Vol 29, No 3 (2025)

Shotgun is the main gun used for bird hunting in rural and mountain area in the Kurdistan Iraq. This type of weapon typically acts at thirty-meter distance accuracy. Shotgun pellet-related accidents donot happen very often. Shotgun bullets have a propensity to fragment into pellets when they strike an object diagonally or after a predetermined distance. In addition to lead, steel, tungsten, and bismuth pellets are also utilized to make these pellets.Regarding the removal or retention of foreign objects like the pellets, there is no agreement. These pellets possess the capability to access distant organs that are difficult to reach by surgical intervention. This kind of situation primarily results in fatalities due to significant damage to internal tissues and organs.

In this report, we present 16 years old male teenage who died due to accidental shotgun shot from very close range in the chest area,the pellets got spread inside his chest. Our victim was unintentionally shot at close range, impacting the middle of his chest tangentially.

Background and objective: Acute Pancreatitis (AP) is linked with leukocyte infiltration and tissue necrosis, however the cellular signaling pathways in pancreas which is leading to organ destruction remain unknown. IL-3 is a powerful controller of different cellular processes that promote pro-inflammatory activities. In this study, we investigated IL-3 signaling role of in acute pancreatitis.

Methods: In C57BL/6 mice, pancreatitis was triggered by L-arginine injection (i.p.). Prior to development of pancreatitis, animals were given an IL-3 inhibitor (100 mg/kg). IL-6, MPO, and MIP-2 levels were measured by ELISA.

Results: The administration of IL-3 significantly reduced the rise in L-arginine in serum amylase, pancreatic neutrophil infiltration, pancreatic edema formation, an acinar cell necrosis. Furthermore, in response to L-arginine challenge, inhibition of IL-3 caused a decrement in the MPO levels in both pancreas and lung (P <0.05). However, IL-3 therapy had a significant impact on L-arginine, provoked macrophage inflammatory protein-2 (MIP-2) induction in the pancreas. Interestingly, in vivo isolation of neutrophils revealed that inhibition of IL-3 significantly reduced MIP-2 and IL-6 pointing to a direct function for IL-3 in regulating chemokine and cytokine expression in neutrophils (P <0.05). Finally, trypsinogen activation induced by secretagogue in acinar calls of pancreas in vitro, was not directly affected by the inhibition of IL-3 (P >0.05).

Conclusion: These findings show that IL-3 signaling has an essential role in acute pancreatitis by controlling tissue injury and neutrophil infiltration thus, in addition to clarifying pancreatitis signaling processes, our findings also raise the possibility that IL-3 can represent a new target in the treatment of severe AP.

Background and objectives: Haemorrhoids is a common presenting problem to the surgical outpatient. Although open haemorrhoidectomy is an effective procedure, it can lead to significant postoperative pain, narrowing and incontinence. Among many alternative procedures with fewer complications, Transanal Haemorrhoidal dearterialization (THD) with mucopexyis an efficacious and safe alternative with less pain and complications. We aimed to evaluate the outcomes of THD, in terms of complications and recurrence rates, in the treatment of symptomatic haemorrhoids.

Methods: this prospective cohort study included all consecutive patients with symptomatic haemorrhoids who underwent THD and rectal mucopexy procedures between January 2013 and December 2022. Patients’ demographics, operative and postoperative data were recorded prospectively. Patients were seen at regular intervals for 60 months. Long-term complications, recurrence and reoperation were recorded during the visits. Microsoft® Excel 2020 and SPSS

version 26 was used for data entry and analysis.

Results: Eighty-six consecutive patients presented with symptomatic haemorrhoids and underwent THD. The mean age was 41 years, and 80% were men. Rectal bleeding was the most common presenting symptom in 61%, followed by pain and prolapse in 15% and 16%, respectively. Eight per cent of patients presented with strangulated haemorrhoids. Grade III haemorrhoids was the commonest (46.5%). Mean operation time was <30 minutes in 65% of cases. Minor bleeding for 2 days was noticed in 43% of cases after surgery, and minor pain for 3-4 days in 45.3%. Recurrence was noted in 5.8% of cases. The reoperation rate was 2.3%.

