Background: Ageing may alter inflammatory and antioxidant responses in patients with pulmonary tuberculosis (TB). Growth differentiation factor-15 (GDF-15) and total antioxidant capacity (TAC) are potential markers of systemic stress and redox status. This study evaluated their associations with microbiological and radiographic disease burden in geriatric patients with active pulmonary TB. Methods: A cross-sectional study was conducted among 40 patients aged ≥60 years with newly diagnosed, drug-susceptible active pulmonary tuberculosis at RSUD Raden Mattaher Jambi, Indonesia, from September 2025 to February 2026. Serum GDF-15 and TAC were measured at diagnosis. Microbiological burden was categorized using semi-quantitative GeneXpert results, while radiographic burden was classified as minimal, moderate, or extensive based on chest radiography. Differences in biomarker concentrations across disease-burden categories were analyzed statistically. Results: The median age was 66 years (IQR, 63–69), and 87.5% were male. GeneXpert results were trace (10%), very low (5%), low (45%), medium (15%), and high (25%). Radiographic disease was minimal in 22.5%, moderate in 22.5%, and extensive in 55.0%. Median GDF-15 and TAC concentrations were 438.36 pg/mL (IQR, 379.76–583.43) and 17.53 (IQR, 13.63–22.19), respectively. Neither GDF-15 nor TAC differed significantly across microbiological burden categories (p = 0.873 and p = 0.570) or radiographic categories (p = 0.386 and p = 0.207). Conclusion: Circulating GDF-15 and TAC were not significantly associated with microbiological or radiographic disease burden in geriatric patients with active pulmonary tuberculosis. These biomarkers may therefore have limited value as standalone indicators of disease burden at diagnosis. Longitudinal studies with larger populations are warranted.

Objective: To compare maternal serum Anti-Müllerian Hormone (AMH) concentrations between women with first-trimester pregnancy loss and those with viable intrauterine pregnancies following spontaneous conception. Methods: This single-centre observational study included 63 women with spontaneously conceived first-trimester intrauterine pregnancies. Transvaginal ultrasonography classified 30 pregnancies as nonviable and 33 as viable at assessment. Serum AMH was measured by enzyme-linked immunosorbent assay. Concentrations were categorized as low (<1.1 ng/mL), intermediate (1.1-4.5 ng/mL), or high (>4.5 ng/mL). Crude Odds Ratios (ORs) were calculated using the intermediate category as the reference. Results: The reported mean serum AMH concentration was lower in the pregnancy-loss group than in the viable-pregnancy group (1.62±1.54 Vs 2.94±1.21 ng/mL, p<0.001). Low AMH occurred in 11 of 30 women (36.67%) with pregnancy loss and 3 of 33 (9.09%) with viable pregnancies. Compared with intermediate AMH, low AMH was associated with higher crude odds of pregnancy loss (OR 7.64, 95% Confidence Interval [CI] 1.79-32.58). The estimate for high AMH was imprecise (OR 2.92, 95% CI 0.77-11.12). Based on the reported category counts, an AMH threshold of <1.1 ng/mL yielded 36.67% sensitivity and 90.91% specificity for identifying nonviable pregnancies in the study sample. Conclusion: Lower serum AMH was associated with first-trimester pregnancy loss at clinical assessment. The low sensitivity at the evaluated threshold limits its utility as a standalone screening marker. Its ability to predict subsequent loss requires prospective evaluation in pregnancies confirmed to be viable at the time of sampling.

Background: Low insertion of the cystic duct can complicate biliary intervention. A plastic stent intended for the common bile duct may enter the cystic duct and remain unrecognized until subsequent surgery. Case presentation: A 62-year-old patient presented with jaundice of five days’ duration. Magnetic resonance imaging and magnetic resonance cholangiopancreatography demonstrated a distal common bile duct stone, intrahepatic and extrahepatic biliary dilatation, and gallstones. Endoscopic retrograde cholangiopancreatography was performed with stone extraction, duct sweeping and irrigation for sludge, followed by deployment of a 7-Fr plastic stent. Two weeks later, elective four-port laparoscopic cholecystectomy was undertaken after cardiac and anaesthetic assessment. The operating surgeon reported achievement of the critical view of safety. The cystic duct was wide and difficult to clip. On opening the duct, a plastic stent was encountered extending toward the gallbladder. Clips were removed to permit stent extraction, and cholecystectomy was completed. The reported postoperative course was uneventful. Retrospective radiological review was interpreted as demonstrating low cystic duct insertion. Conclusion: Unexpected stent material within the cystic duct should prompt reassessment of biliary anatomy and stent position. This case illustrates the value of correlating endoscopic findings, operative observations, and preoperative cross-sectional imaging.

