Vol 29, No 2 (2025)

Background and objective: The myelomeningocele is the most common form of neural tube defect, the early efficient and durable coverage and repair of the dural sac with well-vascularized soft tissue is important for neurological functional outcome and prevention of infection. The latissimus dorsi myo-cutaneous advancement flap is promising in this respect. The objective of the study was to assess the durability and advantages of bilateral latissimus dorsi myo-cutaneous advancement flap for coverage of medium to large-sized thoracolumbar myelomeningocele defects.

Methods: A retrospective study was carried out from 2012-2022, in Erbil (the capital of Kurdistan region, Iraq) at Rozhawa and Erbil Teaching Hospital. Ten infants (four males, and six females), all of them had medium to large thoracolumbar myelomeningocele defects, all managed operatively by two team approach of neurosurgeons and plastic surgeons under general anesthesia, using a bilateral latissimus dorsi myo-cutaneous advancement flap, the defect was closed.

Results: Ten patients were included in the study. Their mean age (SD) was 21.6 (8.3) days, and the age range was 10-35 days. More than half (60%) of the patients were females. The sites of the operation were (thoracic 50%, lumber 40%, and thoraco-lumber 10%). The size was medium in 60% of patients and large in (40%), and the time of the operation was less than two hours in 50% of the patients. Three patients (30%) developed complications, one developed simple edge necrosis, and two developed CSF leakage, and the success rate was 100%.

Conclusion: There are numerous benefits to using a bilateral latissimus dorsi myo-cutaneous advancement flap in comparison to alternative techniques for covering moderate to large thoracolumbar myelomeningocele abnormalities.

Background and objective: The reliability and efficacy of multivitamin pharmaceutical products containing ascorbic acid and folic acid vary due to differences in manufacturing processes and ingredient selection. This research paper presents the development and validation of derivative spectrophotometric and mean-centering methods for the simultaneous determination of ascorbic acid and folic acid both in their pure form and in pharmaceutical formulations. Furthermore, an assessment of the environmental impact of the proposed methods is conducted utilizing the analytical procedure index as a measure of its "greenness" profile.

Methods: Analytical procedures that are simple, accurate, and environmentally friendly were devised to concurrently determine the levels of ascorbic acid and folic acid. These methods include the ratio derivative and mean-centering spectrophotometric techniques, ensuring precise measurements of both substances.

Results: The ratio derivative and mean-centering spectrophotometric techniques for the determination of ascorbic acid and folic acid showed a measurable amplitude and substantial linearity. The ratio spectra derivative, at the amplitude 247.2 nm (1DD 247.2) and 270 nm (1DD 270) ascorbic acid showed linearity from (0.5-15.0 μg/mL) and (0.5-15.0μg/mL) with a detection limit of (0.17 μg/mL) and (0.298 μg/mL), respectively, while folic acid displayed observable amplitude at 314.4 nm (1DD 314.4) with linearity (2.0-15.0μg/mL) and a detection limit of (0.37 μg/mL). The mean-centering method for ascorbic acid and folic acid illustrated assessable peak-to-baseline (356.8 nm) and (346 nm) with the linearity of (0.5-12.0μg/mL) and (2.0-15.0μg/mL), and a detection limit of (0.15 μg/mL) and (0.49 μg/mL), respectively.

Conclusion: The proposed methods were effectively utilized for the simultaneous quantification of both ascorbic acid and folic acid in laboratory-prepared synthetic mixtures as well as pharmaceutical formulations with reasonable levels of precision, accuracy, and recovery.

Background and objective: Diaphyseal femoral fracture is injury that need reduction and fixation. The aim is to compare between treatment of diaphyseal femoral fracture by open and closed technique in primary outcome measures as union and malalignment; and secondary outcome measures as nerve injury, blood loss, exposure to fluoroscopy and infection.

Methods: This cross-sectional study compares two groups of sixty-three patients, with DFF; group A (27patients) were treated by closed reduction by intramedullary interlocking nail and group B (36 patients) by open reduction and internal fixation by plate and screws. Both groups were followed up by union, malalignment, blood loss, nerve injury, infection, exposure to radiation and implant failure. Following surgery, both groups were evaluated at four weeks, six weeks, three months, six months, and one year.

