coplanar plans was greater than that in the non-coplanar arm (p < 0.0001). The coplanar plans also showed higher mean doses to the left lung at V20 in comparison to the non-coplanar plans (p = 0.007). Furthermore, the mean dose to the spinal cord in the coplanar VMAT group was greater than that in the non-coplanar group (p = 0.003). The median survival times were 11 months for HL and 12 months for NHL. Patients treated with coplanar plans had a median survival of 10.36 months, while those treated with non-coplanar plans had a median survival of 8.13 months. The recurrence rate was 23.3%, with a 3.3% risk of cardiac toxicity. Conclusions: The mean PTV coverage in the non-coplanar group surpassed that of the coplanar VMAT group. The median survival for HL patients was less than that for NHL patients within the same follow-up period. The survival rate of patients under coplanar plans exceeded that of patients under non-coplanar plans.
Copyright (c) 2025 Zeina Abd-Aljabbar Mahdi Jaber, Manwar Al-Naqqash https://creativecommons.org/licenses/by-nd/4.0
Evaluation of anatomic and dosimetric changes during simultaneously integrated boost volumetric modulated arc therapy for head and neck cancer
Background: Volumetric modulated arc therapy (VMAT) is the most commonly used radiotherapy (RT) technique for locally advanced head and neck cancers (HNC), concurrent with chemotherapy. Aim: This study aims to evaluate the anatomical changes that may arise in patients undergoing VMAT treatment. Methods: The study involved 20 patients with locally advanced HNC who received VMAT treatment concurrently with chemotherapy. Prior to the initiation of radiotherapy treatment, computed tomography (CT) simulation was conducted for all patients. The prescribed doses for the primary target (PTVP), high-risk lymph nodes (PTV60), and low-risk lymph nodes (PTV54) were 69.96 Gy, 60 Gy, and 54 Gy, respectively, administered in 33 treatment fractions using the simultaneous integrated boost (SIB) technique. Anatomical comparisons were made between CT1, CT2, and CT3, while dosimetric evaluations were performed between iplan, Rplan1, and Rplan2. Results: The analysis revealed a significant weight decrement in terms of anatomical changes in all patients. The gross tumor volume (GTV) decreased notably at CT2 in comparison to CT1. The GTV volume decreased significantly again at CT3. Additionally, there was a substantial reduction in the volume of the parotid glands. For dosimetric evaluation, most organs at risk experienced a noteworthy increase in the received dose. For target coverage, the D95% of the PTVP in the (iplan) was 97%, which significantly increased in Rplan1. Conclusion: Patients with HNC must undergo a new CT simulation during the RT course owing to significant anatomic changes that impact the plan quality. New plans (adaptive plans) should be implemented for a specific number of fractions to ensure the maintenance of initial plan quality.
Copyright (c) 2025 Farah Dirar Yousif, Raad Hefdhi Abedtwfeq https://creativecommons.org/licenses/by-nd/4.0
Patients Journey to hemodialysis centers: Multi-center study
Background: Hemodialysis is used to restore electrolyte balance (sodium levels, potassium in the body, bicarbonate, chloride, as well as magnesium, calcium, and phosphate) and filters the waste products and excess fluid. Unfortunately, developing nations continue to have a severe shortage of resources, which makes it difficult to provide highly technical and costly care like dialysis. Aim: The study's objective is to reveal and trace the journey of patients with end stage kidney disease who are on regular hemodialysis program and how they reach to dialysis centers. Methods: the study was to be conducted in many dialysis centers in different regions in Iraq to trace the patients journey to dialysis centers and how they reach the place. Results: The study population consisted of 400 participants, 60.2% of them were males and 39.8% were females. The majority were between 50-69 years old. Baghdad constituted the greater part of the participant’s province (88.3%). 56.00% of the patients went to dialysis sessions three times per week, 42.25% of them went twice times. (24.75%) of patient get to dialysis center by private car, (68.00%) by Taxi and (6.25%) by bus. 42.75% spent 30 mins-1hr to get to dialysis center, 41.75% spent 10 mins-30 mins .54.61% spend 10,000IQD to 20,000IQD to get to dialysis center. Conclusion: transportation-related issues seem to have an impact on the provision of in-center hemodialysis. This could have an impact on the dialysis provider as well as the particular patient.
Copyright (c) 2025 Ali Jasim Alsaedi , Dalia Ali, Anas Saad Kalaf Aljboori , Anas Nouri Mansour, Zahraa Haider Mahdi , Dalya Sameer Faeq, Riyam Khailed Mahsoob https://creativecommons.org/licenses/by-nd/4.0
A comparative analysis of multidrug-resistant Escherichia coli in urinary tract infections among males and females (2022–2023)
Background: Uropathogenic Escherichia coli (UPEC) is a primary cause of urinary tract infections (UTIs) globally. The increasing antibiotic resistance of UPEC strains poses a significant challenge for treatment in countries like Iraq. Aim: The study aims to evaluate antimicrobial resistance patterns of Escherichia coli (E. coli) among UTI patients, considering age and sex, and to compare these findings with data from other geographical locations. Methods: Our study investigated antibiotic resistance patterns among E. coli strains responsible for UTIs in patients at Karbala Teaching Hospital for Children, Iraq. We specifically examined age and sex differences. Data on 144 E. coli isolates were collected and analyzed for their susceptibility to six antibiotics from January 1, 2022, to December 31, 2023. Results: There were no statistically significant sex-based differences in antibiotic resistance. Ceftriaxone (76%) and nalidixic acid (67%) demonstrated the highest resistance rates among the tested antibiotics in both sexes. In contrast, amikacin (91%) and gentamicin (60%) exhibited higher sensitivity rates compared to other antibiotics. A general trend of increasing antibiotic resistance with age was evident, particularly pronounced for nalidixic acid and ceftriaxone. Conclusion: Amikacin consistently demonstrated relatively low resistance rates across all age groups. Infants under one year of age displayed heightened susceptibility to certain antibiotics, as reflected in lower resistance rates. Conversely, nalidixic acid and ceftriaxone exhibited notably elevated resistance rates across all age groups.
