AMJ (Advanced Medical Journal)
type: channel
publisher: Kurdistan Higher Council of Medical Specialties
language: en
publication name: AMJ (Advanced Medical Journal)
issn: 2958-8979
copyright: The copyright on any article published in AMJ (The Scientific Journal of Kurdistan Higher Council of Medical Specialties )is retained by the author(s) in agreement with the Creative Commons Attribution Non-Commercial ShareAlike License (CC BY-NC-SA 4.0)
items: A Possible Role for Structured Water Utilizing Nanotechnology in Preventing Recurrent Urinary Tract Infections
items: Visual Evoked Potential in Multiple Sclerosis
items: Incidence Rate and Factors Associated with Successful Vaginal Birth after a Cesarean Section at a Tertiary Maternity Hospital
items: Patterns of Thyroid Dysfunction among Women with Menstrual Disorder
items: Thyroid Dysfunction and Anti Thyroid Autoantibodies among Type I Diabetes Mellitus Patients
items: Management of Highly Sensitized Patients in Renal Transplantation: Prospective Single-Center Study
items: Evaluation of the Salivary Parameters (pH, Buffering Capacity and Flow Rate) and Dental Caries Status in Children with Cerebral Palsy: A Case Control Study
items: Prevalence and Predictors of No-Reflow Phenomenon in Patients with Acute Coronary Syndrome in Slemani Cardiac Hospital
items: Correlation of Red Cell distribution width and Neutrophil to Lymphocyte ratio with Disease activity in Rheumatoid Arthritis
items: Association Between Disease Activity and C-reactive Protein to Serum Albumin Ratio in Patients with Ankylosing Spondylitis
items: A Comparative Study Between Pap Smear and Visual Inspection with Acetic Acid in Screening of Cervical Intraepithelial Neoplasia and Cervical Cancer at a Tertiary Maternity Hospital (Erbil/Iraq)
items: Serum Progesterone Hormone Level and Threatened Miscarriage with Its Predictive Value for Viability
items: The Incidence Rate and Perinatal Outcome of Delivered Women with Preterm Premature Rupture of Membrane, at a tertiary maternity hospital within a year
items: Risk Factors and Adverse Perinatal Outcomes of Anemia in Zakho Maternity Hospital
items: Perinatal Outcome in Cesarean and Vaginal Delivery in Meconium-stained Amniotic Fluid
items: Maternal and Fetal Outcomes in Term Deliveries with Meconium-Stained Amniotic Fluid
items: Effect Of Melatonin as a Prophylaxis for Febrile Convulsion
items: Safety of Metformin Continuation During Peri-Procedural Period of Coronary Angiography in Type 2 Diabetic Patients
items: Efficacy of Microneedling Combined with 30% Salicylic Acid Peel Versus Microneedling Alone in the Treatment of Post Acne Scar: A Clinical Trial
items: Characteristics of Patients with Liver Cirrhosis Attending Azadi Center of Gastroenterology and Hepatology-Duhok Kurdistan Region
items: The Association of Inflammatory Biomarkers of Neutrophil-to-Lymphocyte Ratio with Spontaneous Preterm Delivery
items: Frequency, Severity, and Management of Left Main Disease in Acute Coronary Syndrome in Sulaimani Cardiac Hospital
items: Post-operative Pain Management with Erector Spinae Block under Ultrasound Guidance vs Local Anesthetic Instillation at Wound Site in Patients Undergoing Lumbar Spine Surgeries
items: Evaluation of Efficacy of Perioperative Oral Dexamethasone in Reducing Swelling and Ecchymosis After Blepharoplasty Surgery
items: The Prevalence of Denture Related Hyperplasia in Patients Attending Teaching Dental Center in Sulaimani City
items: Delayed gastric emptying in classic pancreaticoduodenectomy vs pylorus-sparing pancreaticoduodenectomy, a retrospective and prospective comparative study
items: Prevalence of Dental Fluorosis Among Basic School Children Aged (8-14) Years in Sulaymaniyah City
items: Cesarian Scar Ectopic Pregnancy: A Tertiary Maternity Hospital Case Series
items: Impact of Clinical Pharmacist-led Intervention on Clinical Outcomes in Patients with Helicobacter pylori Infection
items: Congenital Infantile Fibrosarcoma of The Duodenum, A Case Report

A Possible Role for Structured Water Utilizing Nanotechnology in Preventing Recurrent Urinary Tract Infections
type: item
description: Background and objectives: With increasing antimicrobial resistance, high costs, and antibiotic side effects, non-antibiotic options for preventing recurrent urinary tract infections are being explored. This study assessed the effectiveness of nanotechnology-structured water versus regular bottled water and low-dose Trimethoprim. Methods: A randomized, double-blind, placebo-controlled clinical trial was conducted in Sulaimani city with 300 women who had previously received antibiotic treatment for recurrent urinary tract infections. The participants were divided into three groups: Group M (n=117) received nanotechnology-structured water for 12 months and placebo tablets for six months, administered daily. Group T (n=123) was given 100 mg of Trimethoprim daily for six months and ordinary bottled water for 12 months. Group O (n=109) received only ordinary bottled water for 12 months and placebo tablets for six months. Urine samples were collected at the study's start, during infection episodes, and at the end for urinalysis and cultures. Results: Antibiotic-treated recurrent urinary tract infections occurred in 29% of participants, varying frequency across groups. Recurrence rates in Groups M and T were similar but significantly lower than in Group O. The time to the first recurrence differed notably among groups, with Group M (nanotechnology-structured water) showing an average of 169.44 days, surpassing Groups T and O. Group M had 9%, Group T 15%, and Group O 63% infections. Conclusion: Nanotechnology-structured water shows potential as a preventative measure against recurring urinary tract infections, offering an alternative to costly medications with undesirable side effects.
subject: Articles
  topic: section
subject: Antibiotic Prophylaxis
  topic: keywords
subject: Nanotechnology Water
  topic: keywords
subject: Recurrent Urinary Tract Infections
  topic: keywords
creator: Alaa Al Krush
creator: Kawa Mahmoud
creator: Goran Abdulla
rights: Copyright (c) 2025 Alaa Al Krush, Kawa Mahmoud, Goran Abdulla https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2025-12-01
publication date: 2025-12-01
starting page: 235
ending page: 241
doi: 10.56056/420

Visual Evoked Potential in Multiple Sclerosis
type: item
description: Background and objectives: Multiple sclerosis, a neurological disease with or without optic neuritis may cause abnormal visual evoked potential finding. This study aimed to evaluate role of visual evoked potential in diagnosing multiple sclerosis. Methods: In a comparative cross-sectional study, conducted between 1stJune to 15thAugust 2023 in Shahid Aso teaching hospital, Sulaimani, Iraq. Visual evoked potential and brain magnetic resonance imaging performed for twenty patients which clinically diagnosed or suspected as multiple sclerosis. The data was analyzed by (Statistical Package for the Social Science). Results: In this study eleven male and nine female patients in age range of 18 to 54 years participated, no significant relationship found between visual evoked potential finding with age and gender. Thirteen patients had prolonged visual evoked potential findings. Abnormal brain magnetic resonance imaging findings found in 50% of patients, from which 80% showed prolonged visual evoked potential findings. Fifty percent of patients with normal brain magnetic resonance imaging had prolonged p100 latency. There is a significant relationship at 0.01level between prolonged p100 latency and presence of finding on brain MRI. Conclusion: Visual evoked potential, as a paraclinical biomarker helps diagnosing multiple sclerosis in patients with or without optic neuritis. In this study, abnormal brain magnetic resonance imaging was positively related with prolonging P100 latency on visual evoked potential in multiple sclerosis patients.
subject: Articles
  topic: section
subject: Brain magnetic resonance imaging
  topic: keywords
subject: Multiple sclerosis
  topic: keywords
subject: Optic neuritis
  topic: keywords
subject: Visual evoked potential
  topic: keywords
creator: Asia Ali Rashid
creator: Kamaran Hasan Azeez
creator: Bakhtiar Qadir Hamasalih
rights: Copyright (c) 2025 Asia Ali Rashid , Kamaran Hasan Azeez, Bakhtiar Qadir Hamasalih https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2025-12-01
publication date: 2025-12-01
starting page: 229
ending page: 234
doi: 10.56056/419