Results: there was significant association between type of operation and gender 88.9% of male patients were treated by group A technique while 63.9% of male patients treated by group B technique (P = 0.024), callus formation after 4 weeks 81.5% of group A cases callus formed after 4 weeks (P <0.001), union at 6 months 92.83% of group A united (P = 0.007),intra operative exposure to radiation 100% patients of group A exposed to fluoroscopy (P <0.001), blood transfusion 66.7% of group B cases transfused blood (P <0.001), nerve injury 100% of cases in group B did not have nerve injury (P = 0.029) and range of knee flexion at 6 months 88.9% of group A cases range of knee flexion was 0- ≥ 120 degrees (P = 0.004).

Conclusion: This study found that closed reduction by intramedullary interlocking nail better than open reduction and internal fixation by plate and screws in callus formation after four weeks, union at six months, blood loss and range of knee flexion; while the open reduction and internal fixation by plate and screws was better than closed reduction by intramedullary interlocking nail in nerve injury and exposure to radiation.

Background and objective: The technique of fat grafting can affect the clinical outcomes and aesthetic potential. Micro-fat grafting consists of harvesting fat tissue by using a multi-perforated cannula with 1 mm hole. SR Coleman refined fat tissue that is transferred through a micro-cannula. Stromal vascular fraction (SVF) gel is a novel and mechanically processed fat product with high concentrations of adipose tissue which is derived from stem and other SVF cells. The objective of this study is to investigate and compare the aesthetic potential of microfat and extracellular matrix/stromal vascular fraction gel (SVF-gel) in nasolabial fold [NLF] rejuvenation.

Methods: This is a retrospective study included 20 patients who had both microfat injection and SVF gel grafting for various indications between 3 March 2021 to 27 July 2022 in Rizgary Teaching Hospital and private clinic in Erbil city. Surgeon’s cost, patient’s satisfaction, age, sex, smoking, pain and donor site appearance were evaluated. Microfat was harvested by with multiple 0.8 mm holes smooth side cannula, and processed with a fat stirrer to remove fibers. SVF-gel was prepared according to previously reported mechanical preparation method.

Results: All patients showed improvements in nasolabial fold rejuvenation and augmentation. The result showed that 57.1 of patients were satisfied with their SVF-gel grafting outcomes, while 52.9 of patients were satisfied with microfat grafting, and 10.9 of patients had mild postoperative bruise and pain. In comparison of patients and surgeon-rated satisfactions for SVF and microfat grafting the result was very close 52.9 and 51.8 respectively. SVF-gel and microfat showed effective nasolabial fold rejuvenation effects.

Conclusion: Stromal vascular fraction gel is effective for nasolabial fold rejuvenation, and looks to be superior to microfat injection for improvement of nasolabial fold skin quality.

Background and objective: Cholera is a highly contagious acute diarrheal infection caused by Gram negative Vibro cholerae. A number of disease outbreaks are recorded annually in different countries around the world. The aim of current study is characterization of the 2022 cholera outbreak in the city of Erbil, Kurdistan region/ Iraq.

Methods: The data of2,192 suspected cholera patients who were admitted to the hospital in the period from June 2022 to September 2022.

Results: The results show that 205 (9.4%) of the hospital-admitted patients were identified as cholera positive, and they have complete data. The mean age ±SD of cholera cases was of 35.71 ± 21.9 years old. No association between males and females regarding the age distribution of cholera cases, and the percentage of male-to female-patients were close together (50.2% males to 49.8% females). Moreover, the etiology of the outbreak was identified as V. cholerae O1 serotype Ogawa. The antibiotic sensitivity test of the isolates showed that the strains are sensitive towards meropenem (10µg), Gentamicin (10µg), and Ciprofloxacin (10µg), whereas all the tested bacterial samples shown to be resistant to trimethoprim.

Conclusion: The etiology of the cholera outbreak in the city of Erbil was V. cholerae O1 serotype Ogawa. Around half of the infected people were aged between 20 to 44 years old. This is the first report on the recent outbreak in the Erbil-Iraq.