Conclusion: Data suggest that THD is safe and effective in treating symptomatic haemorrhoids, with low recurrence and reoperation rates.

Background and objective: Needle stick injuries (NSIs) pose a significant occupational hazard for healthcare workers, leading to risks of bloodborne infections. Despite established prevention and control guidelines, the incidence of needle stick injuries remains high, particularly in developing countries. The study aims to assess needle stick prevention and control management in the governmental and non-governmental hospitals inside Sulaimani city-Iraq.

Method: A descriptive cross-sectional study was conducted across 18 hospitals (11 governmental and 7 non-governmental) in Sulaimani City from January to March 2023. Using a pre-designed questionnaire, data was collected through structured interviews with infection control units or hospital administrators. Descriptive statistics were used for data analysis.

Result: The data collected showed that most hospitals have infection control units 14 (77.8%) while 4 (22.2%) did not. The majority of hospitals 17 (94.4%) have a needle stick injury prevention program, including 11 (64.7%) governmental and 6 (35.3%) non-governmental hospitals and also most of these hospitals12 (80%) monitor it is application. Regarding training, 11 (68.8%) of governmental and 5 (31.3%) of non-governmental hospitals offer training, making up a total of 16 (88.9%). Finally, for recording incidences, 8 (88.9%) of governmental and 1 (11.1%) of non-governmental hospitals recorded it, with an overall recording rate of 9 (50%). Conversely, 3 (33.3%) of governmental and 6 (66.7%) of non-governmental hospitals do not record these incidences.

Conclusion: The study concluded that while most Sulaimani city hospitals have needle stick prevention programs, governmental hospitals generally implement and monitor them more effectively than non-governmental ones. Key gaps include inconsistent reporting, follow-up practices, and training.

Background and objective: A staggering of more than half of the global population is affected by Helicobacter pylori infection. The infection is commonly obtained during childhood but may stay asymptomatic with long-term clinical consequences such as gastritis, peptic ulcer illness and stomach cancer. This study carried out to determine the prevalence rate of Helicobacter pylori infection and related variables such as age, gender, educational level, upper GI symptoms and previous infection among patients presenting with gastroduodenal disorders in Erbil city.

Methods: In this cross-sectional study, 240 patients with gastroduodenal disorders from January to June 2023 were enrolled who underwent endoscopy at Rzgary Teaching Hospital and Hawler Teaching Hospital in Erbil, Iraq. Blood samples and Biopsy were taken from the patients for screening anti-Helicobacter pylori antibodies by rapid immunochromatographic assay and histopathology identification, respectively. The extracted data then analyzed by GraphPad Prism with P value less than 0.05 considered statistically significant.

Results: The results showed a high prevalence of H. pylori positivity was 57% in symptomatic patients and higher in those with abnormal findings, 68.8%, compared to normal, 18.2%, P <0.0001. The H. pylori infection showed association with GI abnormalities, especially duodenal ulcers, which were 75% positive; gastro-duodenitis, where the positivity was as high as 62.5%. Lower educational attainment correlated with higher infection rates, thus giving emphasis to health education. Serology provided better sensitivity but possible false positives, therefore requiring confirmation.

Conclusions: It can be concluded the role of H. pylori in upper GI disease and routine testing of symptomatic patients, especially from high-prevalence areas whose symptoms cannot be otherwise explained. Public health methods focusing on hygiene, early detection and proper treatment can diminish the effects that H. pylori partake on gastrointestinal health.