Incidence Rate and Factors Associated with Successful Vaginal Birth after a Cesarean Section at a Tertiary Maternity Hospital
type: item
description: Background and objectives: Globally rates of vaginal birth after one Cesarean section vary significantly. However, in the recent rears it has been gaining popularity due to its potential benefits. The aim of this study is to assess the incidence of successful vaginal birth after Cesarean-section and associated factors Methods: This study, conducted from January 1, 2023, to January 1, 2024, at Maternity Teaching Hospital in Erbil, Kurdistan, used two designs: a cross-sectional study to determine the incidence of successful vaginal delivery after Cesarean-section and a case-control study to assess associated factors. Factors studied included maternal age, gestational age, antenatal care, parity, inter-delivery interval, labor duration, Bishop score, and newborn weight. Results: The average age of the cases (28.4 ± 6.1 years) was significantly higher than that of the controls (26.4 ± 6.5 years), (p-value< 0.001). About half (50.6%) of the control group were primiparous, compared to 32.9% of the cases, also significant at p < 0.001. The average labor duration for cases was 3.66 hours, significantly longer than the controls' average of 2.88 hours (p = 0.002). There was a significant positive correlation between age and the number of previous vaginal deliveries before CS (rho = 0.343, p < 0.001) and prior vaginal birth after cesarean-section (rho = 0.415, p < 0.001). Conclusion: Vaginal birth after Cesarean-section is considered a safe delivery option, and women with at least one Cesarean section should be educated and encouraged to pursue it.
subject: Articles
  topic: section
subject: Cesarean section, Labor
  topic: keywords
subject: Labor
  topic: keywords
subject: Vaginal delivery
  topic: keywords
subject: Vaginal birth after Cesarean-section
  topic: keywords
creator: Kafia Fazil Abdullah
creator: Shahla Kareem Al-Alaf
creator: Lava Ahmed Talat
rights: Copyright (c) 2025 Kafia Fazil Abdullah, Shahla Kareem Al-Alaf, Lava Ahmed Talat https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2025-12-01
publication date: 2025-12-01
starting page: 220
ending page: 228
doi: 10.56056/418

Patterns of Thyroid Dysfunction among Women with Menstrual Disorder
type: item
description: Background and objectives: Thyroid dysfunction can lead to menstrual irregularities and infertility. Thus, this study aimed to assess the frequency and patterns of thyroid dysfunction in patients with menstrual disorders. Methods: This prospective cross-sectional study was conducted at Shar Teaching Hospital, from June 01, 2023, to June 01, 2024, on 200 women with menstrual abnormality. Their thyroid hormone levels were estimated and the correlations between patients’ age, type of thyroid dysfunction, and menstrual abnormality were determined. Results: The mean age of women was 32.14 ± 7.6 years, and most of them were aged 31– 40 years (41.5%) with irregular menses (n=76). Women aged 31- 40 years had the highest incidence of menstrual abnormality (n=83), of which most cases were irregular menses (42.1%). Most patients had thyroid disorder (n=128), of which subclinical hypothyroidism reported the highest level (n=67). The highest mean level of thyroid stimulating hormone was found in patients with amenorrhea (20.81 ± 33.6 µIU/mL), free tri-iodo tyrosin in oligomenorrhea (3.35 ± 1.0 pg/dL) (p=0.02 and p=0.002, respectively) and free tetra-iodo tyrosin in both oligomenorrhea and irregular menses (1.20 ± 0.5 ng/dL). The vast majority of patients had positive anti-thyroid peroxidase antibody (51.5%) and negative thyroid stimulating hormone receptor binding antibody (91%) (p>0.05). Conclusions: Subclinical hypothyroidism is common among patients with menstrual abnormalities, especially young adults. Thyroid-stimulating hormone and free tri-iodo tyrosin were directly associated with menstrual abnormalities, while both anti-thyroid peroxidase antibody and thyroid-stimulating hormone receptor binding antibody were not.
subject: Articles
  topic: section
subject: Cross-sectional study
  topic: keywords
subject: Menstrual disorder
  topic: keywords
subject: Thyroid dysfunction
  topic: keywords
subject: Endocrine disorder
  topic: keywords
creator: Chrakhan Mohemmed Haji Rasul
creator: Taha Othman Mahwy
creator: Zagros Ghaffor Rashid
rights: Copyright (c) 2025 Chrakhan Mohemmed Haji Rasul, Taha Othman Mahwy, Zagros Ghaffor Rashid https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2025-12-01
publication date: 2025-12-01
starting page: 212
ending page: 219
doi: 10.56056/417

Thyroid Dysfunction and Anti Thyroid Autoantibodies among Type I Diabetes Mellitus Patients
type: item
description: Background and objectives: Studies have shown a strong association between Type I diabetes and autoimmune thyroid diseases, particularly autoimmune thyroiditis, with higher rates of thyroid autoantibodies in diabetic patients. Our aim is to study the prevalence of undiagnosed thyroid dysfunction and positive thyroid autoantibodies in Type I diabetes patients. Methods: This was an observational analytic cross?sectional study conducted at Layla Qasim Diabetes Center in Erbil City, Kurdistan Region-Iraq. A total of 86 type I diabetes patients were enrolled during the period between November 2022 and August 2023. We conducted various laboratory tests for all study participants, including thyroid-stimulating hormone, triiodothyronine, thyroxine, fasting blood glucose, glycated hemoglobin, anti-thyroid peroxidase, and Thyroid Stimulating Hormone receptor antibodies. Results: Among the participant patients 8.1% of them had hypothyroidism, and 10.5% had subclinical hypothyroidism and 9.3% of patients had thyroid-stimulating-hormone antibodies, 15.1% had Thyroid Peroxidase antibodies, and 3.5% had both of them. Among patients with hypothyroidism, higher proportion (85.7%) had positive Thyroid Peroxidase antibodies followed by those with subclinical hypothyroidism (55.6%), while in patients with normal thyroid function positive Thyroid Peroxidase antibodies were found in only 2.9% with highly significance difference (p-value <0.001). Conclusion: Higher rates of autoimmune thyroid diseases and positive thyroid antibodies have been reported in patients with type I diabetes mellitus.
subject: Articles
  topic: section
subject: Autoimmune thyroid disease
  topic: keywords
subject: Type I diabetes mellitus
  topic: keywords
subject: Thyroid Peroxidase antibodies
  topic: keywords
creator: Farznda Mustafa Salih Zebari
creator: Halgurd Fathulla Ahmed
rights: Copyright (c) 2025 Farznda Mustafa Salih Zebari, Farznda Mustafa Salih Zebari, Halgurd Fathulla Ahmed https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2025-12-01
publication date: 2025-12-01
starting page: 205
ending page: 211
doi: 10.56056/416

Management of Highly Sensitized Patients in Renal Transplantation: Prospective Single-Center Study
type: item
description: Background and objectives: In kidney transplantation, immunologic risk assessment was performed through pretransplant measurement of human leukocyte antigen, donor-specific antibodies. The aim of this study was to address the impact of early pre-transplant donor-specific antibodies screening. Methods: A cross-sectional study was conducted in the Duhok Kidney Center in the Kurdistan region, Iraq. The study started on the 1st of March 2021 till the 1st of July 2023. A convenient nonrandom sampling of 40 pairs of patients and donors was included in this study. a structural close-ended questionnaire prepared. The first part of the questionnaire included the socio demographic characteristics of the studied sample. The age, gender, occupation, and residency of both the recipient and the donor were recorded. The induction immunosuppression and type of transplants were investigated. Results: Most recipients (70%) were weakly sensitized; the moderate group rated 22.5%, and the strong group rated 7.5%. The mean age of the recipients was 40.02 ± 9.33, and they were followed for 2.05 ±0.84 years. The mean of donor-specific antibodies was compared before and after induction therapy: 4454.02±3227.10 vs 1479.85±1044.12, respectively. The result was highly significant. The history of the previous renal transplants was 17.5%, the blood transfusion was 5%, and the history of pregnancy was 57.5%. The mean difference in glomerular filtration rate was 8 ± 2.6 vs. 81.24 ± 24.06 among the rejected and non-rejected groups. The serum creatine was 6.7 ± 1.01 in the rejected and 1.14 ±1.17 in the non-rejected group. Conclusion: Multiple plasmapheresis sessions were part of the desensitization protocol, with low-dose immunoglobulin and Rituximab administered simultaneously. Based on these findings, in the future, we anticipate that safe kidney transplantation will be performed even in highly sensitized recipients, thereby actively improving their prognosis.
subject: Articles
  topic: section
subject: Allograft
  topic: keywords
subject: Cross-sectional study
  topic: keywords
subject: Donor Specific Antigen Screening
  topic: keywords
subject: Renal Transplantation
  topic: keywords
creator: Herish Othman Abdulrahman
creator: Kais Hasan Abd
rights: Copyright (c) 2025 Herish Othman Abdulrahman, Kais Hasan Abd https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2025-12-01
publication date: 2025-12-01
starting page: 197
ending page: 204
doi: 10.56056/415