Background and objective: Acute appendicitis is the commonest surgical emergencies present throughout all months of the year, but some particular months are associated with higher rates of its incidence. A seasonal pattern of appendicitis with a mostly predominant peak is seen during the summer months in most countries. The aim of this study is to analyze the current knowledge and controversies related to seasonal variability of acute appendicitis in Erbil city.

Methods: A search was conducted using Microsoft Access version 2010, which includes all of the case data from East Erbil Emergency Hospital from March 2, 2010, to November 17, 2021. Some of the patients were eliminated from the study in order to control the incidence of acute appendicitis by season and year.

Results: In this retrospective study, the ages of the patients included were between 1 – 92 years, with a mean age and SD of 24.74 ± 12.29 years, the gender distribution was (56.9%) male and (43.1%) female, in extreme age groups only 316 cases recorded, the most common age group affected by acute appendicitis was teenagers (36.23%), Maximum number of cases presented during summer period (1713 cases, 28.08%) particularly June. while autumn season has least incidence (1293 cases, 21.2%) especially November.

Conclusion: The exact cause of seasonal variation of the incidence of acute appendicitis is still unclear, further studies are necessary to determine the association between seasonal occurrence of acute appendicitis and these factors.

Background and objective: The most prevalent cause of convulsions in young children is febrile convulsions. The ratio of neutrophils to lymphocytes (NLR), the mean platelet volume (MPV), and the platelet count are indicators of inflammation. Children with febrile seizures usually have higher NLR and MPV and less platelet count. The aim of the study is to evaluate the importance of NLR, MPV, Platelet count, MPV/Platelet, and RDW in feverish children with febrile convulsions.

Methods: A case-control study included 163 children with febrile seizures and 163 controls with fever but no seizures. All participants were sent for a red blood cell count (RBC), a white blood cell count (WBC), a hematocrit (Hct), hemoglobin (Hb), a red blood cell distribution width (RDW), a mean corpuscular volume (MCV), a platelet count (PLT), a mean platelet volume (MPV), a monocyte, a lymphocyte, and a neutrophil count, and their percentages were calculated. The absolute neutrophil count divided by the absolute lymphocyte count yields the neutrophil/lymphocyte ratio (NLR). The Mean Platelet volume to platelet count ratio (MPR) was the result of dividing the MPV by platelet count.

Results: The mean ages of cases and controls 22.98 ± 12.43 and 23.05 ±12.60 respectively were not significantly different 55.8% of cases and 45.4% of controls were male. Between cases and controls, WBC count, MPV, neutrophil count, and NLR were significantly higher in cases (P = 0.001, 0.001, 0.033, and 0.001 respectively) while lymphocyte and platelet count were significantly lower in cases.

Conclusion: children with febrile seizures had significantly greater NLR ratios, MPVs, and lower platelet counts.

Background and objective: Diabetes mellitus is a long-lasting metabolic condition with significant morbidity and mortality. This study aimed to determine the prevalence of osteoporosis in type 2 diabetes mellitus patients using a Dual-energy x-ray absorptiometry (DEXA) scan and to find out the factors that are associated with osteoporosis.

Methods: A cross-sectional study was done on 100 type 2 diabetic patients attending the medical ward of Rizgary Teaching Hospital and outpatients of internal medicine and rheumatology in Erbil City from October 2017 to March 2018.

Results: Out of a hundred patients with type 2 Diabetes Mellitus, 28 were men and 72 were women. The prevalence of osteoporosis in type 2 diabetes mellitus was 40%. The age range was from 33-91 years (The mean age 59.5 years). Out of all collected patients, 44 were current smokers. In relation to anti-diabetic medications, among a total of 100 patients, only four of them relied on diet control alone. The majorities, 69 patients, were taking oral hypoglycemic drugs, six patients were exclusively on insulin therapy, whereas 21 diabetic patients were managing their condition through a combination of oral hypoglycemic drugs and insulin therapy. The minimum duration of Diabetes among patients was 2 years. The minimum range of serum vitamin D was six ng/ml while the maximum was 35 ng/ml (mean is 21.1). The minimum serum calcium was 7 mg/dl while the maximum number was 10.6 mg/dl (the mean is 9).

