Ninevah University Journal of Medical Sciences
Ninevah University Journal of Medical Sciences was first published in 2025, it is an international double-blinded peer-reviewed general medical journal published two times per year. The Editor in Chief is assistant professor Dr. Moamin Junaid Al Dubooni. The journals owner and publisher is the College of Medicine / Ninevah University. The online versions are made freely available to all readers
College of Medicine / Ninevah University.
Benefits and Health Consequences of Using Stimulants among Health Care Staff in Nineveh Health Institutions
Background: A stimulant is a substance used to make a person alert, can control weariness and improve performance and cognition. Many healthcare staff choose behavioral or pharmaceutical stimulants, among them the use of food-based stimulants and/or drugs that raise activity in the central nervous system. Objectives: to study the prevalence, benefits, and side effects of using stimulants among healthcare staff in the Nineveh Health Institution. Methods: A cross-sectional study was conducted among 4300 healthcare workers (medical and non-medical personnel) in the Nineveh Health institution over five months (January to May 2025). Using an electronic data collection form consisting of four sections: socio-demographic characteristics (8 items), frequency of stimulant use (6 items), perceived benefits of stimulant use (4 items), and side effects of stimulant use (5 items), with closed-ended questions. The chi-square continuity test was used to compare variables, and a P-value ≤ 0.05 was considered significant throughout data analysis. Results: Out of 4300 participants, 1070 (24.9%) reported using stimulants. Coffee (20.2%) and tea (20.1%) were the most common stimulants. The primary reasons for use were to maintain alertness (44.6%) and as a dietary habit (39.3%). The most frequent side effects were sleep disturbance (67.0%) and tiredness (45.1%), which were most prevalent among married female medical staff aged 46 years or older working in hospitals. In contrast, health problems (29.2%) were more common among married males aged 46 years or older those were non-medical staff working in hospitals. Conclusions: Healthcare staff use stimulants during work to be alert and as a dietary habit to overcome work overload, worries and anxiety that resulted in sleep disturbances, tiredness, and health problems that indirectly affected their performance and efficiency of the work, it is recommended to put strategies in place to improve the work environment and workers’ personal lifestyles involving dietary diversification and caffeine consumption.
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Cigarette Smoking and Early Biochemical Indicators of Bone and Metabolic Health in Iraqi Adult Males
Background :Cigarette smoking has emerged as a significant extrinsic factor influencing skeletal and metabolic homeostasis, primarily through its modulation of vitamin D metabolism, enzymatic activity associated with bone turnover, and alterations in body composition indices. These disturbances may have cumulative implications for bone integrity and systemic health. Objective: This study aimed to elucidate the potential effects of cigarette smoking on serum 25-hydroxyvitamin D levels, alkaline phosphatase activity, body mass index, and waist circumference among apparently healthy adult Iraqi males. Methods: A Cross sectional comparative study was conducted between September 2024 and March 2025, involving 240 adult males (n = 120 smokers; n = 120 non-smokers), stratified by age into two subgroups (20–34 and 35–50 years). Anthropometric and biochemical parameters were assessed using standardized procedures. Vitamin D and alkaline phosphatase were measured via Roche/Hitachi Cobas analyzers. Statistical analysis included t-tests, ANOVA, and Pearson’s correlation coefficients; p < 0.05 was considered significant. Results: Although mean serum vitamin D levels did not significantly differ between groups, a substantially higher prevalence of vitamin D deficiency was observed among smokers (75.83%) compared to non-smokers (64.17%). In smokers, alkaline phosphatase levels were positively correlated with both age and smoking duration (p = 0.011 and p = 0.045, respectively). Among non smokers, advancing age was significantly associated with increased body mass index and waist circumference (p = 0.043), as well as a notable decline in vitamin D levels (p = 0.017). A robust inverse correlation was detected between WC and vitamin D among smokers (r = –0.595, p < 0.001). Conclusion: The findings suggest that chronic tobacco exposure is associated with a higher prevalence of vitamin D deficiency. In contrast, non-smokers exhibited age-dependent metabolic alterations. These data underscore the need for vitamin D level surveillance and metabolic risk screening in smokers.