Evaluation of the Salivary Parameters (pH, Buffering Capacity and Flow Rate) and Dental Caries Status in Children with Cerebral Palsy: A Case Control Study
type: item
description: Background and objectives: Children with cerebral palsy suffer from oral and dental problems more than healthy children, this may be due to poor motor control of orofacial muscles and bad oral hygiene. The objectives of this study are to measure the salivary parameters, dental caries status, to find any correlation between them, and to compare these data with that of healthy siblings. Results: Dental caries were significantly higher in the study group, for the primary teeth P-value = 0.035, and for the permanent teeth P-value = 0.005, salivary flow rate and buffering capacity were significantly lower in the study group, P-value = 0.000 for both of them. pH shows no significant difference, P-value = 0.303, significant correlations noted between both the salivary flow rate and the buffering capacity with dental caries in primary dentition in the study group, P-values = 0.015. Conclusion: Low salivary flow rate and buffering capacity in children with cerebral palsy might be risk factors for dental caries, so, these parameters could be used as screening tools for detecting children who are at risk of dental caries.
subject: Articles
  topic: section
subject: Cerebral Palsy
  topic: keywords
subject: Children
  topic: keywords
subject: Dental Caries Status
  topic: keywords
subject: Salivary Parameters
  topic: keywords
creator: Sherwan Kareem Qader
creator: Ali Fakhree Alzubaidee
creator: Maaroof Tahseen Hassan Najjar
rights: Copyright (c) 2025 Sherwan Kareem Qader, Ali Fakhree Alzubaidee, Maaroof Tahseen Hassan Najjar https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2025-12-01
publication date: 2025-12-01
starting page: 189
ending page: 196
doi: 10.56056/414

Prevalence and Predictors of No-Reflow Phenomenon in Patients with Acute Coronary Syndrome in Slemani Cardiac Hospital
type: item
description: Background and objectives: Understanding factors linked to the no-reflow phenomenon after percutaneous coronary intervention in acute coronary syndromes is important for optimizing reperfusion strategies. The aim of this study is to determine the prevalence and predictors of no-reflow phenomenon in Slemani Cardiac Hospital. Methods: This investigation was a prospective study that was carried out in Slemani Cardiac Hospital; between July 2023 until December 2023, of 150 acute coronary syndrome patients undergoing percutaneous coronary intervention collected data on demographics, clinical characteristics, angiographic findings, and procedural details. Patients were categorized into reflow and no-reflow groups based on final Thrombolysis in Myocardial Infarction flow. Associations between no-reflow and various parameters were analyzed. Results: There was 70% male, with 21.3% hypertension, 4% diabetes, 3.3% dyslipidemia. Common presentations were non-ST elevation myocardial infarction (41.3%), inferior ST elevation myocardial infarction (28%). No significant lesions were seen in 32%. Reflow success rate was 94%, with 6% no-reflow. No-reflow associated with risk factors like dyslipidemia, hypertension, diabetes, and smoking, but not angiographic/procedural variables. Conclusion: Cardiovascular risk factors emerged as key determinants of no-reflow, underscoring the importance of risk modification. The excellent reflow rates and lack of angiographic associations contrast some prior data, warranting further standardized research on no-reflow prediction and mechanisms to guide targeted interventions in acute coronary syndrome.
subject: Articles
  topic: section
subject: Acute Coronary Syndrome
  topic: keywords
subject: Dyslipidemia, Hypertension
  topic: keywords
subject: No-Reflow Phenomenon
  topic: keywords
subject: Percutaneous Coronary Intervention
  topic: keywords
creator: Binar Yadgar Raouf Heshmet
creator: Dana Hama Baqi Mohammed Saeed
creator: Ammar Al-hamdi
rights: Copyright (c) 2025 Binar Yadgar Raouf Heshmet, Dana Hama Baqi Mohammed Saeed, Ammar Al-hamdi https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2025-12-01
publication date: 2025-12-01
starting page: 180
ending page: 188
doi: 10.56056/413

Correlation of Red Cell distribution width and Neutrophil to Lymphocyte ratio with Disease activity in Rheumatoid Arthritis
type: item
description: Background and objectives: The study investigated the relationship between red cell distribution width and neutrophil-to-lymphocyte ratio with disease activity in rheumatoid arthritis. These markers provide insights into inflammation and immune dysregulation, potentially aiding clinical decision-making, and patient management. Methods: In the current cross-sectional study, 105 patients suffering from rheumatoid arthritis who were referred to the Rheumatology and Rehabilitation division in Sulaymaniyah, Kurdistan region from January 2023 to June 2023 were studied. To gather the required data, the patient's medical files and relevant examinations were used. Disease activity measured using disease activity score-28 and clinical disease activity. Results: The study involved patients with an average age of 53.38 years. Eighty patients (76.2%) were females, and 25 (23.8%) were males. Patient and evaluator global disease activity mean were 5.38 and 4.52, respectively. Mean values for red cell distribution width, neutrophil/lymphocyte ratio, erythrocyte sedimentation rate, and hemoglobin were 15.4672, 2.3603, 31.611, and 12.773, respectively. Notably, clinical disease activity showed no significant correlation with age, Body mass index, disease duration, or various hematological parameters. Similarly, no significant associations were observed between Disease activity score-28 and demographic or clinical factors. Conclusion: Neutrophil to lymphocyte ratio and red cell distribution width cannot be utilized as reliable biomarkers to assess disease activity in patients with rheumatoid arthritis.
subject: Articles
  topic: section
subject: Neutrophil to lymphocyte ratio
  topic: keywords
subject: Red cell distribution width
  topic: keywords
subject: Rheumatoid arthritis
  topic: keywords
creator: Solin Nooruldeen Omar
creator: Raouf Rahim Mirza
rights: Copyright (c) 2025 Solin Nooruldeen Omar, Raouf Rahim Mirza https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2025-12-01
publication date: 2025-12-01
starting page: 171
ending page: 179
doi: 10.56056/412

Association Between Disease Activity and C-reactive Protein to Serum Albumin Ratio in Patients with Ankylosing Spondylitis
type: item
description: Background and objectives: Ankylosing spondylitis is a persistent inflammatory rheumatic condition that predominantly affects the axial skeleton. The current research aims to assess the correlation between disease activity and the C-reactive protein to serum albumin ratio among individuals diagnosed with ankylosing spondylitis. Patients and methods: This cross-sectional study was undertaken at Sulaymaniyah Shahid Hemn Teaching Hospital. The study encompassed a cohort comprising 100 patients who were diagnosed as ankylosing spondylitis. The study was conducted between December 2022 and August 2023. By referring to the patients' medical files and by assessing the disease activity using bath ankylosing spondylitis disease activity index and ankylosing spondylitis disease activity score required data were gathered. Results: The patients' age ranged from 20 to 60 years, and (70%) were males. The most common comorbidities included sacroiliitis in (100%) of the patients, enthesitis in (39%) of them, peripheral arthritis in (37%) of them, and dactylitis in (20%) of them. All of the patients received anti-tumor necrosis factor therapy, (21%) and (6%) also received NSAID and DMARD treatments, respectively. CRP/S. albumin CAR was found to have statistically significant relationships with BASDAI and ASDAS scores (p-value<0.001) but not with HLAB27 (p-value=0.46). It was also found that CRP/S. albumin CAR had significant correlations with BASDAI scores (p-value=0.03) and ASDAS scores (p-value<0.001). Conclusion: C-reactive protein-to-serum albumin ratio can be utilized as a reliable indicator to assess disease activity in individuals diagnosed with ankylosing spondylitis.
subject: Articles
  topic: section
subject: Ankylosing spondylitis
  topic: keywords
subject: C-reactive protein
  topic: keywords
subject: Disease activity
  topic: keywords
subject: Serum albumin
  topic: keywords
creator: Avin Mariwan Mohammed Saleh
creator: Raouf Rahim Mirza
rights: Copyright (c) 2025 Avin Mariwan Mohammed Saleh, Raouf Rahim Mirza https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2025-12-01
publication date: 2025-12-01
starting page: 162
ending page: 170
doi: 10.56056/411