Background: Patients with malignancies frequently develop anemia and disturbed iron metabolism. Entamoeba histolytica exposure may contribute to these abnormalities, although evidence in oncology populations remains limited. Objective: To examine the association between E. histolytica IgG seropositivity and iron dysregulation among adults with malignancies. Methods: The study included 190 adult patients attending private oncology clinics in Kirkuk, Iraq, from 20 February to 20 September 2026. Serum E. histolytica IgG was assessed by ELISA. Hemoglobin, serum iron, ferritin, total iron-binding capacity (TIBC) and transferrin saturation were compared between seropositive and seronegative groups. Results: IgG seropositivity occurred in 32 patients (16.84%). Seropositive patients had lower mean hemoglobin (10.4±1.5 versus 11.6±1.6 g/dL) and serum iron (44.8±17.6 versus 63.5±21.2 µg/dL; both p<0.001). Transferrin saturation (17.4±7.2% versus 23.1±8.8%; p = 0.001) and TIBC (263±48 versus 286±52 µg/dL; p = 0.022) were also lower, whereas median ferritin was higher (228 versus 176 ng/mL; p = 0.037). Anemia affected 75.00% of seropositive versus 45.57% of seronegative patients (OR = 3.58; 95% CI: 1.52–8.46). Overall iron dysregulation occurred in 78.13% versus 44.30%, respectively (OR = 4.49; 95% CI: 1.83–10.99). Conclusion: The study findings illustrate an association between E. histolytica IgG seropositivity and reduced circulating iron availability, higher ferritin and greater anemia frequency. IgG does not establish active infection and cross-sectional comparisons cannot demonstrate causality. Validation using observed patient data and stool-based diagnostic testing is required.

Background: Vitiligo is a chronic acquired depigmenting disorder characterized by melanocyte loss and impaired skin pigmentation. Narrowband ultraviolet B (NB-UVB) phototherapy is an established treatment for generalized vitiligo; however, achieving satisfactory re-pigmentation remains challenging. Pumpkin seed oil contains bioactive compounds with potential antioxidant and anti-inflammatory properties, suggesting a possible adjunctive therapeutic role. Objective: To evaluate the effectiveness and tolerability of topical pumpkin seed oil combined with NB-UVB phototherapy compared with NB-UVB alone in patients with generalized vitiligo. Materials and Methods: This comparative clinical study was conducted at the Centre of Dermatology, Medical City, Baghdad, Iraq, between June 2016 and November 2017. Twenty-seven patients with 100 vitiligo patches were enrolled into three treatment groups. Group A included five patients (16 patches) receiving 100% topical pumpkin seed oil twice daily; all discontinued follow-up after two months. Group B comprised 12 patients (42 patches) receiving NB-UVB phototherapy twice weekly, while Group C included 10 patients (42 patches) receiving NB-UVB combined with topical pumpkin seed oil twice daily. Lesion surface area was evaluated at baseline and after two, four and six months. Treatment response, re-pigmentation patterns and reported adverse effects were assessed. Results: At six months, mean lesion area decreased from 3.994±3.564 to 1.961±2.276 cm² in the NB-UVB group (p = 0.002), corresponding to a 50.90% reduction. In the combination group, mean lesion area declined from 4.327±3.363 to 1.769±2.079 cm² (p<0.001), representing a 59.10% reduction. Although the combination produced a numerically greater improvement, the between-group difference was not statistically significant (p = 0.687). Perifollicular re-pigmentation predominated with NB-UVB alone, whereas mixed re-pigmentation was more frequent with combination treatment. Transient erythema, burning and itching were reported with NB-UVB monotherapy, while no adverse effects were reported in the combination group. Conclusion: Both NB-UVB monotherapy and its combination with topical pumpkin seed oil were associated with substantial reductions in vitiligo lesion area over six months. Although adjunctive pumpkin seed oil produced numerically greater improvement, its additional therapeutic benefit was not statistically demonstrated. Larger, adequately powered randomized controlled trials with standardized outcome assessments are warranted to establish its clinical efficacy and safety.