Conclusion: The prevalence of osteoporosis among diabetic patients was common. Significant association was found with old age, long duration of the disease, post-menopausal status of the female and low serum vitamin D level.

Background and objective: Laparoscopic sleeve gastrectomy has become the most common weight loss surgery worldwide. This study aimed to provide insights into the sustained effectiveness of laparoscopic sleeve gastrectomy in achieving weight loss over an extended period.

Methods: This retrospective study was conducted on 116 obese individuals who underwent bariatric surgery in Erbil, Iraq, between May 2021 and May 2022. Baseline demographic and clinical data of the patients were collected. We documented participants' weight trajectories over a 48-week follow-up.

Results: The baseline mean weight decreased from 114.7 kg at the baseline to 101.7 kg at week 12 (P <0.001), 90.7 kg at week 24 (P <0.001), 82.4 kg at week 36 (P = 0.004), and 77.5 kg at week 48 (P = 0.348). A consistent and significant (P <0.001) reduction in weight change percentages was observed as the weeks progressed. The mean weight change percentage started at -11.2% in week 12 and progressively decreased to -32.1% in week 48. A consistent increase in the percentage of excess weight loss was observed as the weeks progressed, starting at 36.3% in week 12 and progressively increasing to 41.1% at week 24 (P = 0.103), 44% at week 36 (P = 0.816), and 78.6% in week 48 (P <0.001). The percentage of excess weight loss was significantly higher among younger age groups, males, singles and those with no chronic diseases, each at different follow-up intervals.

Conclusion: Laparoscopic sleeve gastrectomy participants experienced considerable and sustained weight loss for 48 weeks. Gender, age, marital status, and chronic conditions influenced weight fluctuation to varied degrees. These results offer important insights into the efficacy of laparoscopic sleeve gastrectomy in obesity management, particularly as a short-term way to control weight.

Background and objective: Bullying is a common phenomenon in childhood. It can have a serious effect on well-being and education. Several international studies have revealed that bullying is a regular problem in schools. This study aimed to determine the prevalence and risk factors of bullying among primary school children in Erbil, Iraq.

Methods: A school-based cross-sectional study was carried out among 400 children attending eight public primary schools from different socioeconomic statuses in Erbil city from October 2022 to February 2023. Data were collected by using a self-administered questionnaire in the local language with the researchers' direction and guidance.

Results: Out of 400 students, 52.7% were males, and 41.7% were females, with a male-to-female ratio of 1.1:1. The mean ± SD of age was 11.12 ± 1.13 years, ranging from 9 - 13 years. The prevalence of bullying was (55.8%), and the most common types of bullying were verbal (39.9%) and physical (38.1%). The adjusted logistic regression analysis revealed that being male gender (OR=2.23), age > 12 years (OR=2.33), going to school on foot (OR=2.17), illiterate mothers (OR=0.29), illiterate fathers, read and write, primary school and secondary school (OR=3.58 OR=2.77, OR=4.23, and OR=2.74, respectively), families fight at home (OR=2.15), students bullied by family and or siblings at home (OR=2.58) were significantly associated with bullying behavior.

Conclusion: Bullying is relatively high among primary school children in our region compared to neighboring countries. Parents and teachers should acknowledge and address such problems and encourage collaboration among professionals in the education and health sectors to understand the exceptional problems children experience and identify bullying.

Background and objective: Discussions surrounding the influence of ABO blood groups and Rh factor expressions on the development and progression of breast cancer has persisted over an extended period of time. This study sought to explore the connections between blood group/Rh and occurrence of breast cancer. Additionally, it aimed to elucidate the associations between blood group/Rh and some important prognostic characteristics in breast cancer, such as tumor grade and disease stage.

Methods: The study was retrospective observational analysis performed in Rizgary Teaching Hospital’s Oncology Center in Erbil during the years 2021 and 2022 to investigate the associations between ABO blood group/Rh factor and the risk of breast cancer, including impacts on both the occurrence and the tumor characteristics.