A Comparative Study Between Pap Smear and Visual Inspection with Acetic Acid in Screening of Cervical Intraepithelial Neoplasia and Cervical Cancer at a Tertiary Maternity Hospital (Erbil/Iraq)
type: item
description: Background and objectives: Global concern persists over cervical cancer, demanding efficient early detection methods. The aim of the study was to assess the diagnostic efficacy of Pap smear and visual inspection with acetic acid in detecting cervical intraepithelial neoplasia and early cervical cancer. Methods: This was a cross-sectional, comparative study conducted from the 1st of January 2023 to the 31st of December 2023 at the Maternity Teaching Hospital/Erbil, Iraq, to screen 200 patients, aged between 18-60 years by doing Pap smear and visual inspection with acetic acid for detecting cervical intraepithelial neoplasia and early cervical cancer. The indicators of diagnostic value including sensitivity, specificity, positive and negative predictive values were analyzed. Results: Pap smear exhibited a sensitivity of 94.12% while visual inspection with acetic acid showed a sensitivity of 82.35%. The specificity of Pap smear was 64.52%, whereas the visual inspection with acetic acid test had a specificity of 25.8%. The positive predictive value of Pap smear was 59.26% compared with 37.84% for visual inspection with acetic acid. In terms of negative predicted value, Pap smear achieved 95.24%, whereas visual inspection with acetic acid reached 72.73%. Finally, the diagnostic accuracy of Pap smear was 75%, whereas visual inspection with acetic acid had an accuracy of 45.83%. Conclusion: Pap smear and visual inspection with acetic acid tests possess a high sensitivity and, to a lesser extent, specificity, making them effective screening tools for detecting cervical intraepithelial neoplasia and early cervical cancer.
subject: Articles
  topic: section
subject: Cervical cancer
  topic: keywords
subject: Screening
  topic: keywords
subject: Sensitivity and Specificity
  topic: keywords
creator: Shkofa Khalid Mohammed
creator: Trifa Yousif Mutalib
rights: Copyright (c) 2025 Shkofa Khalid Mohammed, Trifa Yousif Mutalib https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2025-12-01
publication date: 2025-12-01
starting page: 154
ending page: 161
doi: 10.56056/410

Serum Progesterone Hormone Level and Threatened Miscarriage with Its Predictive Value for Viability
type: item
description: Background and objectives: Serum progesterone hormone is essential for pregnancy development and progression. Thus, this study aimed to assess the level of serum progesterone in normal pregnancy and threatened miscarriage with its predictive value for viability. Methods: This case-control study was held in outpatient clinics in the Emergency Departments of Erbil Maternity Teaching Hospital, Erbil, Iraq, from the 1st June 2022 to 31st May 2023 on 75 pregnant women with threatened miscarriages and 75 healthy pregnant women as controls. Diagnosis of threatened miscarriage was made through clinical features, investigations and ultrasonography. Then, the blood samples were collected to assess the serum progesterone level as a predictor for threatened miscarriage and viability of early pregnancy. Results: Most participants (44%) were young (20-29 years old), had low economic status, gave birth to 1-3 children and had a gestational age of >9.0 weeks with no significant difference between both groups (p>0.05). A highly significant association (p<0.001) was observed between pregnant women with threatened miscarriage and non-viability of fetuses. The mean serum progesterone level was obviously decreased in females with threatened miscarriage. The mean serum progesterone hormone level of 20.5 nmol/L was a significant predictor of threatened miscarriage with acceptable validity findings. The mean serum progesterone hormone level of 11.8 nmol/L was a significant predictor of non-viability in pregnant women with threatened miscarriage and acceptable validity findings. Conclusions: The serum progesterone level is an appropriate predictor of threatened miscarriage and fetal viability in early pregnancy.
subject: Articles
  topic: section
subject: Early pregnancy
  topic: keywords
subject: Fetal viability
  topic: keywords
subject: Outpatients
  topic: keywords
subject: Serum progesterone
  topic: keywords
subject: Threatened miscarriage
  topic: keywords
creator: Shilan Muhtasam Ahmed
creator: Trefa Yousuf Mutalib
rights: Copyright (c) 2025 Shilan Muhtasam Ahmed, Trefa Yousuf Mutalib https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2025-12-01
publication date: 2025-12-01
starting page: 145
ending page: 153
doi: 10.56056/409

The Incidence Rate and Perinatal Outcome of Delivered Women with Preterm Premature Rupture of Membrane, at a tertiary maternity hospital within a year
type: item
description: Background and objectives: Many maternal and perinatal complications can result from preterm premature rupture of membrane. This study aims to find the incidence and identify factors associated with, and factors associated with adverse perinatal outcomes among women experiencing preterm premature rupture of membrane. Methods: A cross-sectional study was carried out at Maternity Teaching Hospital in Erbil to calculate preterm premature rupture of membrane incidence in 1 year from 2023 to 2024. Factors such as maternal age, parity, antenatal care, amniotic fluid index were studied as well as the neonate’s APGAR score, birth weight and outcome. Results: For this study; 840 patients were included. The incidence of preterm premature rupture of membrane in 2023 at the maternity teaching hospital in Erbil was 2.18%. Younger age, lower BMI, nulliparity, and history of preterm premature rupture of membrane were associated with preterm premature rupture of membrane (p<0.05). Antenatal care was less common among preterm premature rupture of membrane (55.2% vs. 78.1%) (p<0.05). Preterm premature rupture of membrane was associated with lower APGAR scores in both 1st and 5th minutes of birth (p<0.05). Longer duration of preterm premature rupture of membrane before admission is associated with poor fetal outcome and lower APGAR scores (p<0.05). Conclusion: preterm premature rupture of membrane impacts neonatal outcomes like birth weight and APGAR score. The time between preterm premature rupture of membrane and hospital admission significantly affects outcomes.
subject: Articles
  topic: section
subject: APGAR score
  topic: keywords
subject: Fetal outcome
  topic: keywords
subject: Preterm premature rupture of membrane
  topic: keywords
creator: Dlveen Sherzad Bahjat
creator: Trifa Yousif Mutalib
rights: Copyright (c) 2025 Dlveen Sherzad Bahjat, Trifa Yousif Mutalib https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2025-12-01
publication date: 2025-12-01
starting page: 135
ending page: 144
doi: 10.56056/408

Risk Factors and Adverse Perinatal Outcomes of Anemia in Zakho Maternity Hospital
type: item
description: Background and objectives: Maternal anemia pose significant challenges to perinatal health globally. The current study was conducted to investigate the association between severity of anemia in pregnant women and adverse perinatal outcomes. Methods: A comparative descriptive study was conducted in Zakho Maternity Hospital, Zakho City, Kurdistan Region, Iraq from May 2022 to May 2023 involving 500 women during labor. The sample size included 253 anemic (Hemoglobin <11 g/dl) and 247 non-anemic pregnant women (Hemoglobin ?11 g/dl). Demographic character, mode of delivery and perinatal outcomes were compared between both groups. Results: Among the 253 anemic women during labor involved in the study, 56.0% had mild, 42.4% had moderate, and 1.6% had severe anemia. Higher parity increased anemia risk (P<0.000), Among mothers with moderate anemia, 47.2% were multiparous compared to 26.4% primigravida. Similarly, among those with severe anemia, 42.8% were multiparous compared to 0% primigravida. Anemia was associated with extreme maternal age (<20 and >35 years) and rural housing (p<0.001), although work status had no significant impact (p=0.292). Maternal anemia correlated with poorer Apgar scores, with rates of (75.0%, 9.3%, and 1.4% for severe, moderate, and mild anemia, respectively). More NICU admissions were observed for babies born to mothers with severe anemia (100.0%), followed by moderate (17.8%) and mild (4.9%) anemia. Additionally, more low birth weight cases were observed, with a prevalence of 75.0% in severe anemia followed by moderate (7.5%) and mild anemia (2.1%). Conclusion: A substantial link is there between anemia during pregnancy and maternal characteristics of parity and rural residence. Furthermore, poor perinatal outcomes had significant relation with anemia.
subject: Articles
  topic: section
subject: Anemia
  topic: keywords
subject: Perinatal outcomes
  topic: keywords
subject: Pregnancy
  topic: keywords
subject: Risk factors
  topic: keywords
creator: Saraa Faiz Abdulrahman
creator: Shahla Kareem Alalaf
creator: Fatima Kamal Khalid
rights: Copyright (c) 2025 Saraa Faiz Abdulrahman, Shahla Kareem Alalaf, Fatima Kamal Khalid https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2025-12-01
publication date: 2025-12-01
starting page: 128
ending page: 134
doi: 10.56056/407