Biologic therapy has transformed the treatment of severe chronic rhinosinusitis with nasal polyps, but its evidence base remains concentrated in type 2-predominant disease. Patients with type 1, type 3, or mixed inflammation lack both routine endotyping tools and validated endotype-directed treatment pathways. This review defines the therapeutic gap beyond type 2 chronic rhinosinusitis, critically appraises emerging therapeutic strategies, and identifies diagnostic barriers to prospective treatment selection. PubMed/MEDLINE, Embase, the Cochrane Library, ClinicalTrials.gov, and regulatory sources were reviewed for this narrative review from inception through 27 July 2026, prioritizing guidelines and phase 3 trials over earlier clinical and preclinical evidence. Current biologics have high-level evidence in type 2-predominant chronic rhinosinusitis with nasal polyps, but efficacy has not been established in prospectively defined non-type 2 disease. Interleukin-17 blockade remains supported only by case-level observations. Bacteriophage, regenerative, microbiome-directed, and physical approaches remain investigational. Clinically deployable biomarkers for type 1, type 3, and mixed disease are lacking. The principal unmet need beyond type 2 chronic rhinosinusitis is diagnostic as well as therapeutic. Progress requires reproducible endotyping assays, standardized definitions, and trials prospectively enriched for non-type 2 disease.

Background: Osteoporosis is a common systemic skeletal disease characterized by reduced bone mineral density (BMD) and deterioration of bone microarchitecture, resulting in an increased risk of fragility fractures. Although the disease affects both sexes, women, particularly after menopause, are at substantially greater risk. Data describing gender-related differences in osteoporosis among the Iraqi population remain limited. Objective: To investigate the associations of age, sex, body mass index (BMI), and fracture history with bone mineral density among patients in Kirkuk City, Iraq, and to compare the prevalence of osteoporosis between women and men, with particular emphasis on postmenopausal women. Methods: This cross-sectional study included 5,696 participants aged 10–100 years who attended two major hospitals in Kirkuk City, Iraq. Bone mineral density of the lumbar spine and femoral neck was measured using dual-energy X-ray absorptiometry (DEXA). Bone status was classified according to the World Health Organization T-score criteria. Demographic characteristics, anthropometric measurements, BMI, and fracture history were recorded. Associations between demographic variables and bone status were evaluated using appropriate statistical analyses. Results: Women comprised 90.66% of the study population, whereas men accounted for 9.34%. Participants older than 45 years demonstrated significantly higher rates of osteoporosis in both females (p = 0.013) and males (p = 0.049). Postmenopausal women exhibited the greatest burden of osteoporosis. BMI greater than 25 kg/m² was significantly associated with bone status (p = 0.0137). Osteoporotic fractures occurred significantly more frequently in women than in men (p<0.01). Conclusion: Osteoporosis was substantially more prevalent among women than men in Kirkuk City, with postmenopausal women representing the highest-risk group. Increasing age was the strongest factor associated with reduced bone mineral density in both sexes. These findings support the implementation of early osteoporosis screening and preventive interventions, particularly for women approaching menopause.

Background: The relationship between bilateral tubal ligation (BTL) and subsequent menstrual abnormalities remains controversial. While Post-Tubal Ligation Syndrome (PTLS) has been proposed to include abnormal uterine bleeding (AUB), dysmenorrhea and cycle irregularities, existing evidence is inconsistent and many reported associations may be confounded by underlying gynecologic or systemic conditions. Aim: The aim of this study is to compare menstrual patterns and associated clinical, ultrasonographic and histopathological findings between women with and without bilateral tubal ligation. Methods: A hospital-based case–control study was conducted at the Department of Obstetrics and Gynecology, Al-Imamein Al-Kadhimaein Medical City, Baghdad, Iraq, between 1^st December 2024 and 31^st October 2025. Two hundred women aged 30–50 years attending outpatient gynecology clinics were recruited and equally allocated into a post-BTL group (n = 100) and a non-BTL control group (n = 100). Each group was further stratified into women with and without abnormal uterine bleeding based on FIGO definitions. Eligible participants had a history of regular cycles prior to sterilization and no recent hormonal contraceptive use. Women with pregnancy, lactation, known thyroid disease, coagulopathies, uterine malignancy, or significant systemic illness were excluded. Results: No significant differences were observed between post-BTL and non-BTL women regarding age distribution (p = 0.312), parity (p = 0.186), types of menstrual disorders (p = 0.842), dysmenorrhea severity (p = 0.520), or endometrial thickness (p = 0.901). Histopathological findings were comparable between groups (p = 0.761) and neither the timing nor duration since tubal ligation was associated with AUB occurrence (p = 0.634 and p = 0.733, respectively). Although cycle irregularity was more frequent among post-BTL women (46% vs. 37%), the difference was not statistically significant (p = 0.184). Thyroid dysfunction showed a significant association with AUB overall (p = 0.041). Ultrasonographic abnormalities—such as endometrial polyps, adenomyosis, hyperplasia and ovarian cysts—were significantly more prevalent among women with AUB, independent of tubal ligation status (p = 01). Conclusion: Bilateral tubal ligation was not associated with abnormal uterine bleeding, menstrual cycle disturbances, dysmenorrhea severity, endometrial thickness, or histopathological abnormalities. Structural gynecologic pathology and thyroid dysfunction were the primary contributors to AUB in this population. These findings do not support the existence of a distinct Post-Tubal Ligation Syndrome and emphasize the importance of comprehensive evaluation for alternative causes of menstrual abnormalities before attributing symptoms to tubal ligation.