Alkaline phosphatase; Body mass index; Bone metabolism; Cigarette smoking; Vitamin D; Waist circumference
Synergistic Effects of Coenzyme Q10 and Calcium Carbonate Composite on Mandibular Bone Regeneration in Rabbit Model
Background: Bone healing is a complex process involving the formation of new bone to repair defects. Various supplements, such as Coenzyme Q10 and Calcium carbonate, have been studied for their potential to enhance bone regeneration. Coenzyme Q10 Act as antioxidant that reduces oxidative stress and may promote osteoblast activity, while calcium carbonate provides calcium ions necessary for bone mineralization. Combining two agents together could improve bone healing outcomes, particularly in surgical defects of the mandibular bone. Objectives: The goal of this study was to investigate the effect of Coenzyme Q10 and/or calcium carbonate on blood N-Telopeptides of Type I Collagen (NTx) and Bone-specific Alkaline Phosphatase (BALP) levels, as well as the histological effects in rabbits at the healing site in the mandibular bone following surgery. Methods: In a randomized controlled trial, sixty male New Zealand rabbits underwent surgical creation of a standardized mandibular bone defect. The animals were allocated to six groups (n=10/group): a negative control (empty defect) and five treatment groups where the defect was filled with either Coenzyme Q10, CaCO₃, or one of three CaCO₃: Coenzyme Q10 ratio mixtures (1:1, 1:2, 2:1). Histological and biochemical analyses were performed to assess bone healing at 15 and 30days post operation. Results: All treated groups exhibited a significant decrease in NTx and a significant increase in BALP levels compared to control values at 30 days, confirming a positive shift in bone metabolism. Histological analysis indicated enhanced bone regeneration in all treatment groups compared to the control, with the Coenzyme Q10 + CaCO₃ (1:2) composite showing the most substantial improvement, as evidenced by increased bone fill and osteoblast activity. A one-way ANOVA identified statistically significant differences in bone healing outcomes between the groups (p < 0.05). Conclusions: This study found that a 2:1 calcium carbonate/Coenzyme Q10 composite graft significantly enhances mandibular bone regeneration by dual osteogenic and anti-resorptive mechanisms, supporting its potential as a smart bone graft material.
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Vitamin D and Men's Health: Literature Review
Vitamin D, sometimes referred to as the "sunshine vitamin," provides a number of benefits beyond bone health. In men, it has a role in fertility, metabolic regulation, immunological modulation, and healthy aging. By analyzing its production, mechanisms, physiological functions, and specific effects on male health across several systems, this article aims to clarify the importance of vitamin D in preventative and therapeutic health measures. Vitamin D, previously linked to calcium and bone homeostasis, is now a crucial regulator in various physiological domains affecting men's health. This comprehensive review explores the production, metabolism, and several mechanisms of action of vitamin D, with particular attention to its impact on male fertility, metabolic syndrome, immunological regulation, aging, obesity, and chronic diseases such as type 2 diabetes and autoimmune disorders. According to recent studies, vitamin D receptors are found in male reproductive and metabolic organs, and adequate vitamin D levels are linked to improved musculoskeletal integrity, insulin sensitivity, hormonal balance, and semen quality. The study explores the impact of vitamin D deficiency, a prevalent issue in men globally, and suggests interventional strategies such as supplementation and lifestyle modifications. Vitamin D is a crucial regulator of male physiological and pathological processes, according to all available research, and as such, it merits more attention in clinical practice and public health policy.
Reference Interval of Homeostasis Model Assessment- Insulin Resistance in an Iraqi Adult Population: A Study in Nineveh Governorate
Background: Insulin resistance (IR) is a condition in which the tissues become less responsive to insulin. IR has been linked to many diseases including Type 2 Diabetes Mellitus (T2DM), pre-diabetes, and metabolic syndrome. The most commonly used tool of IR assessment is Homeostasis Model Assessment of insulin resistance (HOMA-IR). In Iraq, there is limited data on the reference interval of HOMA-IR. Objectives: To calculate the reference interval of HOMA-IR among a randomly screened sample of adult people in Nineveh Province, Northern Iraq. Methods: This is a cross-sectional study that finally involved 286 apparently healthy adults (≥25 years). Data were collected in the period from the 1st of September to the end of December 2024. Weight and height were measured and body mass index (BMI) was calculated for each participant. Fasting serum insulin and glucose were tested and used to calculate HOMA-IR. Results: The overall mean ±SD of HOMA-IR for the study population was 2.11±1.34. HOMA-IR 95% reference interval was calculated based on the 2.5th percentile and 97.5th percentile after removing outliers and was (0.53- 4.32). The participants were then divided according to BMI into 3 groups. For subjects with BMI below 25 Kg/m2 , the mean HOMA-IR was 1.62±1.2, and the 95% reference interval was (0.46-3.54). For Subjects with BMI from 25- 29.99 Kg/m2 , the mean HOMA-IR was 1.88±0.75 and the reference interval was (0.64-4.04), however, for subjects with BMI ≥ 30 Kg/m2 , the mean ±SD of HOMA-IR was 2.71±1.61 and the reference interval was established to be (0.49-4.75). Conclusions: The upper end of the reference interval in our study was a bit lower than previous studies in Iraq, and comparable to other studies in the region. Higher BMI is associated with increase in the mean HOMA-IR (p < 0.000). The differences in the methods used to obtain HOMA-IR reference interval may lead to significantly different results.