Perinatal Outcome in Cesarean and Vaginal Delivery in Meconium-stained Amniotic Fluid
type: item
description: Background: Meconium-stained amniotic fluid is a frequent obstetrical disorder accompanied with adverse outcomes. The objective of this study is to assess fetal outcome in relation to mode of delivery in pregnant women complicated by meconium-stained amniotic fluid. Methods: This study was an observational cross-sectional study implemented in High risk and Labor ward of Maternity Teaching Hospital in Erbil city-Kurdistan region/Iraq through the period of one year from 1st of May 2022 to 30th of April 2023 on two hundred pregnant women with meconium-stained amniotic fluid. Maternal factors such as status of membrane, and grade of meconium were assessed. Fetal assessment by APGAR score, birth weight and outcome were analyzed. Fetal follow up continued for one week after birth Results: Severity and incidence of Meconium staining was classified into; light (28.5%), moderate (51.5%) and thick (20%). Cesarean section delivery was more obvious among pregnant women with latent phase of labor (50%) (p<0.001). The thick meconium was highly related to cesarean section delivery (30.9%), low fetal APGAR score at 1minute (40%), low fetal APGAR score at 5 minutes (11%) and high neonatal intensive care unit admission rate (90%) (p<0.001). This study also showed a significant relationship between low fetal APGAR score at one minute and high (72.5%) neonatal intensive care unit admission (p=0.05) among pregnant women with meconium-stained amniotic fluid delivered by cesarean section (p<0.001). Conclusions: The thick meconium-stained amniotic fluid and cesarean section delivery are related to poor perinatal fetal outcomes.
subject: Articles
  topic: section
subject: Caesarean section
  topic: keywords
subject: Fetal outcomes
  topic: keywords
subject: Meconium-stained amniotic fluid
  topic: keywords
creator: Shukriyah Taha Omar Ababakir
creator: Awat Ibrahim Hamadamen
rights: Copyright (c) 2025 Shukriyah Taha Omar Ababakir, Awat Ibrahim Hamadamen https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2025-12-01
publication date: 2025-12-01
starting page: 119
ending page: 127
doi: 10.56056/406

Maternal and Fetal Outcomes in Term Deliveries with Meconium-Stained Amniotic Fluid
type: item
description: Background and objectives: Meconium-stained amniotic fluid is a poor predictor of neonatal outcome. Its presence is a possible sign of fetal distress and is related to poor perinatal outcomes. So, this study aimed to assess the maternal and perinatal outcomes in deliveries complicated by meconium-stained liquor. Methods: A prospective observational cross-sectional study was conducted at Sulaimani Maternity Teaching Hospital, Sulaimaniyah, Iraq from May 01, 2022, to May 01, 2023, on 100 pregnant women with meconium-stained amniotic fluid after membrane rupture. The women's clinical data were collected and observed during labor. Then, the maternal and perinatal outcomes in deliveries complicated by meconium-stained liquor were assessed and analyzed statistically. Results: The age of the pregnant women with meconium-stained amniotic fluid was 29.32 ± 6.6 years, and most of them were multiparous (68%), needed artificial membrane rupture (69%), and delivered by caesarean section (57%). Fetal heart rates were abnormal in 48%, which was higher among cases of grade III meconium (68%), and 29% of neonates had respiratory distress syndrome (p=0.001). Most neonates (71%) required admission to the neonate intensive care unit, with grade III meconium accounting for 76% of admission. The incidence of perinatal fetal death was 1.0%. Conclusions: Mode of delivery and fetal outcome were affected by the grades of meconium-stained amniotic fluid. Most patients with grade II meconium underwent caesarean delivery, while most patients with grade III meconium reported fetal heart abnormalities, fetal respiratory distress syndrome, and neonate intensive care unit admission.
subject: Articles
  topic: section
subject: Fetal outcome
  topic: keywords
subject: Labour
  topic: keywords
subject: Maternal outcome
  topic: keywords
subject: Meconium-stained amniotic fluid
  topic: keywords
creator: Sarah Ibrahim Ghulam
creator: Sallama Kamel Nasir
rights: Copyright (c) 2025 Sarah Ibrahim Ghulam, Sallama Kamel Nasir https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2025-12-01
publication date: 2025-12-01
starting page: 112
ending page: 118
doi: 10.56056/405

Effect Of Melatonin as a Prophylaxis for Febrile Convulsion
type: item
description: Background and objective: The efficacy of melatonin for febrile seizure prevention has been demonstrated in various studies. Febrile seizures are common in children and can be a cause of significant concern for parents. Melatonin is a hormone that regulates sleep-wake cycles and has neuroprotective properties. This study evaluates the effectiveness of melatonin in preventing febrile seizures. We searched to determine whether melatonin can reduce the frequency and severity of febrile seizures compared to a placebo. Methods: A clinical trial study was conducted at Raparin Teaching Hospital from January to June 2023. Patients with febrile seizures were divided into two cohorts: 38 in the melatonin group and 39 in the control group. In the melatonin group melatonin administered every 8 hours for 48 to 72 hours during febrile episodes, while the control group received no medication. Both groups were followed up after six months. Results: There were no significant differences in age, gender, seizure onset age, or number of attacks between both groups. They had similar fever histories over the past six months (p = 0.672). However, 34.8% of the control group had seizures after six months compared to 5% of the melatonin group (p = 0.024). In the melatonin group, 15% experienced dizziness, 5% had headaches, and 80% had no side effects. Conclusions: We advise using melatonin to prevent recurring febrile seizures, avoiding the negative effects of other anticonvulsant drugs.
subject: Articles
  topic: section
subject: Antiepileptic
  topic: keywords
subject: Febrile seizure
  topic: keywords
subject: Melatonin
  topic: keywords
subject: Neuroprotective
  topic: keywords
creator: Sara Abdulrahman Salim
creator: Kawes Omer Zangana
rights: Copyright (c) 2025 Sara Abdulrahman Salim, Kawes Omer Zangana https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2025-12-01
publication date: 2025-12-01
starting page: 104
ending page: 111
doi: 10.56056/404

Safety of Metformin Continuation During Peri-Procedural Period of Coronary Angiography in Type 2 Diabetic Patients
type: item
description: Background The safety of maintaining metformin therapy in patients undergoing coronary angiography is a topic of ongoing debate. The present study aims to examine patients with type 2 diabetes who continued to use metformin while undergoing coronary angiography for the development of contrast-induced nephropathy and lactic acidosis. Patients and Methods This investigation was a cross-sectional study that was carried out in Sulaimani Cardiac Hospital between January 2023 to June 2023 that enrolled 100 patients with type 2 diabetes and baseline creatinine clearance more than 45 ml/min for whom elective coronary angiography was performed. Monitoring of renal function and clinical signs of lactic acidosis were observed. Results The majority of cases (57%) received less than 50 cc of contrast, followed by 50-150 cc in 32 cases. Only one patient, a 70-year-old woman with a baseline impaired creatinine level (1.4 mg/dL), developed contrast-induced nephropathy, and there was no statistically significant change in creatinine level. With vigilant monitoring and proper hydration, her renal function returned to baseline levels within 7 days after the angiogram. Furthermore, there was no lactic acidosis in any of the participants. Conclusion It appears to be safe to continue metformin therapy during coronary angiography for type 2 diabetic patients whose baseline creatinine clearance above 45 ml/min.
subject: Articles
  topic: section
subject: Angiography
  topic: keywords
subject: Acute kidney injury
  topic: keywords
subject: Contrast-induced nephropathy
  topic: keywords
subject: Lactic acidosis
  topic: keywords
subject: Renal failure
  topic: keywords
creator: Dana Hama-Baqi Mohammed-Saeed
rights: Copyright (c) 2025 Dana Hama-Baqi Mohammed-Saeed https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2025-12-01
publication date: 2025-12-01
starting page: 97
ending page: 103
doi: 10.56056/403