Background: Suicide represents a complex public health challenge arising from the interaction of psychological, social, economic, biological, and environmental factors; therefore, it cannot be attributed to a single cause. This study aimed to describe the demographic characteristics, patterns, and documented circumstances of suicide deaths referred to the Department of Forensic Medicine in Kirkuk during 2025. Methods: A retrospective descriptive study was conducted involving all deaths officially recorded and medicolegally confirmed as suicide between January 1 and December 31, 2025. Data concerning sex, age, marital status, educational attainment, occupation, method of death, and documented motive or associated circumstance were extracted from the official records. Categorical data were summarized using frequencies and percentages. Results: The study included 43 cases: 26 males (60.47%) and 17 females (39.53%). The mean age was 25.2 ± 8.8 years, with an age range of 13-49 years. Individuals aged 20–29 years constituted the largest age group, accounting for 23 cases (53.49%). Hanging was the most frequently recorded method of death (18 cases; 41.86%), followed by burning (14 cases; 32.56%) and firearm injury (10 cases; 23.26%).%). Burning was particularly prevalent among females (10/17; 58.82%), whereas hanging predominated among males (13/26; 50.00%). The motive or associated circumstance was undocumented in 22 cases (51.16%). Among the documented circumstances, psychological factors or mental illness were the most frequently reported (9 cases; 20.93%), followed by family-related problems (7 cases; 16.28%). Conclusion: Suicide deaths were concentrated predominantly among young individuals, with a notable sex-related difference in the methods used and a substantial deficiency in the documentation of underlying motives and circumstances. These findings support the establishment of a standardized surveillance system, early mental health assessment, and multisectoral preventive interventions tailored to age- and sex-specific patterns, together with appropriate measures to restrict access to highly lethal means.

Background: Congenital pulmonary airway malformation (CPAM), formerly congenital cystic adenomatoid malformation, is a developmental lung lesion increasingly detected antenatally. Prenatal recognition can facilitate fetal surveillance, delivery planning, postnatal imaging, and coordinated multidisciplinary care. Case presentation: A right-lung lesion was first detected on February 28, 2026, at 17 weeks 5 days of gestation. Ultrasonography demonstrated a 41 x 27 mm lesion containing multiple 4-9 mm cystic spaces within hyperechoic parenchyma, with inversion of the right hemidiaphragm and leftward displacement of the heart and mediastinum. The prenatal appearance was considered suggestive of CPAM/CCAM type II. At 31 weeks 5 days, the lesion measured 56 x 35 mm; the contralateral lung remained preserved, fetal Doppler studies were normal, and no hydrops was reported. A female infant was delivered at term on July 21, 2026, weighing 2.9 kg, with Apgar scores of 7 and 9 at 1 and 5 minutes. Postnatal chest radiography and computed tomography confirmed a predominantly right lower-lobe lesion without aberrant systemic arterial supply. Open right thoracotomy and anatomical right lower lobectomy were performed on July 22, within approximately 24 hours of birth. Postoperative course: The infant underwent structured respiratory, chest-tube, wound, laboratory, infection, and feeding surveillance. The chest tube was removed after 7 days. She was transferred to the Pediatric Ward on day 10 and discharged on day 12, clinically stable on room air with oxygen saturation of 98-99%. She remained clinically well approximately 2 weeks after discharge and at 40 days of age. Conclusion: Prenatal recognition of CPAM enabled planned postnatal assessment and coordinated neonatal management. Very early lobectomy was feasible in this selected infant and was followed by a favorable short-term outcome. This case demonstrates feasibility rather than superiority of immediate neonatal surgery; the optimal timing of resection in clinically stable infants remains unsettled.