Copyright (c) 2025 Hussein Abd Ali Mohammed Sadeq Al Her, Ekhlas Abdulameer Hameed Alazzawi , Yehia Ali Hadi Al-Qhadi https://creativecommons.org/licenses/by-nd/4.0
Alternate day oral iron replacement versus daily intake in women with iron-deficiency anemia in Basrah
Background: Iron-deficiency anemia (IDA) remains a major global health concern, disproportionately affecting women of reproductive age. Conventional daily iron supplementation, though effective, is often associated with poor adherence due to gastrointestinal side effects. Emerging evidence suggests that alternate-day dosing may enhance iron absorption and tolerability, but comparative efficacy data in clinical settings remain limited. Aim: This study aimed to compare the hematological and iron store responses of women with IDA in Basrah, Iraq, between alternate-day and daily oral iron supplementation regimens. Methods: A total of 97 women with confirmed IDA (hemoglobin [Hb] < 12 g/dL, serum ferritin < 15 ng/mL) were enrolled in a prospective follow-up cohort study. The participants were divided into two groups: Group B (n = 48) received 100 mg of elemental iron daily, while Group A (n = 49) received the same dose every other day. Serum ferritin and hematological parameters (Hb, red blood cell [RBC] count, hematocrit) were assessed at baseline, three weeks, six weeks, and three months. ANOVA and paired t-tests were used for statistical analysis, with a significance level of P < 0.05. Results: Compared to the daily group, the alternate-day group exhibited a significantly higher mean increase in serum ferritin (28.6 ± 4.2 ng/mL vs. 22.3 ± 3.8 ng/mL, P = 0.001) and hemoglobin (2.8 ± 0.5 g/dL vs. 2.1 ± 0.4 g/dL, P = 0.001) at three months. The alternate-day group demonstrated earlier and more sustained improvements in iron reserves (P < 0.01 at all follow-ups), but both regimens increased RBC counts. Conclusion: In women with IDA, alternate-day iron supplementation is more effective in restoring hemoglobin and iron stores than daily dosing, possibly due to improved absorption and reduced hepcidin inhibition. These findings suggest potential benefits for patient adherence and clinical outcomes, supporting the use of alternate-day regimens as a superior therapeutic approach. To validate these results, further randomized controlled trials are necessary.
Copyright (c) 2025 Muntadar Jafar Mawla, Mohammed A. Al-Anssari, Qutaiba M. Dawood, Murtadha A. Jeber, Asaad A. Khalaf https://creativecommons.org/licenses/by-nd/4.0
Self-reported post-COVID-19 vaccine signs, symptoms among vaccinated medical staff: Types, severity, and associated factors
Background: Vaccines against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection vary in mechanisms, side effects, and effectiveness. Health care professionals have shown high vaccine coverage rates. Aim: This study aims to assess the prevalence of self-reported clinical signs and symptoms of COVID-19 infection among health care professionals in Iraq and determine the type and severity of COVID-19 vaccine-related symptoms. Methods: A cross-sectional survey was conducted from January 1st to July 1st, 2023, using an online questionnaire disseminated through social media platforms. Results: Among 770 participants, common symptoms included body aches (36.9%), malaise (34%), headache (22%), and fever (20%), with chest pain (4.2%) and vomiting (3.4%) being less common. Most symptoms lasted for a short duration, with 45.9% lasting one day, 36.3% lasting two days, and 17.7% lasting three days. Only 1.6% needed hospitalization, while 72.7% treated the symptoms at home and 25.7% did not require any treatment. Mixed vaccine recipients were more likely to experience multiple symptoms and deoxyribonucleic acid (DNA) vaccines were linked with fever and headache symptoms. Symptoms were more pronounced in individuals with a history of COVID-19 infection but not influenced by vaccine dosage. Conclusion: Symptoms such as body aches, headache, fever, vomiting, and malaise were significantly associated with prior COVID-19 infection and receiving DNA and messenger ribonucleic acid (mRNA) vaccines. Most vaccinated participants managed symptoms at home.
Copyright (c) 2025 Ali Khalid Saeed, Yousif Abdul Raheem https://creativecommons.org/licenses/by-nd/4.0
Role of surgical excision in the treatment of large macrocystic lymphatic malformations in children
Background: Lymphatic malformations are rare benign congenital cystic lesions that can develop anywhere in the body. Therapeutic options for these lesions include intralesional sclerotherapy, surgical excision, and other modalities. Aim: This study aims to assess the safety and efficacy of complete surgical excision as a therapeutic option in the treatment of large macrocystic lymphatic malformations in children, as well as to introduce a novel modification to the surgical procedure. Methods: A prospective study was conducted on 14 patients with large macrocystic lymphatic malformations in different body locations, treated between October 2018 and October 2021 at our institution. Complete surgical excision using a continuous traction technique was the principle therapeutic approach, with no alternative modalities applied. Patients were followed up to assess postoperative cosmetic and functional outcomes, as well as recurrence. Results: Most enrolled patients, comprising 12 (85.7%), presented before the age of 2 years, with eight (57.1%) having lesions in the neck. Clinical diagnosis was possible in 11 (78.6%) cases. Complete surgical excision was successfully achieved in 12 (85.7%) patients, with no significant injury to vital structures. No postoperative functional problems were reported, and esthetic results were satisfactory in the vast majority (92.8%) of patients. Recurrence was not reported in any of the patients enrolled. Conclusion: Complete surgical excision proves to be a safe and effective initial therapeutic modality in the management of large macrocystic lymphatic malformations in children, yielding excellent postoperative results in terms of functional outcomes and recurrence. Utilizing a continuous traction technique during surgical excision has been instrumental in achieving these favorable outcomes.