Efficacy of Microneedling Combined with 30% Salicylic Acid Peel Versus Microneedling Alone in the Treatment of Post Acne Scar: A Clinical Trial
type: item
description: Background and objective: Acne scarring is a common problem with several treatment options available including microneedling, chemical peels and lasers. This study compares the efficacy of microneedling combined with 30% salicylic acid peel versus micro needling alone in the treatment of post acne scar. Methods: This was a clinical trial in which 40 patients with acne scar were randomly assigned to either first group who underwent microneedling at weeks 0,4,8,12 followed by 30% salicylic acid peel at weeks 2,6,10,14 and Second group who underwent microneedling alone at weeks 0,4,8,12. The duration of the study was 6 months from October 2023. Samples were selected from the Dermatology Teaching Center in Sulaymaniyah City, Iraq. The severity and types of acne scars and the adverse effects of microneedling and 30% salicylic acid peel were also measured. Results: The mean Baron and Goodman’s score before treatment in treatment group was 13.30±7.183 and after treatment was equal to 7.84±7.480. The decrease in the score in this group shows a good effect of combined microneedling and salicylic acid peel (P?0.001). The mean score in control group before the intervention was 11.35±4.880 and after the treatment decreased to 9.05±5.404 and this decrease in the score indicated effectiveness of microneedling (P?0.001). Conclusion: Both groups benefited from the treatments but the improvement in the combination group of microneedling with 30% salicylic acid peeling was greater compared to microneedling alone as evidenced by 6 degrees decrease in the score while treatment group had 2 points decrease in the score, indicating the better effect of this combination treatment method.
subject: Articles
  topic: section
subject: Acne scars
  topic: keywords
subject: Efficacy
  topic: keywords
subject: Microneedling
  topic: keywords
subject: Salicylic Acid
  topic: keywords
creator: Wafa Kamal Hama Rahim
creator: Ali Mozan Dhahir Elethawi
rights: Copyright (c) 2025 Wafa Kamal Hama Rahim, Ali Mozan Dhahir Elethawi https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2025-12-01
publication date: 2025-12-01
starting page: 88
ending page: 96
doi: 10.56056/402

Characteristics of Patients with Liver Cirrhosis Attending Azadi Center of Gastroenterology and Hepatology-Duhok Kurdistan Region
type: item
description: Background and objectives: Diagnosis of liver cirrhosis is made histologically, yet patients can present with clinical and laboratory features suggestive of end-stage liver disease and cirrhosis. The aim was to identify the causes, severity, and complications. Methods: A cross-sectional study was conducted from March-October 2023 in the Azadi Center of Gastroenterology and Hepatology in Duhok and included 205 cases. Demographic information was taken from the patients. Then patients were examined and sent to baseline and relevant investigations. A liver biopsy was done in selected patients. Results: The mean age of the patients was 52.4 ± 13.1. years. Males were (57.6%), and non-smokers were (68.3%). Furthermore, (64.4%) of the patients had Anorexia, (52.7%) had weight loss, (46.8%) had fever, and (43.4%) had abdominal pain. Upper endoscopic findings revealed varices in (48.8%), Portal Hypertensive Gastropathy (13.17%), Gastric Antral Vascular Ectasia (8.8%) and erosive gastritis in (3.41%). The metabolic dysfunction associated steatotic liver disease (31.22%), hepatitis B (15.61%), cryptogenic (11.22%), and hepatitis C (5.37%) were the most common types. Regarding the severity, chronic liver disease stage B was the most prevalent type (57.56%) and then type A was (21.46%). The mean scores of the Child-Pugh and the model of end stage liver disease-Sodium score were 8.05 and 18.19, respectively, which are statistically significant. Conclusion: Ascites and esophageal varices as a complication on presentation implies a delay in the presentation and diagnosis alongside under screening for liver cirrhosis. Metabolic dysfunction associated steatotic liver disease plays a major role as an underlying cause.
subject: Articles
  topic: section
subject: Cirrhosis
  topic: keywords
subject: Causes
  topic: keywords
subject: Complications
  topic: keywords
subject: Duhok
  topic: keywords
subject: Prognoses
  topic: keywords
creator: Mustafa Qasim Abdullah
creator: Ali Abdulghani Ramathan
creator: Azad Salih Muhammed
rights: Copyright (c) 2025 Mustafa Qasim Abdullah, Ali Abdulghani Ramathan, Azad Salih Muhammed https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2025-12-01
publication date: 2025-12-01
starting page: 80
ending page: 87
doi: 10.56056/401

The Association of Inflammatory Biomarkers of Neutrophil-to-Lymphocyte Ratio with Spontaneous Preterm Delivery
type: item
description: Background and objectives: Preterm birth is a significant contributor to infant mortality that is closely associated with the inflammatory process. The neutrophil-to-lymphocyte ratio reflects the balance between pro-inflammatory neutrophils and anti-inflammatory lymphocytes. This study assessed the relationship between the neutrophil-to-lymphocyte ratio and spontaneous preterm delivery. Methods: A case-control study was conducted at Sulaimani Maternity Teaching Hospital from May 2022 to May 2023 on 100 women (50 with preterm labour and 50 with full-term labour). In-person interviews were conducted to collect patients’ data. White blood cell, neutrophil, and lymphocyte counts were determined, and then the neutrophil-to-lymphocyte ratio was calculated during the second trimester and at labour onset. Results: The preterm group had significantly elevated white blood cell and neutrophil counts throughout the second trimester and at labour than the control group (p?0.05). The lymphocyte and neutrophil-to-lymphocyte ratio in the preterm group was non-significantly (p>0.05) increased throughout the second trimester and significantly (p?0.05) increased at labour compared to the control group. Blood values were significantly (p?0.05) lower in the preterm group during the second trimester than at labour for all parameters except for neutrophil-to-lymphocyte ratio (p>0.05). All blood parameters were elevated during labour compared to the second trimester, with significant changes to WBC and lymphocyte counts (p?0.05) and non-significant changes (p>0.05) for neutrophils and NRL. Conclusion: The laboratory blood parameters have variable impacts on clinical prediction and emphasizing the possible relevance of inflammatory biomarkers to preterm birth risks.
subject: Articles
  topic: section
subject: Inflammatory biomarkers
  topic: keywords
subject: Laboratory indicators
  topic: keywords
subject: Neutrophil-lymphocyte ratio
  topic: keywords
subject: Preterm birth
  topic: keywords
creator: Tavan Adnan Khdhir
creator: Sallama Nasir Kamil
rights: Copyright (c) 2025 Tavan Adnan Khdhir, Sallama Nasir Kamil https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2025-12-01
publication date: 2025-12-01
starting page: 73
ending page: 79
doi: 10.56056/400

Frequency, Severity, and Management of Left Main Disease in Acute Coronary Syndrome in Sulaimani Cardiac Hospital
type: item
description: Background and objectives: Approximately 6% of acute coronary syndrome patients undergoing coronary angiography are found to have obstructive left main coronary artery disease. Significant left main stem stenosis, defined as a lesion occupying more than 50% of the vessel diameter. The current study aims to determine the frequency and severity of left main disease among acute coronary syndrome patients and evaluate the management strategies for left main disease. Methods: This prospective case series study included over 200 acute coronary syndrome patients systematically selected during hospitalization at Sulaimani Cardiac Hospital over one year from June 1, 2023, to June 1, 2024. The patient was diagnosed as myocardial infarction, coronary angiography was done, diseased vessels recorded and SYNTAX score measured. Sampling method based on convenience. Results: The incidence of left main disease among the 200 patients was 17%. Left main disease was more prevalent in ST elevation myocardial infarction patients compared to non-ST elevation myocardial infarction patients. Out of 34 patients with left main disease, 25 of them were male and 9 patients were female. Patients with triple vessel disease involving the left main had higher Syntax scores (>32). 67% of left main patients were referred for urgent coronary artery bypass graft surgery. Conclusion: This study highlights the significant burden of left main disease in acute coronary syndrome patients. Coronary artery bypass graft surgery remains the preferred treatment for significant left main stenosis.
subject: Articles
  topic: section
subject: Acute myocardial infarction
  topic: keywords
subject: Coronary artery bypass graft surgery
  topic: keywords
subject: Left main disease
  topic: keywords
subject: Percutaneous coronary intervention
  topic: keywords
creator: Pshtiwan Hussein Qadir
creator: Amar Talib Al-Hamdi
creator: Kawa Wsu Hassan
rights: Copyright (c) 2025 Pshtiwan Hussein Qadir, Amar Talib Al-Hamdi, Kawa Wsu Hassan https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2025-12-01
publication date: 2025-12-01
starting page: 66
ending page: 72
doi: 10.56056/399