The present work focuses on using flaxseed husk biomass as an inexpensive, environmentally acceptable biosorbent to remove Mercury ions from aqueous solutions using ultrasonic irradiation. The batch adsorption experiment was conducted to examine the influence of temperature, starting Mercury concentration, and contact duration on adsorption efficacy. The maximal adsorption capacity was 6.385 mg g⁻¹, and the removal efficiency reached 83% at equilibrium for the 90–100 minute research period. The adsorption capacity augmented with prolonged contact time. The adsorption kinetics were analysed using pseudo-first and pseudo-second order models. The pseudo-second-order model (R2 = 0.982) accurately characterised the adsorption process, indicating that the rate-limiting phase was chemisorption. Equilibrium investigations indicated that the Freundlich isotherm model (R2 = 0.909) more accurately represented the adsorption behaviour compared to the Langmuir model (R2 = 0.048), implying adsorption on a heterogeneous surface. Thermodynamic study revealed that the adsorption process was endothermic, characterised by positive changes in enthalpy and entropy. Ultrasonic irradiation improved Mercury removal by augmenting the availability of active sites for adsorption and enhancing mass transfer. The findings demonstrated the efficacy of ultrasonic-assisted adsorption in enhancing the process using flaxseed husk biomass as a sustainable adsorbent for Mercury extraction from polluted water.

Background: Pregnancy leads to major physiological changes, which can cause complications like intrauterine fetal death, hypertensive disorders. Changes in placental leucine aminopeptidase serum levels may indicate placental dysfunction and associated risks for maternal health.

Aim of the study: To evaluate the relationship between maternal serum placental leucine aminopeptidase levels and pregnancy outcomes.

Patients and Methods: A case-control study involving 150 pregnant women was conducted in the Obstetrics and Gynecology department of Al- Khansaa and Al Batool Maternity teaching hospitals from January 1 to June 30, 2025. Participants were divided into three groups: Group 1 (25 cases of intrauterine fetal death), Group 2 (25 cases of hypertensive disorders)  and Group 3 (100 healthy controls). Serum placental leucine aminopeptidase levels were measured to compare between cases and controls, adjusting for gestational age differences.

Results: Maternal serum placental leucine aminopeptidase levels were significantly lower in  case groups compared with the control group (p < 0.001). The intrauterine fetal death group demonstrated the lowest of maternal serum placental leucine aminopeptidase levels. Significant differences were also observed in maternal age, body mass index, gravidity, and parity. Receiver operating characteristic analysis revealed excellent discriminative ability of  maternal serum placental leucine aminopeptidase as a predictor of adverse pregnancy outcomes, with an area under the curve of 0.999 and cut-off points 812.7566.

Conclusion: Lower maternal serum placental leucine aminopeptidase levels were showed in  complicated pregnancies, which may indicate negative pregnancy outcomes.

Background: Varicocele is one of the most common surgically correctable causes of male infertility, affecting approximately 15% of the general male population. It is detected in nearly 35% of men with primary infertility and up to 81% of those with secondary infertility. Several operative techniques are currently available for varicocele repair, including open and laparoscopic approaches.Aim: To compare open bilateral subinguinal varicocelectomy and laparoscopic bilateral varicocelectomy regarding operative time, clinical outcome, seminal fluid analysis, postoperative complications, operation-related pain, hospital stay, and return to normal activity.Patients and Methods: This prospective comparative study was conducted at the Urology Department of Al-Imamain Al-Kadhymain Medical City from January 2015 to August 2016. A total of 63 male patients with bilateral varicocele were enrolled and divided into two groups. Group I included 30 patients who underwent open bilateral subinguinal varicocelectomy, whereas Group II included 33 patients treated with laparoscopic bilateral varicocelectomy. Clinical assessment, semen analysis, operative time, postoperative complications, pain score, hospital stay, and return to normal activity were evaluated and statistically analyzed.Results: The mean age was 28 ± 8 years in the open surgery group and 25 ± 7 years in the laparoscopic group. Operative time was significantly shorter in the laparoscopic group (45 ± 9 minutes) compared with the open group (50 ± 20 minutes) (P < 0.05). Operation-related pain was significantly lower in the open surgery group (2.8 ± 1.2) compared with the laparoscopic group (4.1 ± 1.3) (P < 0.05). Improvement in semen analysis was observed in both groups without statistically significant differences (P > 0.05). Most patients had no postoperative complications. The mean hospital stay was one day in both groups, and no significant difference was found regarding return to normal activity.Conclusion:Both open bilateral subinguinal varicocelectomy and laparoscopic bilateral varicocelectomy are effective and safe techniques for bilateral varicocele treatment. Laparoscopic surgery offers shorter operative time and faster recovery, whereas open surgery is associated with lower postoperative pain.