Background: Patent ductus arteriosus (PDA) is a common cardiovascular condition in premature infants and is associated with significant morbidity and mortality if not treated promptly. Ibuprofen has been widely used for pharmacological closure of PDA; however, concerns regarding adverse effects have led to increasing interest in alternative therapies such as acetaminophen. Methods: A prospective comparative study was conducted in the Neonatal Intensive Care Units (NICUs) of Dr. Jamal Ahmed Rashid Pediatric Teaching Hospital and the Maternity Hospital in Sulaymaniyah from July 2023 to February 2024. Seventy-five preterm neonates with echocardiographically confirmed PDA were included. Infants were divided into three groups: 25 received oral ibuprofen, 25 received oral acetaminophen, and 25 were managed conservatively due to parental refusal of treatment. PDA closure and adverse effects were evaluated using echocardiography and laboratory investigations. Results: Among the 75 infants studied, 43 (57.3%) were male and 32 (42.7%) were female. The gestational age ranged from 25 to 37 weeks, with 64% of infants older than 27 weeks. PDA closure was observed in 19 (76%) infants treated with ibuprofen and 15 (60%) infants treated with acetaminophen. Overall, 34 out of 50 treated infants (68%) achieved ductal closure. In the untreated group, spontaneous closure occurred in 10 out of 25 infants (40%). The likelihood of closure was higher in infants with gestational age greater than 27 weeks. Regarding safety, most infants experienced no adverse effects. In the ibuprofen group, side effects included decreased platelet count in 2 cases (8%), increased renal function tests in 3 cases (12%), and necrotizing enterocolitis in 1 case (4%). In the acetaminophen group, decreased platelet count occurred in 2 cases (8%) and elevated liver function tests in 2 cases (8%). The overall mortality rate was 9.3%, predominantly among infants with gestational age ≤27 weeks. Conclusion: Oral ibuprofen demonstrated a higher PDA closure rate compared with oral acetaminophen in premature infants. However, acetaminophen showed a comparable safety profile and may represent a reasonable alternative treatment option when ibuprofen is contraindicated or not tolerated. Further studies with larger sample sizes and longer follow-up periods are recommended to determine the optimal pharmacological approach for PDA closure in preterm infants.

Background: Primary unexplained recurrent pregnancy loss (URPL) remains a major reproductive health problem, and increasing evidence suggests that immune and inflammatory dysregulation may contribute to its pathogenesis.  Objective: To assess first-trimester maternal serum PTX3 levels in women with primary unexplained recurrent pregnancy loss and compare them with healthy pregnant controls, and to evaluate the potential diagnostic value of PTX3 in predicting URPL. Patients and Methods: This prospective case-control study was conducted at Tikrit Teaching Hospital, Iraq, from January 2024 to December 2024. Eighty pregnant women in the first trimester were enrolled and divided into two groups: 40 women with primary unexplained recurrent pregnancy loss and 40 healthy pregnant controls with at least one previous uncomplicated pregnancy. Women with known causes of recurrent miscarriage, smoking, multifetal pregnancy, hypertension, preeclampsia, intrauterine growth restriction, preterm birth, or intra-amniotic infection were excluded. Maternal venous blood samples were collected under aseptic conditions, and serum PTX3 levels were measured using enzyme-linked immunosorbent assay (ELISA). Results: Maternal demographic and baseline clinical characteristics were comparable between the two groups, with no significant differences in maternal age, duration of marriage, height, weight, body mass index, socioeconomic status, residence, smoking status, or gestational age at sampling (p>0.05). In contrast, serum PTX3 levels were significantly higher in the URPL group than in controls (12.00 ± 4.07 vs. 1.69 ± 0.91 ng/mL, p<0.001). PTX3 levels also showed a progressive increase with the number of previous miscarriages, rising from 9.7 ± 2.8 ng/mL in women with three miscarriages to 14.7 ± 2.6 ng/mL in women with six or more miscarriages. Diagnostic analysis showed that a PTX3 cutoff value of 6.0 ng/mL provided the best balance between sensitivity (87.5%) and specificity (90.0%) for predicting URPL. Conclusions: First-trimester maternal serum PTX3 levels are significantly elevated in women with primary unexplained recurrent pregnancy loss and increase with miscarriage frequency. These findings support a possible role of PTX3 in the inflammatory and immune mechanisms underlying URPL and suggest that PTX3 may serve as a promising early biomarker for identifying women at increased risk.