Post-operative Pain Management with Erector Spinae Block under Ultrasound Guidance vs Local Anesthetic Instillation at Wound Site in Patients Undergoing Lumbar Spine Surgeries
type: item
description: Background and objectives: Ultrasound-guided nerve blocks are becoming vital in postoperative pain management. This study compares the efficacy of Erector Spinae Plane Block with local anesthetic instillation at the wound site for postoperative pain management in lumbar spine surgeries. The aim is to identify effective pain management approaches, minimizing analgesic use. Methods: This trial was done on 50 cases undergoing lumbar spine surgeries at Hawler Teaching Hospital, between April 2023 and January 2024. Patients were assigned into two groups, 25 in each. Group 1 patients received the Erector Spinae Plane Block, while Group 2 patients received local anesthetic instillation. Follow-up of patients’ pain perception and analgesic usage were done through a questionnaire. Results were analyzed through frequency analysis and factor analysis. Results: The analysis revealed patients who underwent Erector Spinae Plane Block were associated with a lower incidence of postoperative pain (72%, while 96% in instillation) and reduced reliance on analgesics (52%). Local anesthetic instillation at wound site was associated with more severe pain and more usage of analgesics (80%). Lumbar radiculopathy was not common in those who underwent the block (only 4%, while 76% in instillation). The percentages of variance for group 1 (72.52%) and group 2 (71.181%) shows effective results for both and successful capture of postoperative experiences by the principal components. Conclusion: Erector Spinae Plane Block emerges as a promising postoperative pain management technique for lumbar spine surgeries, offering relief and minimizing analgesic usage.
subject: Articles
  topic: section
subject: Erector spinae plane block
  topic: keywords
subject: Local anesthetic instillation
  topic: keywords
subject: Pain management
  topic: keywords
subject: Spine surgery
  topic: keywords
creator: Tarza Lateef Mohammed
creator: Abdulhameed Al-dabbagh
creator: Rekawt Fadhil
rights: Copyright (c) 2025 Tarza Lateef Mohammed, Abdulhameed Al-dabbagh, Rekawt Fadhil https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2025-12-01
publication date: 2025-12-01
starting page: 56
ending page: 65
doi: 10.56056/398

Evaluation of Efficacy of Perioperative Oral Dexamethasone in Reducing Swelling and Ecchymosis After Blepharoplasty Surgery
type: item
description: Background and objectives: Blepharoplasty, a common cosmetic procedure, can lead to postoperative issues like swelling and bruising. Steroids are occasionally used to address these concerns and speed up recovery. This study aims to evaluate how effective steroids are in reducing periorbital swelling and bruising in blepharoplasty patients. Methods: From November 2022 to June 2023, a descriptive analysis was conducted on forty participants at Dermodento Center and Safin private hospitals in Kurdistan/Iraq. The participants were divided into two groups. Group 1 (twenty individuals) received Dexamethasone 8 mg tablets thirty minutes before surgery, continuing for three days post-surgery. Group 2 (twenty participants) did not receive steroid treatment. Periorbital swelling and bruising were assessed using a standardized visual inspection scale, enabling objective measurement and comparison between the steroid-treated and non-treated groups. Results: Among the 40 patients, 35 were female and 5 were male, with an average age of 39.19. Median swelling scores decreased from 1.5 (range: 1.0-2.0) on POD 1 to 0 (range: 0.0-1.0) on POD 7. Similarly, median ecchymosis scores decreased from 2.0 (range: 1.0-2.0) on POD 1 to 0 (range: 0.0-1.0) on POD 7. The study demonstrated a significant reduction in swelling and ecchymosis among participants who received steroid treatment compared to the control group, with statistically significant results (p < 0.05). Conclusion: Steroids reduce periorbital swelling and bruising after blepharoplasty, enhancing outcomes and patient satisfaction, and highlighting their procedural benefits.
subject: Articles
  topic: section
subject: Blepharoplasty
  topic: keywords
subject: Dexamethasone
  topic: keywords
subject: Ecchymosis
  topic: keywords
subject: Edema
  topic: keywords
creator: Rabar Abas Hama amin
creator: Zanyar Mustafa Amin
creator: Bayad Jaza Mahmood
rights: Copyright (c) 2025 Rabar Abas Hama amin, Zanyar Mustafa Amin, Bayad Jaza Mahmood https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2025-12-01
publication date: 2025-12-01
starting page: 48
ending page: 55
doi: 10.56056/397

The Prevalence of Denture Related Hyperplasia in Patients Attending Teaching Dental Center in Sulaimani City
type: item
description: Background and Objectives: One of the typical clinical findings among complete denture users is denture-related hyperplasia, characterized by bone resorption and flabby soft tissues beneath, classified into two types: inflammatory fibrous hyperplasia and inflammatory papillary hyperplasia. The goal of this study is to evaluate the prevalence and factors associated with denture hyperplasia among a group of complete denture wearers. Methods: A cross-sectional observational study examined 146 complete denture wearers at Shorsh Teaching Dental Center in Sulaimani City between July 2022 and July 2023. A predesigned questionnaire was used, including: presence and types of hyperplasia and its relation to gender, age, type of the prosthesis, duration of wearing the denture, nocturnal denture wearing, history of fracture/repair or reline, professional who fabricated the prosthesis, denture cleaning method, and frequency of cleaning. Results: The percentage of hyperplasia was 38.4% while inflammatory fibrous hyperplasia and inflammatory papillary hyperplasia types were 35.6% & 1.4% respectively. Hyperplasia was 38(67.9%) of night wearers compared to 21(23.3%) non-night wearers with a highly significant difference (p<0.001). Also; significant relation in history of fracture/repair or reline (p=0.030) and with regard to frequency of denture cleaning (p=0.010). No differences were observed in presence of hyperplasia across age groups (p=0.215), gender (p=0.070), type of prosthesis (p=0.385), duration of wearing dentures (p=0.158), professional who fabricated the prosthesis (p=0.344) and denture cleaning method (p=0.379). Conclusions: The prevalence of denture hyperplasia was 38.4% which was the more common among night denture wearers.
subject: Articles
  topic: section
subject: Complete denture
  topic: keywords
subject: Denture hyperplasia
  topic: keywords
subject: Epulis fissuratum
  topic: keywords
subject: Papillary hyperplasia
  topic: keywords
creator: Banan Sarwer Al-Bajalan
creator: Jwan Fateh Abdulkareem
rights: Copyright (c) 2025 Banan Sarwer Al-Bajalan, Jwan Fateh Abdulkareem https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2025-12-01
publication date: 2025-12-01
starting page: 39
ending page: 47
doi: 10.56056/396

Delayed gastric emptying in classic pancreaticoduodenectomy vs pylorus-sparing pancreaticoduodenectomy, a retrospective and prospective comparative study
type: item
description: Background & objectives: The standard surgical method for treating pancreatic cancer and periampullary tumors is pancreaticoduodenectomy, Classic Whipple and Pylorus-preserving pancreaticoduodenectomy were the two surgical options, we intended to compare the incidence of delayed gastric emptying between Classic Whipple and Pylorus-preserving pancreaticoduodenectomy. Methods: A retrospective and prospective comparative study included fifty patients who underwent elective surgical pancreaticoduodenectomy including both Classic Whipple or pancreaticoduodenectomy in Zheen and Par hospitals between 2019 and 2024, comparing the elements of delayed gastric emptying with the options of surgical techniques and pre-operative status of the patients. Results: Most (37 patients) underwent the Classic Whipple, and the rest (13 patients) underwent the pancreaticoduodenectomy, significantly 100% of the Pylorus-preserving pancreaticoduodenectomy group had delayed gastric emptying, whether of grade A, or B (69.2%, and 30.8% respectively), while, 35.1% of patients in the Classic Whipple group didn’t develop it (p = 0.029). Two patients in the Classic Whipple group developed pancreatic fistula, compared with 0% in the other group (p = 1.000). Three patients (8.1%) in the Classic Whipple group developed chyle leaks, compared with 0% in the other group (p = 0.558). Four patients (10.8%) in the Classic Whipple group developed wound infection, compared with 0% in the other group (p = 0.561). Conclusion: delayed gastric emptying incidence significantly associated more with Pylorus-preserving pancreaticoduodenectomy, putting in consideration the postoperative morbidity which was increased in classic Whipple resection patients. Pylorus-preserving pancreaticoduodenectomy appears to be safe and just comparable with the Classic Whipple procedure.
subject: Articles
  topic: section
subject: Classic Whipple
  topic: keywords
subject: Delayed gastric emptying
  topic: keywords
subject: Jejunojejunostomy
  topic: keywords
subject: Pylorus-preserving pancreaticoduodenectomy
  topic: keywords
creator: Janan Wadea Zora
creator: Muhammed Nyazi Gheni
creator: Dilshad Abdulkareem Shexani
rights: Copyright (c) 2025 Janan Wadea Zora, Muhammed Nyazi Gheni , Dilshad Abdulkareem Shexani https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2025-12-01
publication date: 2025-12-01
starting page: 31
ending page: 38
doi: 10.56056/395