Background and objective: Giardia lamblia is a flagellated protozoan that lives and proliferates in the small intestine of human and other mammals causing gastrointestinal disorder called giardiasis. Giardiasis mainly spreads in developing countries which lack sanitation and hygiene awareness and persons become infected by ingestion of contaminated food and water with mature cysts. This study was designed to detect the distribution of giardiasis in human and to differentiate between the assemblages of Giardia lamblia A and B by using Glutamate dehydrogenase (gdh) gene

Methods: A total of 2000 fecal samples were collected from symptomatic and asymptomatic food handler aged ranged between (20-30) and more than 30 years old that regularly attend the central laboratory in Erbil city. Primary diagnosis depends on a direct microscopic examination of the stool. Genotyping was done for Giardia positive samples (n = 39) targeting the Glutamate dehydrogenase gene (gdh) using two sets of primers for amplification of 458bp fragment, by RFLP and PCR-sequencing screening methods for G. lamblia.

Results: Out of the total 2000 samples screened for G. lamblia, 39 (1.95 %) were positive. According to the multiple alignment results, it was found that the isolates belonged to sub-assemblage AII 21 (53.8%), assemblage B 11 (28.2%), sub-assemblage BIII 9 (81.8%) and sub-assemblage BIV2(18.2%) genotypes. No statistically significant result was found between symptomatic and asymptomatic as assemblage and sub-assemblage genotypes.

Conclusion: The present study provides the first data on the assemblages and sub-assemblages of G. lamblia in food-handlers in Kurdistan region, Iraq. Identification and confirming of AII, B, BIII, and BIV genotypes in Erbil community indicates the anthroponotic and anthropozoonotic transmission cycle of Giardia infection. Our understanding of the diversity of G.lamblia mainly comes from the sequence information of multiple gene loci.

Background and objective: Many chemotherapeutic drugs may induce cardiotoxicity which limits their clinical use. Cyclophosphamide is an anticancer drug that is associated with dose dependent cardiotoxicity. Cardioprotective agents are being investigated as a means to prevent or treat cardiotoxicity. The aim of this study is to investigate the possible protective effects of liraglutide, alone and in combination with L-arginine, against cyclophosphamide induced cardiotoxicity in rats.

Methods: This study was conducted on 28 male Wistar albino rats, which were distributed into four groups, with each consisting of seven rats. Group C functioned as negative control while group CP acted as positive control. Group L received liraglutide and LA group was given liraglutide and L-arginine. After 21 days of treatment, the rats from group CP, L, and LA were injected with cyclophosphamide to induce cardiotoxicity. Blood samples were collected for measurement of hs-Troponin T (hs-TnT), heart-fatty acid binding protein (H-FABP), superoxide dismutase (SOD), and neutrophil gelatinase associated lipocalin (NGAL) while the hearts were taken for histopathological examination.

Results: Cyclophosphamide administration significantly increased myocardial injury markers (hs-troponin T and H-FABP), and inflammatory/renal injury marker (NGAL) while it significantly reduced antioxidant enzyme (SOD) in the serum with histopathological analysis showing signs of cardiotoxicity. Liraglutide alone and in combination with L-arginine improved the biochemical parameters and histopathological structure of the heart compared to cyclophosphamide group.

Conclusion: The findings from this prospective study suggest that liraglutide pretreatment, alone and in combination with L-arginine, provided cardioprotection against cyclophosphamide-induced cardiotoxicity.

Background and objective: Pharmacovigilance and adverse drug reaction (ADR) reporting are crucial for safeguarding medication safety. Community pharmacists play a vital role in the identification and reporting of ADRs. The objective of this study is to evaluate the knowledge, attitude, and practice of community pharmacists in Erbil city about pharmacovigilance and ADR reporting.

Methods: A cross-sectional study was carried out utilizing a structured, interviewer-administered questionnaire that involved a sample of 350 community pharmacists via convenience sampling method. The questionnaire collected demographic data and the pharmacist's knowledge, attitude, and practice toward pharmacovigilance and ADR reporting. SPSS was used for data entry and analysis.

Results: Among the participants, 47.4% displayed poor knowledge, 46.6% exhibited moderate knowledge, and merely 6% demonstrated a good knowledge. More than half of the participants (54.9%) maintained an overall positive attitude; however, the majority (58.6%) exhibited poor practices. The results indicated a statistically significant association between participants' knowledge and attitude levels, as well as between knowledge and practice levels (P <0.001). However, there was no statistically significant association between participants attitudes and practice levels (P = 0.815).