Copyright (c) 2025 Hiba Mahmood Yousuf, Moaied A. Hassan https://creativecommons.org/licenses/by-nd/4.0
Pattern of cancer mortality in Basrah governorate from 2018–2022
Background: Cancer is the second leading cause of death globally, with an estimated 9.6 million fatalities reported in 2018. Thus, understanding the impact of cancer rates and examining how cancer deaths are distributed by age and have changed over the years is crucial. Aim: This descriptive statistical study aimed to identify the most prevalent cancer types responsible for deaths in the Basra Governorate from 2018 to 2022, along with their distribution across various age groups and geographical areas. Methods: The study utilized a descriptive statistical approach based on death certificate data from Basra Governorate, encompassing all cancer-related deaths from 2018 through the end of 2022. The data were processed using Excel and Statistical Package for the Social Sciences (SPSS) software, and the outcomes were presented in tables and charts. Results: The findings revealed an increase in cancer-related fatalities from 2018 to 2022, although the proportion of cancer deaths relative to total deaths experienced a slight decline. The incidence of cancer deaths rose with age, with lung cancer accounting for the highest percentage, followed by breast cancer, brain cancer, and hematological malignancies, which were most prevalent among children. Among the younger demographic, cancers of the breast, brain, and digestive system were the most common. For individuals aged 40 to 60, breast, lung, and digestive system cancers were predominant, while lung, bladder, and breast cancers were most frequently observed in those aged 60 and older. The central region of the governorate recorded the highest percentage of cancer deaths, followed by Al-Zubair and Abi Al-Khaseeb districts, with no significant difference in cancer death rates between genders. Conclusion: Over the past five years, the cancer-specific mortality rate experienced a slight reduction, with lung, breast, and brain cancers presenting the highest frequencies and cancer death rates increasing with advancing age.
Copyright (c) 2025 Huda Hassan Al-Abboodi, Jafar Fawzi Al Badran , Nada Hasan Abdulraheem https://creativecommons.org/licenses/by-nd/4.0
Septoplasty without packing or splints: Our experience
Background: Septoplasty is a common surgical procedure performed in otorhinolaryngology departments to correct nasal septum deviation. Traditionally, nasal packing or splints used to stabilize the septal mucosal flaps and promote adhesion. However, these can cause complications such as nasal obstruction until removal, dry mouth, watering of eyes, severe pain during pack removal, headache, difficulty swallowing, and hypoxia. Methods: This prospective longitudinal observational study conducted on 50 patients undergoing septoplasty for nasal obstruction without the use of nasal packing or splints. This study included 50 patients who presented to the ENT department with nasal obstruction over one year (October 2021 to October 2022). The septal mucosa was sutured using 4-0 poly glycolic with an initial few quilting sutures, followed by continuous sutures to approximate the flaps and prevent septal hematoma. Patients monitored on the day of surgery and during follow-ups for bleeding or hematoma. The severity of nasal obstruction assessed using the NOSE score preoperatively, then reassessed at one week and one month postoperatively. Follow-up examinations evaluated the nasal cavities for synechiae, hematoma, septal perforation, or residual deviation. Results: Among the 50 patients, 36 were male and 14 were female. The youngest patient was 15 years old, and the oldest was 57 years old. Minor bleeding occurred in two patients within a few hours postoperatively in the recovery room. These patients treated with intravenous tranexamic acid (500 mg) without requiring nasal packing. No complications occurred in the remaining patients, and no long-term complications were observed in any case. Conclusion: Septoplasty was performed using multiple continuous trans-septal sutures after initial quilting sutures for stabilizing the corrected septum with absorbable 4-0 Vicryl suturing material, without nasal packing or splints, is an effective method for preventing hematoma and synechiae. This technique also avoids the discomfort and complications associated with foreign material inside the nasal cavity. Thus, septoplasty can be safely performed as a daycare procedure.
Copyright (c) 2025 Jafar Fawzi Al Badran, Huda Hassan Al Abboodi https://creativecommons.org/licenses/by-nd/4.0
Assessment of knowledge about toxoplasmosis among nursing college students
Background: Toxoplasmosis is a parasitic disease caused by Toxoplasma gondii. Humans acquire toxoplasmosis by consuming infected meat containing cysts of T. gondii or through contact with cat feces. Toxoplasmosis is known to cause miscarriage, also referred to as spontaneous abortion or pregnancy loss, which pertains to an unviable intrauterine pregnancy occurring during the first trimester and is the most common type of miscarriage. Aim: The aim of this study is to assess the level of knowledge of nursing students about toxoplasmosis. Methods: A questionnaire was administered to 90 nursing students. The self-completed questionnaire consisted of 17 questions covering the parasite, its diagnosis, clinical symptoms, and prevention of toxoplasmosis. Results: There was no significant relationship between participants’ knowledge and any of the demographic variables. Regarding participants’ knowledge, 28.9% demonstrated poor knowledge, 70% showed moderate knowledge, and only 1.1% exhibited good knowledge. Conclusion: The knowledge of nursing students regarding toxoplasmosis was found to be unsatisfactory
Copyright (c) 2025 Zainab Hassan, Saba Adnan, Abdulameer Abdullah Al-Musawi https://creativecommons.org/licenses/by-nd/4.0
Adverse side effects of hemodialysis in patients with end-stage chronic renal disease at Kassala Dialysis Center, Sudan
Background: Hemodialysis is a treatment for advanced renal failure; however, various complications can arise following the procedure. Aim: This study aimed to investigate the incidence of adverse side effects during hemodialysis in patients with chronic renal failure. Methods: This descriptive hospital-based study was conducted on 105 patients treated with hemodialysis between November 2020 and January 2021 at the Kassala Dialysis Center in Kassala City, Kassala State, Sudan. Data were collected through interviews using a questionnaire designed to address the research questions. The data were analyzed using the software Statistical Package for the Social Sciences version 16. Results: The findings indicated that 61% of this study group were male and 39% were female. The disease duration ranged from 1 to 5 years in 56 patients (53.3%). The age group ranged from 10 to 80 years, with approximately half of the study population in the age groups of 31–40 and 41–50 years. Regarding educational level, the majority were illiterate, representing 45 patients (42.9%). The most common symptoms mentioned by patients included joint pain (56 patients, 53.3%), sleeping problems (34 patients, 32.4%), and muscle cramps (33 patients, 31.4%). The most frequently used medication for symptom relief was paracetamol (46 patients, 43.8%), followed by diclofenac sodium (14 patients, 13.3%). Conclusion: The most common adverse effects of hemodialysis are joint pain, sleeping problems, and muscle cramps. Addressing the adverse effect of hemodialysis could lead to comprehensive managing the patients with end-stage chronic renal disease ultimately improving the patient outcome and efficiency of health car delivery.