Introduction and Aim: Ectopic pregnancy (EP) is a potentially life-threatening gestational event in which a conceptus implants outside the uterine cavity. Early detection is vital to avoid the complications. The purpose of the present study was to examine serum HSP70 in women having a diagnosis of EP in comparison with normal IUP and sein diagnostic accuracy. Materials and Method: A case control study done in Azadi Teaching Hospital, Iraq, during the period from January- May/ 2024. A total of 86 women in the first trimester (4–12 weeks) were enrolled: 38 with EP, and 48 with IUP. The levels of serum HSP70 were detected with an Elisa kit. Clinical, laboratory and demographic data were retrieved and statistically analyzed. Results: The mean serum HSP70 concentration of EP cases was significantly higher (in 0.465±0.221 pg/mL) than IUP cases (in 0.153±0.068pg/ mL, p < 0.001). ROC curve analysis revealed high diagnostic accuracy with an AUC of 0.927. At a cut-off level of 0.1805 pg/mL, sensitivity and specificity both reached 92.1% and 87.5%, respectively usefully distinguished from healthy subjects to esthesioneuroblastoma patients (p<.001), positive predictive value was 85%, negative predictive value was 93.5%. Symptoms and signs were abdominal pain (86.8%), vaginal bleeding (65.8%) and cervical excitation (44.7%). Age, BMI and gravidity did not differ significantly between the two groups. Serum β-hCG concentrations were significantly higher in the EP (1592±87 mIU/mL) than in IUP (2036±874 mIU/mL), (p = 0.003. The levels of HSP70 were associated with the clinical severity in terms of shoulder pain and hemodynamics. Conclusions: Serum HSP70 is markedly high in ectopic pregnancy and can be used as an early noninvasive and sensitive supportive biomarker algorithmic to β-hCG estimation, and ultrasonography.

Background: Age-related hearing loss (ARHL) is a progressive bilateral sensorineural hearing impairment predominantly affecting high frequencies. Increasing evidence suggests that oxidative stress plays a central role in cochlear degeneration and auditory cell senescence. However, clinical data evaluating systemic oxidative stress biomarkers in ARHL patients remain limited in Iraqi populations. Objective: To assess the association between oxidative stress biomarkers and age-related hearing loss and to evaluate their diagnostic and predictive value. Methods: This hospital-based case–control study was conducted at the Department of Otolaryngology, Al-Kindy Teaching Hospital, Baghdad, between 1^st April 2024  and 30^th June 2025. A total of 100 participants were enrolled: 50 patients diagnosed with ARHL and 50 age- and sex-matched controls with normal hearing thresholds. All participants underwent pure-tone audiometry (0.5–8 kHz). Hearing severity was classified as mild, moderate, severe, or profound. Serum levels of malondialdehyde (MDA), superoxide dismutase (SOD), and glutathione peroxidase (GPx) were measured using ELISA kits. Statistical analysis included independent t-test, chi-square test, Pearson correlation, logistic regression, and ROC curve analysis. Results: Patients with ARHL demonstrated significantly elevated MDA levels (5.80±1.20 nmol/mL) compared with controls (3.40±0.90 nmol/mL, p < 0.001). Antioxidant enzymes were significantly reduced in cases: SOD (92.50±15.30 vs. 118.60±17.40 U/mL, p < 0.001) and GPx (38.40±6.80 vs. 49.70±7.10 U/L, p < 0.001). MDA showed a strong positive correlation with pure-tone average (r = 0.62, p < 0.001), while SOD (r = −0.58, p < 0.001) and GPx (r = −0.55, p < 0.001) were negatively correlated. Logistic regression identified MDA as an independent predictor of ARHL (Adjusted OR = 3.10, p < 0.001). ROC analysis revealed good diagnostic performance for MDA (AUC = 0.88), SOD (AUC = 0.85), and GPx (AUC = 0.82). Conclusion: Oxidative stress is strongly associated with age-related hearing loss. Elevated lipid peroxidation and reduced antioxidant defense appear to contribute to ARHL severity. MDA, SOD, and GPx may serve as useful biomarkers for risk assessment and early detection of ARHL.

