Background: Endoscopic endonasal transsphenoidal pituitary surgery (EETPS) is widely adopted for the management of pituitary adenomas and sellar lesions; however, postoperative cerebrospinal fluid (CSF) rhinorrhea remains a major source of morbidity. Objective: This study aimed to evaluate the clinical outcomes of endoscopic sellar reconstruction after transsphenoidal pituitary surgery from an otolaryngologic perspective, with particular emphasis on the effectiveness of a standardized, graded reconstruction algorithm in minimizing postoperative CSF rhinorrhea and associated complications. Methods: This hospital-based observational cross-sectional study was conducted at Imam Ali Hospital and Al-Kindy Teaching Hospital, Baghdad, Iraq, between March 2024 and May 2025. A total of 195 consecutive adult patients undergoing EETPS for pituitary adenomas or other sellar lesions were included. All procedures were performed using a collaborative neurosurgical-otolaryngologic endoscopic approach. Sellar reconstruction was carried out according to a standardized, graded algorithm based on intraoperative CSF leak status and defect size. Demographic data, tumor characteristics, intraoperative findings, reconstruction techniques and postoperative outcomes were analyzed. The primary outcome was postoperative CSF rhinorrhea, while secondary outcomes included postoperative complications and factors associated with CSF leakage. Results: Intraoperative CSF leakage was observed in 74 patients (37.95%), including high-flow leaks in 21 patients (10.77%). Multilayer reconstruction was employed in 148 cases (75.90%), with nasoseptal flap utilization in 62 patients (31.79%). Postoperative CSF rhinorrhea occurred in 12 patients (6.15%) and was significantly associated with high-flow intraoperative CSF leakage (28.57%, p = 0.001), macroadenoma size (p = 0.009) and absence of vascularized flap reconstruction (p = 0.003). Other postoperative complications were infrequent and generally mild. Conclusion: A standardized, graded sellar reconstruction algorithm in EETPS is effective in reducing postoperative CSF rhinorrhea, particularly when reconstruction strategies are escalated in cases of high-flow intraoperative CSF leakage. From an otolaryngologic perspective, the integration of vascularized flaps and tailored reconstruction plays a crucial role in improving surgical outcomes and minimizing CSF-related complications.

Background: Hyperphosphatasia with Impaired Intellectual Development Syndrome (HPMRS, Mabry syndrome) is a rare autosomal recessive disorder caused by mutations in genes responsible for glycosylphosphatidylinositol (GPI)-anchor biosynthesis. It is characterized by persistently elevated serum alkaline phosphatase (ALP), intellectual disability, seizures, dysmorphic features, and skeletal abnormalities. Case Presentation: We report the case of an 18-month-old Iraqi girl with genetically confirmed HPMRS-1 (PIGV mutation). She presented with refractory generalized tonic–clonic seizures, cortical blindness, hypotonia, global developmental delay, and distinct craniofacial and skeletal dysmorphism. Laboratory investigations showed persistently elevated ALP levels (2–20× above normal). Brain MRI demonstrated cerebral atrophy. Whole-exome sequencing confirmed a pathogenic PIGV mutation consistent with HPMRS-1. Despite treatment with multiple antiepileptic drugs including valproate, brivaracetam, lacosamide, and pyridoxine, seizures remained poorly controlled. Conclusion: This is the first genetically confirmed case of HPMRS reported from Iraq. The case highlights the importance of considering HPMRS in infants presenting with developmental delay, refractory seizures, and unexplained hyperphosphatasemia. Early diagnosis is essential for genetic counseling, supportive management, and avoidance of unnecessary investigations.