Conclusion: The study's findings revealed that slightly more than half of pharmacists had adequate fundamental knowledge of pharmacovigilance and ADR reporting and exhibited generally positive attitudes, yet gaps were evident in the practical application of ADR reporting practices. Additional training and education may still be necessary to gain a more profound understanding of the details of pharmacovigilance and enhance pharmacists’ engagement with ADR reporting.

Background and objective: Hypertension is a significant public health issue both globally and in Iraq, it plays a major role in cardiovascular morbidity and mortality. Although highly educated, university employees may still be at risk due to sedentary habits, stress, and poor health practices. Assessing their knowledge, attitudes, and practices (KAP) related to hypertension is essential for developing effective prevention and management strategies. This study aimed to evaluate the knowledge, attitudes, and practices concerning hypertension and its risk factors among employees of public universities in Erbil City.

Methods: A cross-sectional descriptive study was carried out among academic and administrative staff at Erbil Polytechnic University, Hawler Medical University. Salahaddin University participants were selected using Stratified random sampling. Data were gathered through a structured questionnaire that included demographic information and assessed knowledge, attitude and practice related to hypertension, The collected data were analyzed using SPSS, employing both descriptive and inferential statistical methods.

Results: The study included 400 participants, aged between 22 and 69 years. The average knowledge score was 44.4%, with 66.5% of participants exhibiting poor knowledge. Attitudes toward hypertension were mostly positive reflected by an average score of 65.63%; nonetheless, 63.7% of participants displayed neutral attitudes. The average practice score was 50.13%, with 50.7% of participants showing poor health practices. Significant associations were observed between knowledge levels and factors such as gender, education, occupation, and income (P <0.05). higher practice scores were associated with older age, higher education, chronic health conditions, and longer years of service.

Conclusion: Despite generally positive attitudes, there is a significant gap in knowledge and health-promoting practices related to hypertension among university employees in Erbil. Targeted educational programs, workplace wellness initiatives, and ongoing health promotion efforts are suggested to enhance knowledge, attitude and practice and lower the risk of hypertension in this population.

Background and objective: Acute lung injury (ALI) it considered as a very serious illness characterized by inflammatory lung swelling, leading to acute hypoxic respiratory failure. c-Raf G-protein has been shown to regulate inflammation we predicted that c-Raf could regulate neutrophil infiltration in LPS induced sepsis in mice model.

Methods: 18 albino mice (6 weeks age, weighing 26±2 grams) were randomly assigned to three groups: the control group (they were injected by normal saline intraperitoneally, n=6), the LPS (lipopolysaccharide) group (50 mg/kg LPS Were injected intraperitoneally, n=6), the GW5074 + LPS group (2 mg/kg of the selective c-Raf inhibitor GW5074 were given intraperitoneally 15 minutes before LPS injection, n=6). After 24 hours, the mice were sacrificed, then inflammatory cell counts, proinflammatory cytokines (TNF-α, IL-1β, MPO activity, CXCL-2, IL-6) were measured. The lungs were then isolated for molecular target analysis, histopathological, and immunohistochemical evaluations.

Results: Resemble to the LPS group, pretreatment of mice with c-Raf inhibitor significantly decreased MPO, CXCL-2, TNF-α, IL-1β and IL-6, activity. GW5074 weakened migration and infiltration of inflammatory cells, showing a marked reduce in MPO (6.0 ±0.2 vs. 2.2±2.0 P <0.05) as well as CXCL-2(132.8± 2.0 vs. 80.4±6.0 P <0.05) in the sham, LPS, and GW5074 + LPS. Additionally, IL-6 levels in treatment group significantly decrease compared with LPS group (123 ± 4.0 vs. 71.2 ± 6.0 P <0.05).

Conclusion: The conclusions of this research propose that c-Raf may have anti-inflammatory and protective effects against LPS-stimulated ALI in mice.