Copyright (c) 2025 MUZAMIL AHMED, Mustafa Edrees Gobara Khairelseed, Muzdlefa Idriss Ibrahim Ahmed , Mutaz Ahmed Awad Mohammed , Mutaz Rashid Eltayeb Omara , Motaz Nuggedalla , Mohammed A.A. Abdelmotalab https://creativecommons.org/licenses/by-nd/4.0
Case report: A durable response to Anastrozole re-challenge with Everolimus in a patient with advanced-stage estrogen receptor-positive breast cancer
Estrogen receptor-positive breast cancer is a heterogeneous disease characterized by its dependence on estrogen for growth and progression. Although hormonal therapy remains the cornerstone of treatment, many patients eventually develop resistance, leading to recurrence and disease progression. This case report describes a durable response to a rechallenge with Anastrozole (Arimidex) in combination with Everolimus (Afinitor), an mTOR inhibitor, in a patient with advanced (stage IV) ER+ metastatic breast cancer.
Copyright (c) 2025 Vincent Emma P Weiss https://creativecommons.org/licenses/by-nd/4.0
Barriers to diet and exercise among patients with type 2 diabetes mellitus in Basrah hospitals
Background: Type 2 diabetes mellitus (T2DM) is growing health concern globally, particularly in the Middle East. To encourage individuals to adopt a healthy lifestyle essential for managing diabetes, it is imperative to thoroughly understand the barriers, especially those that can be modified, encountered by patients following nutritional and exercise medical advice. Aim: The primary objective of this study was to investigate the barriers related to nutrition and exercise among patients with T2DM in hospitals located in Basrah. Methods: This cross-sectional study included 194 adults with history of T2DM who were visiting the outpatient departments of internal medicine in four selected hospitals in Basrah. Data was collected using a specially prepared questionnaire administered through direct interviews with the diabetic patients by the investigators. The questionnaire encompassed general information about the participant and barriers to diet and exercise among patients with T2DM. Results: Most of the participants were aged 40 years and older (82.5%). Approximately 46.9% of the participants adhered to their doctor’s dietary recommendations. Only 20.6% of the diabetic patients engaged in physical exercise. Among non-adherent patients with T2DM, the most frequently reported barriers to nutrition included a lack of preference for the recommended diet (86.4%), lack of motivation (57.2%), and lack of knowledge (52.4%). The most commonly cited barriers to exercise were lack of energy (87.0%), lack of willpower (81.8%), lack of skill (77.9%), and fear of injury (73.3%). Conclusion: The study revealed that the compliance of diabetic patients to dietary and exercise recommendations was low. Therefore, it is crucial for health professionals to proactively address the mentioned barriers, and policymakers should design active nutritional practice guidelines for patients with T2DM.
Copyright (c) 2025 Jhood Abdul Samad Molan , Fatima K. Hassan , Miaad K. Khaddam , Zainab A.R. Antesh , Hudaa S. Karim , Duaa H. Kuraiz , Fatima H Abboud https://creativecommons.org/licenses/by-nd/4.0
Evaluating the outcome of different reconstructive surgical options for the management of shoulder deformity following obstetrical brachial plexus injury due to Erb’s palsy
Background: Obstetrical brachial plexus paralysis (OBPP) refers to an injury to all or part of the brachial plexus occurring at the time of delivery. Injuries associated with the upper brachial plexus are termed Erb’s palsy, while those associated with the lower brachial plexus are referred to as Klumpke palsy. Obstetrical brachial plexus injuries are often associated with large birth weight and shoulder dystocia. Aim: This study aims to evaluate the outcomes of different secondary reconstructive surgical options for the treatment of OBPP Methods: This prospective study was conducted at Basra General Hospital from October 2022 to November 2023. Sixty-eight patients (43 males and 25 females) were included, with 49 patients experiencing right-side involvement and 19 with left-side involvement. All patients had Grade 2 OBPP according to the modified Mallet score. Secondary reconstruction involved subscapularis release for 48 patients, derotation osteotomy for 12 patients with fixation using plates and screws, and tendon transfer for eight patients in the form of trapezius transfer to the upper humerus. Results: In the subscapularis release group, 42 out of 48 patients (87.5%) reported satisfaction with the surgical outcome, noting improvements in their ability to eat and drink. In the derotation osteotomy group, 11 out of 12 patients (81.7%) were satisfied with the result of surgery, while the trapezius transfer group expressed dissatisfaction with the surgical outcome. Conclusion: Subscapularis release surgery is suitable for early and flexible OBPP, yielding satisfactory results, while derotation osteotomy is appropriate for fixed OBPP in toddlers and older children, also demonstrating good results. Trapezius tendon transfer showed unsatisfactory outcomes.