Background:  Pilonidal sinus disease (PNS) continues to pose a surgical dilemma and is commonly encountered in young adults, primarily due to the high rate of recurrence and long healing time with traditional midline techniques. Contemporary reconstructive procedures, such as the Keystone perforator flap and the Bascom cleft-lift procedure, have been proposed to reduce recurrence, promote wound healing, and produce better cosmesis through off-midline closure under no tension. Objective: This study aimed to compare the clinical outcomes of the Keystone perforator flap and the Bascom cleft-lift operation in the management of chronic and recurrent PNS at Al-Kindy Teaching Hospital.  Methods: A retrospective observational study was conducted from January 2022 to June 2025, including 200 patients diagnosed with primary or recurrent PNS. Group A (n=100) underwent the Keystone perforator flap, while Group B (n=100) received the Bascom cleft-lift procedure. Data were analyzed using SPSS v26 to evaluate operative time, healing duration, hospital stay, complications, recurrence, and patient satisfaction. Results: The Keystone flap achieved significantly faster complete wound healing (21±3 days vs. 42±6 days; p<0.001) and shorter hospital stay (2.1±0.6 days vs. 3.8±1.2 days; p<0.001) compared to the Bascom operation. Postoperative complications were fewer in the Keystone group, with lower rates of infection (5% vs. 9%), seroma (4% vs. 10%), and wound dehiscence (3% vs. 8%). Recurrence within one year was lower among Keystone patients (2% vs. 7%), alongside significantly higher cosmetic satisfaction (92% vs. 80%) and earlier return to work (15±4 days vs. 28±6 days; p<0.001). Conclusion: The Keystone perforator flap provides superior outcomes compared to the Bascom operation, including faster healing, reduced morbidity, lower recurrence, and enhanced cosmetic and functional recovery. It represents a reliable reconstructive option, especially for large or recurrent PNS cases, while the Bascom operation remains a valuable alternative for smaller or primary lesions.

Background: Scleral melt (surgically induced necrotizing scleritis, SINS) is an uncommon but vision-threatening complication after pterygium surgery. Pharmacologic modulation of postoperative inflammation may influence tissue integrity. Objective: To assess the impact of postoperative anti-inflammatory regimen on the incidence, timing, and severity of scleral melt after standardized pterygium excision. Methods: Prospective cross-sectional study at Al-Kindy Teaching Hospital and Imam Ali Hospital, Baghdad (1 March–31 December 2024). Adults with primary nasal pterygium underwent excision with direct scleral suturing by a single surgeon. Patients were randomized to one of three postoperative regimens (n=15/group), all receiving ofloxacin 0.3%: Group I fluorometholone 0.1%; Group II prednisolone acetate 1%; Group III ibuprofen ophthalmic drops. Exclusions: abnormal ESR/CRP, autoimmune disease, positive culture, prior ocular surgery/trauma. Follow-up at 1 week, 1 month, and 3 months recorded scleral thinning/necrosis, graded as mild/moderate/severe. Primary outcome was scleral melt incidence; secondary outcomes included time to onset, risk factors, and management outcomes. Results: Scleral melt occurred in 10 (22.22%): 0/15 (0.00%) in fluorometholone, 4/15 (26.67%) in prednisolone acetate, and 6/15 (40.00%) in ibuprofen groups. Severity distribution among melts: mild 4 (8.89%), moderate 3 (6.67%), severe 3 (6.67%). Mean time to onset was earlier with ibuprofen (14.2±3.9 days) than prednisolone acetate (18.6±4.2 days); both differed from fluorometholone (no cases; p=0.02 and p=0.04, respectively). Chronic UV exposure 9/30 (30.00%; p=0.03) and dry-eye symptoms 4/12 (33.33%; p=0.04) were associated with melt; diabetes was not (p=0.19). Management: discontinuation of anti-inflammatory plus lubricants resolved 6/10 (60.00%) in 18±5 days; amniotic membrane grafting 3/10 (30.00%) resolved in 27±6 days; 1/10 (10.00%) required conjunctival autograft (improved with scarring). Conclusions: Postoperative regimen is a key modifiable determinant of scleral integrity after pterygium surgery. Fluorometholone 0.1% showed a favorable safety profile (0.00% melt), whereas prednisolone acetate 1% and topical ibuprofen were associated with higher and earlier melt rates. UV protection and aggressive lubrication should be emphasized, and routine postoperative NSAIDs should be avoided.