Results: Upon analyzing 303 patients with breast cancer, the study disclosed a lack of statistically significant link between blood group/Rh and the occurrence of breast cancer when compared to the control group, as evidenced by a p-value of 0.608 for ABO blood group and 0.838 for Rh factor associations. Moreover, examination of a smaller subset of 187 patients revealed no statistically significant influence of blood group/Rh factor on either the tumor grade (P = 0.319 for ABO and P = 0.710 for Rh) or the disease stage of breast cancer (P = 0.925 for ABO and P = 0.876 for Rh).

Conclusion: These findings emphasize the importance of dispelling potential misconceptions, suggesting that blood groups may not be a decisive factor in predicting or understanding breast cancer. This may contribute to refining medical perspectives and guiding more targeted avenues for future research.

Background and objective: Recent trends have indicated a shift in the mean incident age for screenable cancers toward younger populations. This study examines this shift in Sulaymaniyah city, Iraq, over the last 12 years, in comparison to the data of developed and regional countries.

Methods: A study was conducted on the data collected from health facilities in Sulaymaniyah. It focused on breast, colon, lung, prostate, and cervix cancers between the years 2011 and 2022.

Results: The typical age at which these five malignancies were diagnosed decreased significantly in Sulaymaniyah. (P-value less than 0.001). The most noticeable changes were in prostate and colon/rectum cancers. Compared to nearby and advanced countries, Sulaymaniyah's average ages of occurrence were mostly lower. This indicates that there is a local trend or early detection methods in practice in this region.

Conclusion: The study shows a big drop in average age of cancers found on screens in Sulaymaniyah. This implies that it is imperative to reevaluate cancer screening and prevention strategies, as the number young people falling ill has increased relative to previous years.

Background and objective: Acheliaoligocephala DC. is recommended by traditional healers of the Kurdistan Region of Iraq for treating wound healing and gastrointestinal complaints. In medicinal applications, A. oligocephala leaves are crushed and topically placed over the wound. The aim of the study is to investigate the phytochemistry and biochemical properties of the plant. We describe for the first time the flavonoid fraction was separated by preparative thin layer chromatography from the leaves methanolic and 70% methanolic extracts of A. oligocephala and the total poly phenolic content was determined according to the Folin-Ciocalteau assay using gallic acid as the reference standard.

Methods: The present study describes the scientific exploration of the antioxidant activity and preparative thin layer chromatography (TLC) separation of the flavonoids fraction and Folin-Ciocalteau Assay of Achelliaoligocephala DC. that has been collected in the Kurdistan Region of Iraq, in which it has been utilized as herbal medicinal remedy.

Results: Interestingly, the methanol extracts of leaves showed significant total phenolic contents (70.05%). The flavonoid contents are expressed as mg quercetin equivalent/g of extracts. However, the methanol extracts of leaves exhibited higher flavonoid contents (61.77%). Additionally, the FRAP (Ferric Reducing Antioxidant Parameter) of the obtained extracts were investigated. The results showed values of 6.565 and 14.443 (mol/L Fe²⁺/g extract), of methanolic and hydroalcoholic leaf extracts respectively.

Conclusion: The results obtained in the present study indicated Achelliaoligocephala can acts as a potential source of flavonoids and antioxidant.

Background and objective: Traffic accidents are a contributing factor to any loss of life, property, or services. It occurs when a vehicle collides with another vehicle or object. Certain elements will manifest, resulting in harm and potentially preventable incidents, and reduced by using the right strategies. These losses came from lower production and recovery costs. This study aimed to identify management, risk factors, and associated causes of traffic accidents in Erbil city.

Methods: This retrospective study was conducted from January 2008 to December 2023, in Erbil City, Iraq. Data was collected form national Incident monitoring system (NIMS) at directorate of Health, Erbil, KRG, Iraq. All acquired data were compiled until August 2020; thereafter, certain cases were excluded and not gathered due to the COVID-19 lockdown.