Background: Femoral shaft fractures in adults are major long-bone injuries that commonly follow high-energy trauma and are associated with substantial morbidity, prolonged hospitalization, and clinically important complications. Objective: To determine the frequency, patterns, and predictors of complications among adults with femoral shaft fractures managed at Al-Kadhimiya Teaching Hospital and Imam Ali Hospital, Baghdad, Iraq. Methods: A hospital-based retrospective observational study was conducted from February 1, 2021 to June 30, 2025. Adults (≥18 years) with radiologically confirmed femoral shaft fractures and complete records were included, pathological and periprosthetic fractures and incomplete files were excluded. Data were extracted from admission logs, operative records, and radiology databases. Variables included demographics, injury mechanism, fracture characteristics (including AO/OTA classification), open/closed status, associated injuries, comorbidities (including smoking and diabetes), treatment modality, time to surgery, hospital course, and early/late complications. Standard radiographs were used to assess alignment and union. Results: A total of 312 patients were analyzed (mean age 36.8±12.4 years), most were males (236, 75.64%) and urban residents (204, 65.38%). Road traffic accidents were the leading mechanism (182, 58.33%), followed by falls from height (71, 22.76%). Most fractures were closed (247, 79.17%), with a substantial proportion of open fractures (65, 20.83%). AO/OTA 32-B patterns predominated (131, 41.99%). Intramedullary nailing was the main treatment (208, 66.67%), and the mean time to surgery was 3.4±1.9 days. Major complications included delayed union (36, 11.54%), surgical site infection (29, 9.29%), nonunion (21, 6.73%), malunion (18, 5.77%), and implant failure (15, 4.81%). Significant predictors of major complications were smoking (p=0.002), diabetes (p=0.004), open fractures (p<0.001), surgical delay >5 days (p<0.001), and associated injuries (p=0.011). Conclusion: Adult femoral shaft fractures in Baghdad predominantly affect young men and are primarily caused by road traffic trauma. Complications remain frequent and are strongly associated with modifiable patient factors (smoking, diabetes) and injury/management factors (open fractures, polytrauma, delayed surgery). Targeted prevention and optimized perioperative pathways focusing on early stabilization and risk-factor control may improve outcomes.

Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a heterogeneous inflammatory disease predominantly driven by type-2 immune responses, yet objective assessment of disease control remains challenging. Circulating biomarkers that reflect underlying inflammatory activity may improve disease stratification and monitoring. Interleukin-5 (IL-5) plays a central role in eosinophilic inflammation, while calprotectin (S100A8/A9) reflects innate immune activation and neutrophilic pathways. Aim: To evaluate serum calprotectin and IL-5 levels in patients with CRSwNP compared with healthy controls and to assess their association with disease control, endoscopic findings, symptom severity, olfactory dysfunction and systemic corticosteroid use. Materials and Methods: This hospital-based case-control study was conducted in Baghdad, Iraq, (Imam Ali Hospital, Al-Kindy Teaching Hospital) between February 2024 and March 2025. Thirty patients with confirmed CRSwNP and thirty age- and sex-matched healthy controls were enrolled. Disease control was assessed clinically and endoscopically. Serum calprotectin and IL-5 levels were measured using enzyme-linked immunosorbent assay (ELISA). Results: Serum calprotectin and IL-5 levels were significantly higher in CRSwNP patients than in controls (p <0.001 for both). Within the CRSwNP group, uncontrolled disease was associated with markedly elevated calprotectin and IL-5 levels compared with controlled disease (p = 0.003 and p = 0.001, respectively). Both biomarkers increased progressively with worsening endoscopic inflammation, higher sinonasal symptom severity and greater olfactory impairment (p <0.001). Patients with frequent systemic corticosteroid use exhibited the highest serum biomarker levels, indicating a greater inflammatory burden. Conclusion: Serum calprotectin and IL-5 are significantly elevated in CRSwNP and correlate closely with disease severity, poor control, endoscopic inflammation, symptom burden, olfactory dysfunction and treatment intensity. These findings support their potential utility as accessible systemic biomarkers for assessing inflammatory activity and disease control in CRSwNP, complementing clinical and endoscopic evaluation.