Background: Respiratory diseases are among the leading contributors to global morbidity and mortality, with obstructive and restrictive lung diseases posing significant health and socioeconomic challenges. In India, the burden is disproportionately high due to widespread risk factors such as smoking, household air pollution, occupational exposures, and post-tuberculosis sequelae. Punjab, with its high prevalence of tobacco use, industrial and agricultural exposures, and reliance on biomass fuels, faces particular vulnerability. Despite this, community awareness regarding risk factors, symptoms, and preventive strategies remains poorly documented. Materials and Methods: A descriptive, cross-sectional study was conducted among 400 adults in Punjab using a structured, self-administered Google Form questionnaire. The tool comprised four sections: socio-demographic data, exposure history, 20 multiple-choice knowledge questions on obstructive and restrictive lung diseases, and overall knowledge scoring (excellent: 16–20; good: 12–15; fair: 8–11; poor: 0–7). The questionnaire was validated through expert review and pilot testing (Cronbach’s alpha = 0.82). Data were analyzed using descriptive statistics and Chi-square tests to assess associations between knowledge levels and socio-demographic factors, with significance set at p <0.05. Results: Of the 400 respondents, 37.0% were aged 30–44 years, and the gender distribution was nearly equal. Urban residents constituted 53.5% of the sample, while 46.5% were rural. Exposure to risk factors was widespread, with 23.0% active smokers, 29.5% passively exposed to tobacco smoke, 26.5% reporting occupational dust exposure, and 30.5% exposed to household biomass smoke. Knowledge assessment revealed that 61.5% correctly identified asthma and COPD as obstructive diseases, 71.5% recognized smoking as a major cause, and 78.0% acknowledged preventive strategies such as smoking cessation, clean fuels, and protective masks. However, awareness of restrictive diseases and their irreversibility was limited (56.0%). Overall, 18.5% had excellent knowledge, 32.0% good, 33.0% fair, and 16.5% poor. Education, residence, and occupation were significantly associated with knowledge levels (p<0.05), while age and gender were not. Conclusion: Awareness of obstructive and restrictive lung diseases among the general public of Punjab is moderate, with substantial gaps in knowledge about restrictive conditions, environmental exposures, and disease irreversibility. Education, occupation, and residence strongly influence awareness, highlighting structural inequalities in health literacy. Targeted health education interventions focusing on rural populations and less educated groups, coupled with integration into existing non-communicable disease programs, are essential to reduce the burden of chronic respiratory diseases in Punjab.

Background: Hypertension is a leading modifiable risk factor for cardiovascular morbidity and mortality worldwide and is often termed the “silent killer” due to its asymptomatic onset. Awareness of hypertension and its lifestyle risk factors is a cornerstone of prevention, yet data from geographically unique high-altitude districts such as Shimla, Himachal Pradesh, remain limited. This study assessed community awareness, knowledge gaps, and misconceptions regarding hypertension, alongside socio-demographic determinants influencing awareness levels. Material and Methods: A descriptive, cross-sectional study was conducted among adults (≥18 years) residing in rural and urban areas of Shimla district between Feb 2025 and May 2025. A validated, bilingual (English/Hindi) questionnaire comprising socio-demographic details and 20 multiple-choice awareness questions was disseminated via Google Forms using convenience sampling. The survey link was circulated through social media, email, and local health networks. Knowledge scores (0–20) were categorized as very good (16–20), good (12–15), fair (8–11), and poor (0–7). Data were analyzed using SPSS version 25, applying descriptive statistics and Chi-square tests to examine associations between knowledge levels and socio-demographic variables, with p<0.05 considered significant. Results: A total of 400 participants completed the survey, with a mean age distribution skewed towards older adults (≥50 years: 32.5%). Males comprised 52.5% of respondents, and 60.0% resided in rural areas. Overall, 25.5% demonstrated very good knowledge, 39.5% good, 23.0% fair, and 12.0% poor. Highest awareness was recorded for identifying a sphygmomanometer as a BP measuring device (79.5%) and recognizing high salt intake as a modifiable risk factor (75.0%). Notable gaps included awareness of urban–rural prevalence differences (57.3%) and recommended screening frequency (61.8%). Knowledge was significantly associated with age (p=0.049), education (p<0.001), occupation (p=0.010), income (p<0.001), and residence (p=0.012), but not with gender or marital status. Conclusion: While a majority of adults in Shimla district exhibited good to very good awareness of hypertension and its modifiable risk factors, critical deficits persist in symptom recognition and preventive screening knowledge, particularly among rural, less-educated, and lower-income groups. Targeted, culturally relevant educational interventions and integration of routine blood pressure screening into community health activities are essential to bridge awareness gaps and mitigate the long-term cardiovascular disease burden in this high-altitude Himalayan setting.