Results: A total of 41669 road traffic accidents were recorded during 2008-2023. A high incidence was found in 2023, and 2022 accounted for 4769 (11.44%), and 4613 (11.07%). While low prevalence was seen in 2012 (7.96%), 2015 (7.47%), 2016 (7.40%), 2014 (7.35%), 2013 (7.21%), 2018 (7.19%), 2017 (6.89%), 2021(5.96%), 2019 (5.04%), 2020 (4.66%), 2011 (3.10%), 2010 (3%), 2008 (2.45%), and 2009 (1.71%). Among all accidents with a high prevalence were car crashes (79.66%), followed by a lower prevalence of motorcycles (10.74%), pedestrians (7.53%), bicycles (1.91%), and car explosion (0.13%).

Conclusion: Human conduct is linked to a high rate of traffic accidents leading to injuries and fatalities. Road accidents have become a significant public health hazard. A new strategy for mitigating the seriousness of this issue is necessary.

Background and objective: Cystic echinococcosis which caused by the larval stage of the tapeworm Echinococcus granulosus is one of the important public health challenges worldwide. Various strains have been recorded. Available evidences revealed that pathogenesis of the disease has been associated with parasite genotype. The current study aimed to investigate role of mitochondrion partial genome polymorphisms, in responsiveness to albendazole treatment in murine model.

Methods: Hydatid cysts were obtained from infected livers of sheep. Protoscoleces from each isolate were separated into two batches. First preserved in ethanol (70%) at -20 ^o C for molecular investigation. The second part was used for direct in vivo experiment. Genomic DNA was extracted and mitochondrion partial genome was amplified and sequenced. Fourteen groups of Mice (twelve mice each) were infected experimentally with protoscoleces from 14 hydatid cysts isolates. Responsiveness of each isolate to albendazole was assessed.

Results: The sequencing profiles revealed no polymorphisms in 6 of the 14 studied isolates, while minor sequence polymorphisms, 0.33 %, that resulted in corresponding amino acid replacement, were observed in 3 of the isolates. Furthermore, remarkable DNA sequence polymorphisms were observed in 5 of the isolates, that caused affectable amino acid replacement in the suggested polypeptide sequences. Treatment efficacy of albendazole was positively correlated (r = 0.128) (P <0.001) with the polymorphism in E. granulosus mitochondrion partial genome.

Conclusion: A polymorphic sequence profiles of E. granulosus mitochondrion partial genome can be used to detect the sensitivity of the causative strains to albendazole. However, further studies should be conducted to involve hydatid cyst isolates from other intermediate hosts, and to assess the effectiveness of other anthelmintic drugs against various strains of the tapeworm E. granulosus.

Background and objective: Matricaria Chamomilla extract has profound biological and pharmacological properties and it has been widely used for its medicinal effects. It may be helpful in preventing hepatic damage induced by drugs. The chemotherapeutic agent 5-FU has been widely used for solid types of cancer however, liver toxicity is one of its serious side effects. The present study was designed to evaluate the effectiveness of Matricaria Chamomilla flower extract for hepatotoxicity induced by administration of 5-FU into rabbits.

Methods: A total number of 20 rabbits were randomly divided in to four groups, group 1 received distilled water, group 2 treated with chamomile extract (100mg/kg/day),group 3 and 4 animals were injected with 20mg/kg/day of 5-FU for 5 consecutive days and on day 6 started to receive treatment with either distilled water or chamomile extract that continued up to day 14, in which animals were sacrificed to get liver samples for histopathological analysis. A Kruskal-Wallis H and Post-Hoc tests were used for the statistical analysis and comparisons between the groups.

Results: The histopathological study showed significant inflammation of hepatic tissue in the group using 5-FU compared to control and chamomile treated groups.However, using chamomile after 5-FU induced hepatotoxicity didn’t show any significant reduction of inflammation of the hepatic tissue when compared to 5-FU treated group.

Conclusion: Although chamomile has profound biological and pharmacological properties such as anti-inflammatory and antioxidant activities that may be helpful in preventing hepatotoxicity induced by some drugs but in this study it didn’t show effectiveness in treating 5-FU induced hepatotoxicity at the dose and duration used.