Background and objective: Entamoebahistolytica is a protozoan parasite with high prevalence rates in tropical and subtropical regions of underdeveloped countries. The outcomes of Entamoebahistolytica infection are mostly asymptomatic; only a fraction of those infected develop dysentery and, in rare cases, liver abscesses. Its pathogenicity is due to a huge number of virulence factors. This study investigated the risk of Entamoebahistolytica among food handlers, screening, Sequencing, and phylogenetic tree of Ameobopore-c.

Methods: Total of 563 stool samples were collected from food handlers who visit the central laboratory in Erbil City every year. Wet mount microscopic examination was performed to diagnose the Entamoeba species, molecular analysis was done for positive samples. FavorPrep Stool for DNA Isolation Mini Kit (Favorgen, Taiwan) was utilized. PCR analysis was done targeting the Amoebopore-c gene using one set of primers to amplify the 705 bp fragment. Gel electrophoresis was performed to visualize the amplified DNA under Ultraviolet light. Fifteen random positive samples of the PCR product were sent to Macrogen in South Korea to determine the DNA sequence of the Amoebopore-C gene present in the Entamoebahistolytica.

Results: The study found no statistically significant relationships between infection rates and demographic or socioeconomic characteristics. In fact, that 21 of the 50 microscopic positive cases were also positive by PCR.15 sequences of the amoebapore-C gene revealed that a modification in a single nucleotide leads to a modification in a single amino acid. Alignment of amoebapore C, according to NCBI-BLAST Homology Sequence, showed the following identity percentages to samples from different countries: India (99.4%), the USA (99.18% and 99.7%), Iraq (99.38%), and Hamburg (99.84%)

Conclusion: PCR is a highly sensitive method for detecting Entamoebahistolytica. The Entamoebahistolytica isolates showed high homology in amoebapore-C gene sequences compared to global strains.

Background and objective: Alzheimer's disease (AD) is a slowly worsening brain disease linked to ongoing inflammation, with Tumor Necrosis Factor Alpha (TNF-α) playing a significant function in its progression. Ras-related C3 botulinum toxin Substrate 1(Rac1)regulates inflammatory signaling and may influence TNF-α expression in AD. The aim is to investigate the impacts of Rac1 inhibition on TNF-α expression and neuropathology in a streptozotocin (STZ)-induced AD mouse model.

Methods: There were three groups of male Swiss albino mice: Control (control), STZ (AD model), and NSC23366 + STZ (Rac1 inhibitor). The treatment group received 5 mg/kg NSC23366 before STZ administration. ELISA measured TNF-α, amyloid beta 42 (Aβ42) and tau levels in the brain and serum. Histopathological analysis assessed neuroinflammation and neuronal damage.

Results: Streptozotocin (STZ) significantly increased Aβ42, tau, and TNF-α levels (P <0.05). NSC23366 treatment reduced these markers, indicating neuroprotection. In the STZ group, histological analysis showed severe neuroinflammation and neuronal damage. Conversely, NSC23366 reduced the quantity of inflammatory cells and scores of brain injury (P <0.05).

Conclusion: Blocking Rac1 lowers neuroinflammation caused by TNF-α, lowers the damage caused by tau and amyloid plaques, and slows down neurodegeneration in AD. Targeting Rac1 may provide an achievable therapeutic strategy for the management of Alzheimer's condition.

Background and objective: Echinococcus granulosus can cause hydatidosis, or echinococcosis, in both herbivores and omnivores. Hydatid cysts are the larval stage of this tapeworm. As a zoonotic illness, it affects people all over the world. Devastating effects on human and animal health as well as massive economic losses, disproportionately felt in the agriculture sector, characterize this disease. Genomic segments from cox1 and nad1 genes have allowed for the identification of distinct genotypes of Echinococcus granulosus sensu stricto (s.s.) in both humans and domesticated animals. The current investigation aimed to distinguish between the G1/G3 genotypes of Echinococcus granulosus (s.s.) in cattle via the nad5 gene fragment.