Copyright (c) 2025 Mohamedbakir Abbas abdulzahra, Thamer A. Hamdan https://creativecommons.org/licenses/by-nd/4.0
The correlation of vitamin D3 with biochemical markers in β-Thalassemia major patients
Background: Vitamin D3 is essential for pediatric development and normal growth. Aim: This study aims to analyze the hematological characteristics of both β-thalassemia patients and controls; their liver and renal functions; and calcium, phosphorus, and parathyroid hormone levels and their correlation with vitamin D3. Methods: Ninety teenage subjects, comprising 45 patients with β-thalassemia major (selected from the Hereditary Blood Diseases Center in Basrah during their regular checkups) and 45 apparently healthy individuals selected from relatives and friends, aged between 12 to 15 years (42.2% males and 57.8% females) were included in a 2023 case-control study at the Hereditary Blood Diseases Center. A gel tube with approximately 5 mL of blood was utilized for biochemical analyses, and a portion of the sample was transferred into a test tube for complete blood count testing. Liver and renal functions were evaluated by measuring the activities of aspartate transaminase (AST), alkaline phosphatase (ALP), alanine transaminase (ALT), blood urea, and serum creatinine. Serum concentrations of parathyroid hormone, vitamin D3, calcium, and phosphorus were also estimated. Serum ferritin and complete blood count were performed as well. The Statistical Package for the Special Science version 29 was utilized, employing several methods to assess the connection between the variables, including the Mann-Whitney U test, Pearson Chi-Square, Pearson correlation, and linear regression (to assess the correlation between the variables). A p-value of < 0.05 was considered statistically significant. Results: Regarding demographics, the only significant difference was in BMI (p = 0.0001). ALT, AST, and ALP levels were significantly higher in β-thalassemia patients compared to healthy individuals, with significant differences (p = 0.0001 for all). Blood urea and serum creatinine levels were statistically significant (p = 0.0001). A highly significant difference was found in serum levels of vitamin D3 (p = 0.0001), with PTH significantly higher in patients (p = 0.0001). Calcium levels were also significantly different (p = 0.0001), but no significant difference was found in phosphorus levels (p > 0.05). Regarding hematological indices, a highly significant association was found in Hb, RBC, HCT (p = 0.0001), and MCV (p = 0.025) levels, while MCH, MCHC, WBCs, and platelets did not have significant differences (p > 0.05). Conclusion: β-Thalassemia significantly affects hematological and biochemical markers in all patients. Vitamin D3 levels are negatively correlated with ALT, AST, serum ferritin, PTH, and calcium levels in patients.
Copyright (c) 2025 Wasen Jameel Hussain, Mustafa Abd Almajeed Hussein , Rehab Abdulwehab Jaafer, Newal Khalil Ibrahim https://creativecommons.org/licenses/by-nd/4.0
Demography, annual incidence, and risk factors of inhibitors for pediatric hemophilia A in Basra Center for Hereditary Blood Diseases
Background: Hemophilia A is a rare X-linked congenital bleeding disorder characterized by a tendency to bleed. This is the primary tendency of the disorder, with most of the bleeding occurring internally into the joints. A significant complication of hemophilia treatment is the development of neutralizing antibodies against factor VIII replacement therapy, known as inhibitors. Aim: This study aimed to investigate the demography of pediatric hemophilia A patients at the Basra Center for Hereditary Blood Diseases and assess the annual incidence of positive inhibitors and their associated risk factors. Methods: A descriptive, retrospective, registry-based study was conducted for hemophilia A patients registered at the Basra Center for Hereditary Blood Diseases from October 2018 to October 2023. A total of 110 males aged < 1 year to £ 15 years, with a median age of 8.7 ± 3.8 years, were included in this study. Patient Information collected included the date of birth, age at diagnosis, severity of disease, symptoms at diagnosis, quantitative inhibitor levels, and risk factors for inhibitor development. Results: In this study, 46 patients (42%) were ≥10 years old, and 53 patients (48.1%) were diagnosed between 1–5 years. Among the hemophilia A patients, between one year and five years, 48 (43.7%) had moderate severity. The primary symptom at diagnosis was postoperative bleeding in 29 patients (26.3%), followed by mucocutaneous bleeding in 26 patients (23.7%). A total of 22 out of 110 (20%) patients developed inhibitors, with 21 of these (95.5%) classified as high-titer, predominantly in severe hemophilia A patients with factor VIII levels < 1 (12/22 patients, 54.5%). The annual incidence of inhibitors decreased over the last five years from 46 to 13 (registered patients/year) and from 18 to 2.7 (examined patients/year). Severity of disease, family history of positive inhibitors, age at first exposure to factor VIII therapy, history of intensive factor VIII treatment, and type of factor VIII replacement were statistically significant correlates of inhibitor development. Conclusions: The annual incidence of inhibitor development has decreased over the last five years. Severity of disease, family history of positive inhibitors, age at first exposure to factor VIII therapy, history of intensive factor VIII treatment, and type of factor VIII replacement are significant risk factors for inhibitor development.
Basra, Haemophilia A, inhibitor, risk factors.
Copyright (c) 2025 Oula Abdullah Najim, Azeezah Mohammed Mohsin https://creativecommons.org/licenses/by-nd/4.0
Monitoring Al-Hijamah therapy on PCV% in tobacco smokers: Pre-post analysis
Background: Al-hijamah is a traditional therapy used to clear blood and interstitial fluids, thereby helping maintain optimal levels of various blood solutes. Smoking is known to increase packed cell volume percentage (PCV%), leading to increased blood viscosity and associated complications. Aim: This study aimed to examine the impact of Al-hijamah therapy on reducing elevated PCV levels in healthy adult smokers Methods: A pre-post study was conducted on 25 healthy male adults aged 30–55 years who underwent Al-hijamah therapy in Fallujah, Iraq. All the participants were smokers who were medication-free and had PCV% values near the upper limit. Al-Hijamah was performed at five specific points of the posterior neck, bilateral paraspinal areas of the neck, and the thoracic spine. Venous blood samples were collected to measure PCV% three and seven days before and after the treatment. The result was statistically analyzed using t-test and p-value by SPSS version 25. Results: The pre-treatment PCV% values were equal to nearly the upper limit of the normal range (mean = 46.12%). A statistically significant reduction was observed after three days of treatment (mean = 43.20%, p-value = 0.000), which decreased slightly after four more days (43.16%). There was no significant change between day 3 and 7 (p-value = 0.942). Conclusion: Al-hijamah therapy can rapidly and significantly reduce elevated PCV% in healthy adult smokers within three days of treatment, with effects persisting for at least a week.