Into the uterine wall, or both. It encompasses conditions such as placenta accreta (PA) and placenta previa (PP), which are associated with significant maternal and neonatal morbidity. Aim: This study aimed to assess the association between second-trimester levels of serum human chorionic gonadotropin (hCG) and alpha-fetoprotein (AFP), measured between 24 and 30⁺⁶ weeks of gestation, and the prediction of pathological placentation. Patients and Methods: This prospective case-control study was conducted in Tikrit City from 1^st of December 2023, to 1^st of september 2024. Ninety pregnant women with singleton gestations who delivered at Tikrit Teaching Hospital and had complete documentation of second-trimester serum screening results were included. Participants underwent maternal serum biochemical screening between the 24 and 30⁺⁶ weeks of gestation. The study cohort was divided into two groups: women with pathological placentation (n=60: PA=30, PP=30) and a control group with normal placentation (n=30), matched for gestational age, parity, and history of cesarean sections. Exclusion criteria included multiple gestations, incomplete data, fetal anomalies, and maternal comorbidities. Maternal serum levels of AFP and hCG were measured using time-resolved fluorescence immunoassay. Results: Women with pathological placentation were older (mean age 35.2±5.6 years) compared to the control group (31.7±4.9 years, p = 0.007). Differences were observed in the indications for cesarean delivery, with higher incidences of placenta previa (41.67% vs. 3.33%, p = 0.005) and low-lying placenta (5% vs. 0%, p = 0.041) in the pathological group, while prolonged second-stage labor was more common in the control group (0% vs. 16.67%, p = 0.015). Women with pathological placentation had higher rates of hysterectomy (5% vs. 0%, p = 0.004), blood transfusions (28.33% vs. 3.33%, p<0.001), anemia (41.67% vs. 3.33%, p<0.001), and postpartum hemorrhage (PPH) (28.33% vs. 3.33%, p<0.001). Neonates of these women had higher rates of NICU admissions (60% vs. 16.67%, p = 0.04) and transient tachypnea of the newborn (TTN) (16.67% vs. 6.67%, p = 0.045). Elevated levels of AFP (1.25±0.30 vs. 1.10±0.28) and hCG (1.45±0.52 vs. 0.98±0.36) were significantly associated with pathological placentation. Logistic regression analysis indicated that lower AFP and hCG values at the 25^th percentile significantly reduced the risk of pathological placentation, whereas higher hCG values at the 75th percentile significantly increased the risk (adjusted OR: 2.31, p = 0.001). ROC curve analysis demonstrated moderate diagnostic accuracy with an area under the curve (AUC) of 0.580 for AFP, 0.670 for hCG, and 0.675 for the combined markers. Conclusion: Elevated serum levels of hCG and AFP in the second trimester are significantly associated with pathological placentation, particularly in cases of placenta previa and accreta. Combined assessment of these markers provides moderate diagnostic accuracy for predicting pathological placentation. These findings suggest the potential use of hCG and AFP as part of a screening strategy to identify women at risk for pathological placentation, allowing for tailored management and improved maternal and neonatal outcomes.