Methods: The present study was conducted in Erbil city. Sheep, goat, and cattle hydatid cyst samples (36 isolates) were collected from the Erbil slaughterhouse. In addition, 11 fresh human hydatid cyst samples were taken from patients with hydatid cysts who underwent surgical operations in Rizgary Teaching Hospital. The hydatid cysts were subjected to examination for fertility and viability in addition to DNA extraction for genotyping based on the Nad5 gene.

Results: Out of 42 samples, 15 samples were sequenced, and all samples belonged to the G1 genotype (sheep strain). DNA sequencing of hydatid cysts from both animal and human sources showed mutations in various positions of the Nad5 gene, consistent with the dominant G1 genotype. In human samples, several variations overlap with other hosts, but unique ones include human 11,12 glycine/alanine at 142 arginine/glutamine, glycine/threonine at 303 valine/phenylalanine, T/A at 334 valine/aspartic acid, and T/C at 361 arginine/histidine, which result in 99% identity to the G1 strain.

Conclusion: Humans and animals in Erbil most commonly harbor the G1 genotype of E. granulosuss. s.s. according to the study. The findings provided additional evidence that the Nad5 gene accurately distinguished between humans and cattle, sheep, goats, and E.granulosus G1/G3 isolates.

Background and Objective: Hormonal contraceptives play a critical role in family planning and women’s health, yet pharmacists’ involvement in dispensing and counseling on their use remains underexplored in Iraq. This cross-sectional study investigates the dispensing and counseling knowledge of community pharmacists and pharmacy assistants in Erbil, Kurdistan Region, Iraq.

Methods: A total of 450 participants were recruited from 37 randomly selected quarters using cluster sampling. All pharmacies in these clusters were included, and all eligible staff were invited to participate. Data were collected via a structured questionnaire face to face covering demographics, contraceptive knowledge, dispensing and counseling practices, challenges, and pharmacy setting.

Results: The study identified notable knowledge gaps, especially regarding long-acting methods such as IUDs and injectables. While 78% believed they had adequate information for counseling, 27.8% lacked formal training. Familiarity was significantly associated with public sector employment (P <0.001), increased years of experience (P <0.001), and educational level (P <0.001). Although females showed higher familiarity than males, the association was not statistically significant (P = 0.554).

Conclusion: Although almost all pharmacists and assistants were familiar with hormonal contraceptives and willing to counsel, gaps in formal training specially on long-acting methods parsest. Familiarity was linked to experience, public sector work, and education. Structured, targeted training programs are essential to address the knowledge gaps in hormonal contraceptive methods, particularly among early-career pharmacists.

Background and objective: Community pharmacies play a crucial role in healthcare, offering accessible medication dispensing and patient-centered services. Their responsibilities have expanded to include pharmaceutical care that enhances treatment outcomes. Patient satisfaction influences adherence and pharmacist relationships. This study examines patient perceptions and satisfaction with community pharmacy services in Erbil city-Iraq, considering socio-demographic factors.

Methods: This cross-sectional study was conducted in community pharmacies across Erbil, Kurdistan-Iraq, from September 2024 to March 2025. A total of 800 patients participated, selected through a multistage sampling method. First, 20 pharmacies were chosen randomly, and using convenience sampling, 40 patients were selected from each pharmacy. Data were analyzed using SPSS (version 27), applying statistical tests such as the Chi-square and T-tests. A P-value of ≤0.05 was considered statistically significant.

Result: Prescription pickup (53.4%) was the main reason for pharmacy visits. Satisfaction was high for pharmacist knowledge (71.1%) and communication (72.8%), though issue resolution (37.5%) and collaboration with healthcare providers (48.4% neutral) needed improvement. Most of the respondent (64.6%) preferred doctors for consultations.

Conclusion: Patient satisfaction with community pharmacy services in Erbil was high, particularly regarding pharmacist expertise, communication, and convenience. However, there is a need to strengthen communication with healthcare providers and to establish more effective procedures for addressing patient complaints and service-related issues. Educated patients showed higher expectations, highlighting the need for better pharmacist-patient communication.