Copyright (c) 2025 Bahaa Burhanuldeen Kargule https://creativecommons.org/licenses/by-nd/4.0
Concurrent dermatological manifestations, COVID-19 infection, and MDS/RCMD-RS: A unique case report
A 24-year-old male with refractory cytopenia with multilineage dysplasia and ring sideroblasts (MDS/RCMD-RS) who developed severe dermatological manifestations concurrent with COVID-19 infection. The patient exhibited complex vasculitic and purpuric skin lesions, which were hypothesized to result from COVID-19-induced endothelitis and vasculitis, exacerbated by underlying immune dysfunction from MDS. Despite treatment with EPO therapy, cyclosporin, and supportive care, the patient's condition deteriorated rapidly, leading to fatal respiratory failure. The report underscores the interplay between hematologic malignancies, immune dysregulation, and COVID-19, highlighting the potential for exacerbated dermatological and systemic complications in such patients. This case emphasizes the need for heightened vigilance and tailored management strategies for MDS patients infected with COVID-19.
Copyright (c) 2025 Amenah S. Abdulkareem, Qutaiba M. Dawood, Asaad A. Khalaf https://creativecommons.org/licenses/by-nd/4.0
Inflammatory markers levels in total knee arthroplasty
Copyright (c) 2025 Vitorino M. Santos, Andressa P. Tedeschi, Vitor R. D. Modesto https://creativecommons.org/licenses/by-nd/4.0
Knowledge and attitudes of doctors in Basra governorate regarding the International Classification of Diseases (ICD-10)
Background: The International Classification of Diseases, Tenth Revision (ICD-10), is a critical tool for standardizing health information globally. Despite its widespread adoption, gaps in understanding and application among healthcare providers persist, potentially affecting patient care and health system efficiency. Aim: To examine the knowledge, attitudes, and practices of physicians regarding the implementation of the ICD-10 system Methods: This descriptive, cross-sectional study assessed the knowledge and attitudes of 67 healthcare professionals (27 specialists, 25 senior residents, eight general practitioners, and seven junior residents) from various medical settings in Basra, southern Iraq, including hospitals and clinics. Participants completed a questionnaire evaluating their familiarity with and application of ICD-10, particularly in tasks such as death certification. Data were analyzed using SPSS version 26, with the Chi-Square Test employed to explore relationships between knowledge levels and demographic as well as professional variables. Results: While 61% of respondents reported familiarity with ICD-10, only 8% demonstrated “Good” proficiency in its application. A notable 60% exhibited “Poor” proficiency, particularly in death certification procedures. Statistical analysis found no significant correlation between professional role or years of practice and ICD-10 knowledge levels (Chi-Square values = 14 and 5.5, P-values = 0.1 and 0.9, respectively). The primary source of ICD-10 knowledge was self-education (54%), with formal training programs contributing minimally (15%). Despite recognizing the importance of ICD-10, only 14.9% of doctors regularly applied these standards in their practice, and 68.7% had never participated in any formal ICD-10 training. Conclusion: This study highlights a significant gap in the effective application of ICD-10 among medical professionals in Basra, pointing to systemic deficiencies in training and education. There is a critical need for comprehensive training programs and policy interventions to enhance ICD-10 understanding and usage. Strengthening these efforts could improve clinical documentation, patient care, and overall health system management, bridging the gap between the perceived importance of ICD-10 and its practical implementation
Copyright (c) 2025 Nada Hasan Abdulraheem Al-Kawaz , , Huda Hassan Muhaibes Al-Abbodi, Ziyad Tarik Shwaish https://creativecommons.org/licenses/by-nd/4.0
Knowledge of mothers about neonatal danger signs attending Children’s Welfare Teaching Hospital in Medical City Directorate, Baghdad, Iraq
Background: The first 28 days of life, known as the neonatal period, represent a critical time when infants are at the highest risk of mortality. Most neonatal deaths occur in low-income countries with inadequate healthcare systems. The World Health Organization has identified specific neonatal danger signs (NDSs) that indicate potential illness. Aim: This study aimed to assess Iraqi mothers’ understanding of neonatal risk signs in 2024 and identify factors influencing this knowledge. Method: This descriptive cross-sectional hospital-based study involved 400 mothers attending the Children’s Welfare Teaching Hospital in Baghdad from November 2023 to March 2024. Mothers who could identify at least three of the 10 NDSs were considered to have good knowledge. Results: The study found that 223 (56%) mothers had high knowledge. The most recognized NDSs were jaundice (65%), fast breathing (60%), and elevated body temperature (51.75%). The least recognized signs included Lowered temperature (0.75%), redness, foul smell, umbilical discharge, skin rash, and eye drainage (4% each). Good knowledge was significantly associated with increased prenatal care visits. Mothers who received guidance from non-health facility consultants were more knowledgeable. About 15% mothers reported seeing no warning signs in their children. Conclusion: The study conducted at the Children’s Welfare Teaching Hospital in Baghdad revealed that mothers possessed a fair understanding of NDSs, with jaundice being the most commonly recognized. Mothers who received advice from non-health facility advisers, primarily family and social media, showed significantly higher knowledge levels. Recommendations include enhancing educational programs in antenatal and postnatal care, utilizing mass media, and conducting community-based studies to improve maternal understanding of NDSs.