Background and objective: Correlating gross placentas abnormalities with perinatal outcomes is crucial for understanding their clinical impact. The aim of this study was to determine the prevalence of gross placentas anomalies within a sample of Kurdish women after delivery and subsequently assess the association between these anomalies with early neonatal outcomes.

Methods: A cross-sectional study was conducted at the labor ward of Maternity Teaching Hospital, Erbil city, Kurdistan region, Iraq between 15th of August 2023, and 14th of August 2024 on 500 freshly delivered placentas from term newborns. Placentas morphological and structural anomalies were identified and correlated with maternal demographic and early neonatal outcomes.

Placental morphological anomalies (weight, diameter, and thickness) were linked to maternal preeclampsia, diabetes, hypothyroidism, and anemia. Gross anomalies significantly impacted early neonatal outcomes (Apgar scores, birth weight, NICU admission, neonatal deaths).

Conclusion: A significant placental abnormalities are common and strongly correlated with adverse neonatal outcomes, particularly when maternal medical disorders are present. Therefore placental assessment is vital for predicting and preventing these outcomes.

Background and objective: Alopecia areata is a non-scarring type of patchy hair loss accompanied by profound psychological distress. This study aims to assess the effectiveness of intralesional triamcinolone acetonide against intralesional vitamin D3 injection in treating alopecia areata.

Methods: This interventional therapeutic study was conducted on 40 adult patients who were divided into two groups. For a maximum of three sessions, 20 patients in Group I received intralesional injections of vitamin D3 (cholecalciferol aqueous preparation 100 000 IU/2 ml) every three weeks. Twenty patients in Group II underwent three sessions of intralesional injections of triamcinolone acetonide every three weeks. Clinical assessments were conducted both at baseline and following each session.

Results: The largest proportion of the sample (42.5%) were aged 20-29 years, more than two-thirds of the patients (67.5%) were males, about 2.5% of the patients had thyroid disease and 2.5% had atopy. In both groups there was significant increase in McDonald’s score, (P <0.001). After receiving three sessions, more than half (55%) of the steroid group had terminal regrowth in all areas, compared with 25% in the Vitamin D3 group. The difference was close to the level of significance (P = 0.063). No significant association was detected between the terminal regrowth on the third session with the following variables: number of patches (P = 0.783), size of the patch (P = 0.152), area (P = 0.319), in both groups

Conclusion: For patchy alopecia areata, both intralesional steroid and intralesional vitamin D3 are easy, safe, and affordable treatment options.

Background and objective: Interleukin-4 inhibits the secretion of many inflammatory cytokines and it acts as anti-inflammatory against insulinits that induced by autoimmunity in type-1 diabetes. This cross-sectional study aimed to determine the serum level IL-4 in patients with T1D and T2D, and to look into its relation to other pro-and anti- inflammatory cytokines and glycemic status.

Methods: Patients with a history of type-1 (T1D) (Group I, n=75) and type-2 (T2D) diabetes (Group II, n=75) were recruited from the Center of Diabetes in Erbil. Glycemic indices (included fasting serum glucose, insulin, glycated hemoglobin, c- peptide) and inflammatory-related cytokines (including highly sensitive C-reactive protein [hs-CRP], IL-1β, IL-4, IL-10, Interferon [INF-γ], and tumor necrosis factor [TNF-α]) were measured.

Results: Group II patients showed significant increase of hs-CRP, IL-10, and IL-4, while the serum levels of IL-1β and INF-γ were significantly reduced compared with Group I. Significant inverse correlations between IL-4 with each of the following markers; hs-CRP (r=-0.858), IL-1β(r=-0.890), INF-γ(r=-0.859), IL-10(-0.685), and TNF-α (r=-0.733) with predictive values ranged between 46.9% and 73.8% were observed in the Group II but not in the Group I. Non-significant correlation between IL-4 and glycemic indices were observed in Group I and II.

Conclusion: We conclude that determination of IL-4 can help to discriminate between autoimmune-from inflammatory markers that are associated with diabetes, and can serve as a predictor cytokine in T2D.