Background and objective: Educating youth on matters of sexuality and relationships is essential for fostering healthy attitudes and behaviors. This study aimed to assess the knowledge levels and sources of information regarding sexual health among individuals who experienced sexual violence in the Kurdistan region of Iraq. The study population included both detainees and individuals seeking medicolegal services, providing a broader understanding of the information gaps and educational needs within this vulnerable group.

Methods: Using a quantitative survey design, 200 participants were selected through convenience non-probability sampling. The sample included detainees and individuals seeking medicolegal services across correctional and forensic facilities in the Kurdistan region of Iraq. All participants had histories of sexual abuse. Structured interviews were conducted to gather data on their knowledge of sexual health and sources of information.

Results: A meager 26% had received any formal sex education. Significant barriers persisted, as 60% noted disparities in how such topics were discussed between genders. Despite limited knowledge, 92% wanted to help other victims. Moreover, 62% understood how abuse can damage relationships, 55% turned to social media for answers with few trusted others to ask, and a paltry 11% reported their own victimization to authorities. Statistical analysis revealed strong connections between information levels and age, gender, and education attainment (P <0.05).

Conclusion: This research uncovers substantial gaps in sex education for detainees who survived sexual assault. Demographic factors strongly influenced what information sources one utilized and perspectives about such matters. Future studies should profile trends across wider populations and design targeted educational initiatives for parents of children aged 10 and up to remedy these critical information shortfalls.

Background and objective: Successful H. pylori eradication is critical for the management of peptic ulcer disease. Recent evidence suggests that community pharmacy counselling may drive better patient motivation, adherence, and clinical outcomes. This study aimed to evaluate the pharmacological impact of structured community pharmacy counseling on treatment motivation, medication adherence, H. pylori eradication, and the resolution of key symptoms in Iraqi patients with peptic ulcer disease.

Methods: This was a quantitative, randomized controlled trial conducted in Erbil City. This study carried out in selected private clinics from November 2024 to April 2025. A total of 100 patients diagnosed with Helicobacter pylori were enrolled and randomly assigned to two groups: (50 intervention group and 50 control group). Data were collected on variables including demographic information, epigastric pain, dyspepsia, heartburn, fatigue, and stool antigen test results, patient motivation, medication adherence. Statistical analysis was performed using GraphPad Prism, applying appropriate tests such as the Chi-square test and Fisher’s exact test based on the nature of the data.

Results: The study included 100 participants with a mean age of 36.55 ± 10.84 years; 58% were male and 42% were female. Patients in the intervention group showed significantly higher motivation (86% vs. 44%, P <0.0001) and better medication adherence (94% vs. 24%, P <0.0001) compared to the control group. The eradication rate of H. pylori was significantly higher in the intervention group (90%) compared to the control group (54%), with a P-value of 0.0001. Moreover, the intervention group recovered more on symptoms, including reductions in epigastric pain (64% vs. 48%, P = 0.0012), dyspepsia (80% vs. 60%, P = 0.0629), heartburn (80% vs. 60%, P = 0.0167), and fatigue (76% vs. 52%, P = 0.011) compared to the control group.

Conclusion: Community pharmacy counseling significantly improves patient motivation and adherence, leading to superior H. pylori eradication and symptom relief. Our findings advocate for the integration of structured pharmacy counseling in to peptic ulcer disease management protocols.

Background and objective: Keratoconus (KC) is a progressive non inflammatory bilateral (usually asymmetric) ectatic corneal disease characterized by paraxial stromal thinning, with vision loss from irregular astigmatism and myopia. The purpose of this study is to evaluate the results of implantation of Intrastromal Corneal Ring (ICRS), the improvement of visual acuity and long-term mechanical stability results of keratometers values in KC after 5 years follow up of those cases.

Methods: One or two ICRS segments were used for the management of KC, the study continued for ten years and each case completed 5 years of follow up, the study started in January 2010 and ended in October 2019, the patients were collected from Erbil Teaching Hospital or from the researcher’s private clinic. Statistical analysis included preoperative and postoperative keratometry (K) values, and uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA).