Copyright (c) 2025 Amna Amer, Faris AL-Lami, https://creativecommons.org/licenses/by-nd/4.0
Mothers’ plan to protect their children from COVID-19 and other viral illnesses
Background: Mothers play a critical role in safeguarding the health and well-being of their children—a vulnerable population—particularly during outbreaks of infectious diseases. Aim: This study investigated the strategies employed by mothers to protect their children from COVID-19 and other viral illnesses. Methods: A cross-sectional study was conducted at the outpatient pediatric clinics of Basra Maternity and Children Hospital and Almawani Teaching Hospital, 118 mothers were enrolled from diverse backgrounds. Data was collected through structured interviews and a standardized questionnaire designed to assess maternal practices, attitudes, and experiences concerning the protection of their children. The key areas explored included hygiene practices, adherence to public health guidelines, and access to healthcare services. Results: Most participating mothers were between 20 and 40 years of age (79.66%), had attained a college education or higher (54.23%), and were primarily housewives (56.77%). Among the reported protective behaviors, 91.5% of mothers used hand sanitizers containing at least 60% alcohol, 75.4% cleaned and disinfected household objects and surfaces, and 60.16% frequently washed their hands with soap and water. Additionally, 94.91% communicated with family and friends solely through social media rather than in-person visits. A total of 66.94% avoided contact with individuals exhibiting flu-like symptoms, while 81.35% provided their children with information and health instructions regarding viruses. Furthermore, 71.4% reported preparing a sufficient supply of prescription medications for chronically ill children during the lockdown period. Conclusion: A positive association was found between the mothers’ level of education and certain preventive behaviors, such as disinfecting household surfaces, educating their children about viruses, and adhering to quarantine practices during the pandemic. However, no significant relationship was observed between education level and behaviors such as hand washing, sterilizing, avoiding sick individuals, or preparing a list of hospitals. This study’s findings provide valuable insights for developing evidence-based recommendations targeted at mothers, healthcare professionals, and policymakers. These results support the need for tailored educational programs and resources to enhance caregiver preparedness and protect children’s health during future infectious disease outbreaks.
Copyright (c) 2025 Miami Kadhum Yossif, Rehab Abdulwehab Jaafer https://creativecommons.org/licenses/by-nd/4.0
The diagnostic value of tumor markers (CA242, CA19-9, CEA) in patients with adenocarcinoma of the stomach
Background: Gastric cancer is a significant health issue worldwide; it ranks fourth among cancers, following those of the lung, breast, and colon. Tumor markers can be utilized as screening and diagnostic tests for neoplastic diseases. Aim: This study aims to evaluate value and the efficacy of tumor markers (CA242, CA19-9, CEA) in patients with gastric carcinoma and to investigate the utility of single and combined tumor markers for the diagnosis of gastric carcinoma. Methods: The serum level of CA242, CA19-9, and CEA were measured in 40 patients with gastric carcinoma, using the ELISA technique, compared with 20 patients with benign gastric conditions and 20 healthy controls. Chi-square tests and F-test were employed for statistical analysis. Results: The mean age of patients with gastric cancer was 54.7 ± 12.8 years, with a male-to-female ratio of approximately 1.2:1. Serological data indicated that 60%, 37.5%, and 50% of these patients had positive results for CA242, CA19-9, and CEA, respectively. A statistically significant difference was observed in the mean serum level of CA19-9 between gastric cancer patients and controls. Additionally, CA242 demonstrated the best sensitivity (CA242 71%), while CA19-9 exhibited the highest specificity. The combination of tumor markers (CA19-9 and CEA), (CA242 and CEA), and (CEA and CA19-9) increased specificity to 97%. Conclusion: The novel tumor marker CA242 was the most sensitive for gastric cancer while CA19-9 was the most specific. Furthermore, a significant increase in serum CA19-9 levels was of diagnostic value. The combination of two tumor markers enhanced the specificity of the test.
Copyright (c) 2025 ahmed alosfoor, RAFAH TALIB, AIDA RASHID MANSOUR, NAHLA GHANIM https://creativecommons.org/licenses/by-nd/4.0
Distribution of resistance genes among carbapenem-resistant Acinetobacter baumannii isolated from different clinical specimens
Background: Carbapenems are the drugs of choice for serious hospital-acquired infections and for patients in intensive care unit affected by multidrug-resistant microorganisms, particularly Acinetobacter baumannii. Carbapenem-resistant Acinetobacter baumannii (CRAB) poses a significant threat to public health. Aim: The study aims to focus the distribution of carbapenemase-encoding genes belonging to classes A and B (blaGES, blaKPC, and blaNDM) among CRAB isolated from various clinical specimens. Methods: A total of 55 bacterial isolates were collected from different clinical specimens and underwent identification using Chrom agar and the Vitek 2 compact (ID) system. The checkerboard technique, modified Hodge test, and Vitek 2 compact (AST) system were employed to detect CRAB. PCR techniques were used to identify the presence of blaGES, blaKPC, and blaNDM. Results: Of the 55 isolates, 43 (78.1%) were identified as A. baumannii, with 39 (90.6%) of these being CRAB. All CRAB isolates could produce carbapenemase. The percentages of CRAB isolates possessing blaGES, blaKPC, and blaNDM were 28.2%, 15.4%, and 48.7%, respectively. In contrast, 25%a percentage of non-CRAB isolates possessing blaKPC and blaNDM had 25% of each. Conclusion: A high prevalence of CRAB capable of producing carbapenemase and harboring blaGES, blaKPC, and blaNDM genes belonging to classes A and B was observed among various infections in Al Najaf hospitals.
Copyright (c) 2025 Dr. Ahlam K. N., Ghufran R. T. https://creativecommons.org/licenses/by-nd/4.0
Significance of platelet parameters in the diagnosis of neonatal sepsis
Background: The gold standard test for diagnosis of neonatal sepsis is blood culture, even though no single laboratory test has 100% sensitivity and specificity. The diagnosis of sepsis cannot be made with a single test or any particular combination of testing methods. Therefore, it's necessary to identify diagnostic indicators that are both practical and affordable for every healthcare facility, while also having adequate sensitivity and specificity. This study aims to evaluate the role of platelet indices in diagnosing neonatal sepsis. Methods: A prospective, case-control study was conducted over 12 months at the Al-Kadhymiah Pediatric Hospital in Baghdad. It involves comparing 82 neonates with sepsis to 82 healthy controls. Basic investigations were sent before commencing antibiotic treatment and compared between both groups. Results: The only factor that differed significantly between the two groups was the type of pregnancy, in which 18.29% of neonates with sepsis were from multiple pregnancies compared with only 7.32% of normal neonates with such pregnancies, with a significant difference. Total platelet count was significantly lower (p=0.021) while mean platelet volume and platelet distribution width were considerably higher in the case group than in the control group (p<0.001). Blood culture was positive in 45 neonates (54.88%), and Staphylococcus aureus was the most commonly isolated bacteria. Conclusion: Neonates with sepsis have significantly lower platelet count and higher levels of the mean platelet volume and platelet distribution width. Platelet parameters are easily obtained from the complete blood count and could be used as adjuvant indices to diagnose neonatal sepsis.