Prevalence of Dental Fluorosis Among Basic School Children Aged (8-14) Years in Sulaymaniyah City
type: item
description: Background and objectives: Fluoride is supported by much scientific evidence for its carious preventing effect. It has an important role in public health, but an excess amount of fluoride results in a condition called fluorosis. This study aimed to determine the prevalence of fluorosis among basic schoolchildren aged eight to fourteen years old in the Sulaymaniyah City/ Kurdistan region of Iraq and find relations of fluorosis with age, sex, and other demographic variables. Methods: in a cross-sectional study design, among 174203, 798 basic schoolchildren were chosen by multistage sampling method in Sulaimaniyah city in October and November 2022 and examined by modified Dean’s fluorosis index to assess fluorosis status. A form was also provided to be filled out and signed by the parents, which contained informed consent, demographical background, and information about the study. Results: Of 798 candidates examined, 389 (48.7%) were male and 408 (51.1%) females. The prevalence of fluorosis among participants was 18.54%, and the majority of cases were questionable 69 (47.58%) and very mild fluorosis 69 (47.58%), the rest were mild fluorosis 10 (6.89%), moderate fluorosis 1 (0.68%), and no severe fluorosis. There was a significant difference in fluorosis status between ages (p<0.001), but other demographic data have no statistically significant effect on fluorosis status, except for education of the mother p value<0.0001. Conclusions: Dental fluorosis is a public health concern in Sulaymaniyah City, the cause appears to be dietary sources other than drinking water which we recommend to be further investigated before any fluoridation programs.
subject: Articles
  topic: section
subject: Dental public health
  topic: keywords
subject: Enamel fluorosis
  topic: keywords
subject: Fluoride
  topic: keywords
subject: Water fluoridation
  topic: keywords
creator: Khulia Ibrahim Al Jaf
creator: Fadil Abdullah Kareem
creator: Sherzad Ali Ismael
rights: Copyright (c) 2025 Khulia Ibrahim Al Jaf, Fadil Abdullah Kareem, Sherzad Ali Ismael https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2025-12-01
publication date: 2025-12-01
starting page: 23
ending page: 30
doi: 10.56056/394

Cesarian Scar Ectopic Pregnancy: A Tertiary Maternity Hospital Case Series
type: item
description: Background and objective: Higher rates of cesarean section nowadays were accompanied with increased incidence of cesarean scar ectopic pregnancy. The purpose of this study was to investigate the clinical characteristics, therapy and outcome of the caesarean scar ectopic pregnancies Methods: A cross-sectional study implemented in the Maternity Teaching Hospital in Erbil city-Kurdistan region/Iraq through the period of one year from 1st of May 2022, to 30th of April 2023 on sample of 25 women with cesarean scar ectopic pregnancy. The cesarean section ectopic pregnancy was diagnosed in hospital according to history, clinical examination and ultrasonography findings. This study examined characteristics, history, diagnostics, management, and outcomes of pregnant women with cesarean scar ectopic pregnancy Results: Mean age of the women was 31 years and 52% of them were obese. The presenting symptom of cesarean-section ectopic pregnancy among studied women was vaginal bleeding (52%), followed by missed periods (24%), pain & bleeding (16%) and only pain (8%). Common initial management of women with CSEP was medical treatment (76%), followed by combined treatment (16%) and surgical treatment (8%). The mean gestational age was significantly longer among women with cesarean scar ectopic pregnancy treated surgically, while shorter in women treated medically (p=0.001). Conclusions: The risk factors of cesarean-section ectopic pregnancy are increased age, obesity, grand multi-gravidity, prior cesarean-sections and common presentation is vaginal bleeding at early gestational age.
subject: Articles
  topic: section
subject: Cesarean section ectopic pregnancy
  topic: keywords
subject: Initial management
  topic: keywords
subject: Resolution
  topic: keywords
creator: Midya Mohammed Ameen Mirkhan
creator: Aryiana Khalis Jawad
rights: Copyright (c) 2025 Midya Mohammed Ameen Mirkhan, Aryiana Khalis Jawad https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2025-12-01
publication date: 2025-12-01
starting page: 15
ending page: 22
doi: 10.56056/393

Impact of Clinical Pharmacist-led Intervention on Clinical Outcomes in Patients with Helicobacter pylori Infection
type: item
description: Background and objectives: Helicobacter pylori infection is prevalent and persistent in some cases. The rising incidence of drug resistance in this infection necessitates enhanced treatment methodologies. Our aim was to compare the efficacy of conventional therapy with that of a clinical pharmacist-led intervention for the management of Helicobacter pylori infection. Methods: This randomized controlled trial included 100 therapy-naïve patients with confirmed Helicobacter pylori infection, recruited from an outpatient private clinic in Koye-Erbil, Iraq, between May and November 2023. Patients were randomly assigned to either the control group (receiving conventional therapy) or the intervention group (receiving additional clinical pharmacist-led interventions focused on personalized treatment plans, patient education, and adherence support). Treatment success was assessed using the Helicobacter pylori stool antigen test for follow up one-month post-treatment. Medication compliance was evaluated using the Morisky-Green scale. Results: In this study, 54 (54.0) patients were female and 46 (46.0) patients were male. The intervention group showed a significantly higher rate of H. pylori eradication, with 42 (84%) patients testing negative in the second stool antigen test compared with 28 (56%) patients in the control group (p ? 0.002). Furthermore, medication compliance was significantly better in the intervention group of 36 (72%) patients compared to the control group of 18 (29%) patients (p < 0.013). Conclusion: Clinical pharmacist interventions improve therapeutic outcomes and medication compliance in patients with Helicobacter pylori infection. Although integrating into peptic ulcer disease management teams enhances the treatment effectiveness.
subject: Articles
  topic: section
subject: Clinical pharmacist intervention
  topic: keywords
subject: Controlled trial
  topic: keywords
subject: Helicobacter pylori infection
  topic: keywords
subject: Medication adherence
  topic: keywords
creator: Dlawar Hamad Mahmood
creator: Suha Saeed Azeez
creator: Hemn Shawgery
rights: Copyright (c) 2025 Dlawar Hamad Mahmood , Suha Saeed Azeez, Hemn Shawgery https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2025-12-01
publication date: 2025-12-01
starting page: 6
ending page: 14
doi: 10.56056/392

Congenital Infantile Fibrosarcoma of The Duodenum, A Case Report
type: item
description: Background: Congenital infantile fibrosarcoma is a rare soft-tissue tumor in the pediatric age group and seldom involves the gastrointestinal tract. Methods: This study is a case report study done in the Raparin Pediatric Hospital in Erbil on 9 days old boy with signs of intestinal obstruction. After explorative laparotomy a solid mass involving duodenojejunal junction was found, resection of the mass was done with end-to-end anastomosis and approval was taken from patient’s parents. Results: Histopathologic examination showed extensive replacement and effacement of the small bowel architecture by a cellular neoplasm. The tumor was extended through muscularis propria to the serosa with histological features consistent with congenital infantile fibrosarcoma, the diagnosis was confirmed by immunohistochemistry and genetic analysis which demonstrated the t(12;15) translocation. The baby was discharged on the 5th hospital day and followed up for 2 years without recurrence. Conclusion: Here we reported a rare case of congenital infantile fibrosarcoma arising from the small bowel in a new born baby, operated on, totally resected and histopathology proved the diagnosis and the patient was disease free after 2 years follow up.
subject: Articles
  topic: section
subject: Children
  topic: keywords
subject: Congenital
  topic: keywords
subject: Fibrosarcoma
  topic: keywords
creator: Hawkar Abdulla kakahmed
creator: Jalal Ali Jalal
creator: Ava Tahir Ismael
creator: Saman Salahaddin Abdulla
rights: Copyright (c) 2025 Hawkar Abdulla kakahmed , Jalal Ali Jalal, Ava Tahir Ismael, Saman Salahaddin Abdulla https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2025-12-01
publication date: 2025-12-01
starting page: 1
ending page: 5
doi: 10.56056/391