Results: Forty-six eyes of 37 patients were involved in this study, topographical corneal changes showed by the decrease in the mean of K1, medians of K2 and the mean of K1 &K2 especially in the first postoperative month and remain stable in most of the cases throughout the 5 years period, this was statistically significant by (P <0.001) value. The medians of UCVA increases in the first 3 years and at some time slightly decreases and remain stable throughout the 5 years of follow up but better than before the operations, and this statistically significant by (P <0.001), the medians of CDVA improved from preoperative to postoperative period during the 5years follow up and remain stable, it was statistically significant (P <0.001), The preoperative Mean of K declined from 52.0(±4) to 48.0(±3.3) in postoperative period and that was statistically significant (P <0.001)

Conclusion: There was a significant improvement in the visual acuity and keratometric readings of cases with advanced keratoconus and high astigmatism after implantation of ICRS in which the VA did not improved by glasses or contact lenses, subsequently  there was improvement of  the topographic state of the cornea and quality of vision for long time and  this delay the need for corneal grafting surgery.

Background and objective: Acute coronary syndrome (ACS) is the predominant cardiovascular disease cause of death. One of the newer criteria for assessing acute coronary syndromes (ACS) is serum high-sensitive C-reactive protein (hs-CRP), which has demonstrated predictive value for coronary artery conditions independently of conventional cardiovascular risk factors. This study aimed to evaluate and assess the correlation between highly sensitive C-reactive protein (hs-CRP) and the severity of acute coronary syndrome subtypes.

Methods: This cross-sectional study was performed on 180 patients diagnosed with ACS at the Surgical Specialty Hospital-Cardiac Center in Erbil, Iraq. Subjects were classified into three groups according to the types of ACS: Group I (STEMI patients-83 individuals), Group II (NSTEMI patients-74 individuals), and Group III (UA patients-23 individuals). Parameters of high-sensitivity C-reactive protein (hs-CRP), cardiac biomarkers, and lipid profile were evaluated for all patients.

Results: The study population consisted of 74.4% males and 25.6% females, aged 30 to 90 years, with a mean age of 58.66±12.03 years. Among all patients, 66.1% had hyperlipidemia, 58.3% had hypertension, 40% had diabetes, and 67.2% were smokers. Patients with myocardial infarction (STEMI and NSTEMI) had significantly higher levels of hs CRP (P = 0.026), troponin T hs (P <0.001), and CK-MB (P = 0.044) compared to UA patients. There was also found a positive significant correlation between serum hs-CRP with total cholesterol, LDL-C, and troponin T hs among ACS patients with statistically significant (r=0.171, P = 0.022), (r=0.202, P = 0.007), and (r=0.229, P = 0.002), respectively.

Conclusions: The current study shows that serum hs-CRP could serve as a useful biomarker for assessing disease severity in ACS patients.

Background and objective: Polypharmacy, the concurrent use of five or more medications by a patient, is linked to substantial negative outcomes. These include adverse reactions, potentially hazardous drug-drug interactions, mortality, and adherence issues, in addition to cost problems. Finally, the feeling of being overmedicated has been associated with a lower reported quality of life related to health. This study aimed to determine the prevalence of polypharmacy among patients visiting community pharmacy in Erbil city and the association of sociodemographic characteristics with polypharmacy, in addition to measuring the adherence of participants by using the Morisky Medication Adherence Scale (MMA-4).

Methods: During the period from November 2024 to March 2025, a cross-sectional study was conducted in twelve community pharmacies in Erbil city. A multistage cluster sampling method was used in order to collect data from 800 patients who were diagnosed with at least one chronic condition and used medication for at least three months.

Results: Among chronic disease patients, polypharmacy prevalence was 32.5%, and statistical analysis highlighted significant associations between the likelihood of polypharmacy and both the age of the patient and their level of education. However, the same analysis did not reveal a significant connection between a patient's gender and the presence of polypharmacy.

Conclusion: A substantial one-third of Erbil community members with chronic illnesses experience polypharmacy. This rate might be an underestimation, as hospital studies, including more complex cases with multiple conditions and acute needs for various medications, usually report higher figures.