Copyright (c) 2025 Sawsan Hussein, Farah Yassen Flayyih, Saja Mohammed Adil https://creativecommons.org/licenses/by-nd/4.0
Knowledge and practice of undergraduate medical students regarding self-medication: A cross-sectional survey in Baghdad, Iraq
Background: The global trend of self-medication is rising, making it a priority to investigate associated risks that could lead to life-threatening complications. Aim: To assess self-medication practices among undergraduate medical students and evaluate their knowledge and the factors influencing their use of self-medication Methods: A cross-sectional questionnaire-based study was conducted among 234 medical students from various medical colleges in Baghdad between November 2023 and March 2024. Participants were selected randomly. Data were collected and analyzed using SPSS version 23. The chi-square significance test was performed, and P-values ≤ 0.05 were considered statistically significant. Results: The study found that 72% of participants reported using self-medication at least twice a week in the past six months. Painkillers and cold medications were the most commonly used drugs without prior consultation. More than half of the participants (53%) relied on their previous knowledge as a source of information for obtaining medications, and they trusted social media more than physicians for medical advice. Conclusion: Self-medication practices were highly prevalent among undergraduate medical students in Baghdad, with many relying on their own experience for medical knowledge. Academics and pharmacists should educate students about the risks of improper self-medication and enforce stricter regulations on prescription-only medications.
Copyright (c) 2025 Samer Shukur Mohammed, Wael Waleed Mustafa https://creativecommons.org/licenses/by-nd/4.0
Outcome of newborns with diabetic mothers
Background: Diabetes mellitus (DM) is a metabolic disease that can affect pregnant women; if diabetic mothers are not well controlled, newborns may face higher risks of serious problems during pregnancy and at birth. Methods: This study was a cohort follow-up study that assessed the outcome of infants born to diabetic mothers (IDM). It involved two groups: a study group of 77 IDM (45 males and 32 females) born at Basra maternity and Children Hospital during the set six-month period (January 1 to June 30, 2018) and a control group of 137 infants born to non-diabetic mothers (69 males and 68 females) during the same period. Both groups were followed up to 28 days of life (the neonatal period). Results: The study results showed that the rates of preterm birth, macrosomia, respiratory distress syndrome, and hyperbilirubinemia were significantly higher among IDM (14.3%, 41.6%, 13%, and 10.4%, respectively) than among infants of non-diabetic mothers (5.1%, 5.8%, 0.7%, and 0.7%, respectively), with a p-value of <0.05. Additionally, a p-value rate of congenital malformations among IDM was higher than that among non-diabetic mothers (6.5% vs. 0.7%). The study also revealed that the most common metabolic disorder affecting IDM was hypoglycemia, which affected 40.3%, while neonatal death among IDM was 4%, compared to 0.77% for infants of non-diabetic mothers (causes of death included two due to preterm birth and one due to congenital heart disease). Conclusion: The results of the present study suggest that preterm birth, macrosomia, respiratory distress syndrome, hyperbilirubinemia, and hypoglycemia are significantly associated with diabetes during pregnancy. Hence, family planning, preconception counseling, and special antenatal care are recommended for diabetic mothers to reduce the risk of infant morbidity and mortality.
Copyright (c) 2025 jihad kadhim, professor, doctor https://creativecommons.org/licenses/by-nd/4.0
Comparative analyses of immune marker levels in seronegative and seropositive Iraqi rheumatoid arthritis patients
Background: Rheumatoid arthritis (RA) comprises an inflammation-based condition with a clinical phenotype that is mainly reliant on the occurrence of rheumatoid factor and anti-citrullinated protein antibodies. Literature indicates that seronegativity might be accompanied by higher severity of clinical symptoms, while higher disease activity, based on the recent classification criteria should also be associated with seronegativity. Aim: This investigation targets the identification of more efficient immune markers of RA seropositivity as well as examining the possibility that the latter is associated with lower severity. Methods: Serum samples from 128 RA patients, 106 seropositive and 22 seronegative, were analyzed using ELISA to determine the levels of four biomarkers: Wnt-1-induced secreted protein-1 CCN4, vascular cell adhesion molecule-1 (VCAM-1), matrix melloprotenase-3 (MMP-3), and granulocyte-macrophage colony-stimulating factor (GM-CSF). Additional clinical parameters were also investigated through a special questionnaire form that also covered demographic data. As a measure of RA activity, the parameter of joint disease activity score 28 (DAS28) was adopted. Results: Patients with seronegativity demonstrated higher RA activity, i.e., DAS28ESR score, in comparison with seropositive ones. Their sera also contained higher levels of the four tested immune markers in comparison with both seropositive patients and healthy controls. Das-28 ESR levels exhibited significant direct proportional correlations to CCN4, VCAM1, MMP3, GM-CSF, and Das-28CRP values. Conclusions: The tested four immune markers are considered biomarkers with high reliability and effectiveness to discriminate between seronegative and seropositive patients, as well as for the monitoring and prediction of RA activity and joint and bone damage in seronegative patients.
Copyright (c) 2024 Ahmed Aledany, Eman T. Ali, Ali Nazar Mohammed, Falah Hassan Shari https://creativecommons.org/licenses/by-nd/4.0