Knowledge, Attitudes, and Barriers Toward COVID-19 Vaccination Among Health-Care Workers in Nineveh Health Directorate, Iraq
Background: The rapid dissemination of COVID-19 has highlighted the critical importance of vaccination to break the cycle of disease dissemination within the community. Vaccination protects both individuals and others from infection. Objectives: To study the knowledge, attitudes, and barriersregarding COVID-19 vaccination among healthcare workers in health institutions in Nineveh governorate, Iraq. Methods: A cross-sectional study was conducted among 1,296 health-care workers in the Nineveh Health Directorate over a six-month period. Data were collected using an electronic questionnaire consisting of three parts: (1) socio-demographic characteristics, (2) general information, and (3) attitudes toward COVID-19 vaccination. A three-point Likert scale was used, and the mean scores were calculated.Result: The study revealed that 51.1% of participants were male, 45.2% had a university education, 69.3% were medical staff, and 54.6% were working in hospitals. Nearly half (46.9%) had 10 years or less of work experience, and the vast majority (86.6%) had been vaccinated. The grand mean score for general information was 2.5. Two-thirds of participants (61.1%) were vaccinated by Pfizer. The main reasons for refusing vaccination were fear of vaccine-related complications (67.8%) and the COVID-19-related death of a relative (58.7%). Conversely, the most common reason for accepting vaccination was direct contact with an infected person (71.8%).The grand mean score for attitude was 2.1. A significant association was found between greater work experience and higher knowledge regarding COVID-19 vaccination (P = 0.010). Conclusion: Health-care workers in the Nineveh Health Directorate demonstrated good knowledge, positive attitudes, and high uptake of COVID-19 vaccination. However, targeted educational programs are needed to strengthen awareness among younger and less experienced staff.
Corona pandemic; COVID -19 vaccination; Health-staff awareness.
Impact of Gender on the Relationship Between Obesity and Inflammatory Markers in Rheumatoid Arthritis
Background: Obesity is associated with elevated inflammatory markers such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), which can complicate disease activity assessment in rheumatoid arthritis (RA). Gender specific differences in fat distribution and immune response may further modulate this relationship. Objectives: To evaluate the impact of gender on the association between obesity and systemic inflammatory markers (CRP, ESR) in patients with RA in remission or low disease activity, compared to obese non-RA controls. Methods: A cross-sectional study was conducted on 126 RA patients (70 obese and 56 non-obese) and 50 obese healthy controls. RA diagnosis was based on 2010 ACR/EULAR criteria. Patients were grouped by gender and obesity status. CRP and ESR levels were compared using Mann–Whitney U tests, with subgroup analysis by gender. Results: Obese RA males exhibited significantly higher CRP and ESR levels compared to non obese RA males (p = 0.004, 0.038, respectively). In RA females, CRP was moderately elevated in obese compared to non-obese (p = 0.041), while ESR differences were non-significant. Obese male controls also showed elevated inflammatory markers, suggesting adiposity-related inflammation even in the absence of RA. Overall, visceral fat in males appeared to exert a stronger influence on systemic inflammation. Conclusion: Gender significantly influences the inflammatory response to obesity in RA. Male patients, particularly those with obesity, show disproportionately elevated CRP and ESR levels that may not reflect actual disease activity. This underscores the need for gender-specific interpretation of inflammatory markers to avoid misclassification and overtreatment in RA.
Patients’ Perceptions Towards the Participation of Medical Students in Their Care
Background: Patients Examination is an essential part of the medical education, through interaction with real patients, medical students learn most important skills like critical thinking, diseases, in addition to leadership, empathy, communication, and diagnosis, management of many professionalism. These skills are needed for the medical student to become an efficient physician. Objectives: Is to determine patient’s perception towards involvement of students in their medical care. Methods: An observational cross-sectional multicentric study was conducted in five major teaching hospitals in Mosul between February and April 2023. A convenience sampling method was used to recruit 206 patients from internal medicine, surgery, obstetrics and gynecology, and pediatrics departments. Data were collected through a validated structured questionnaire administered via face-to-face interviews. Results: A total of 219 patients were approached, and 206 agreed to participate (response rate: 94%). The median age was 27 years (range: 4 days to 87 years). Of the participants, 128 (62.1%) were female and 78 (37.9%) were male. Patients’ perceptions varied: on average, 90.3% agreed to medical student involvement for history taking, attending in the operating room, and performing examinations. However, only 58.7% approved interventional procedures performed by students. Overall, 88.3% approved history taking and clinical examination under supervision, while 66% agreed to these activities without supervision.Conclusion: Patients have positive perception towards medical students, the agreement levels affected by the nature of interaction, presence of a supervision, gender, and the department they admitted in.
Verification of Glypican 4 and Hormonal Changes in Patients with Polycystic Ovarian Syndrome: A Case-Control Study
Background: Polycystic ovarian syndrome (PCOS) is commonly linked to insulin resistance and metabolic disturbances. Early diagnosis improves outcomes. Objectives: This study examined the relationship between serum glypican-4 (GPC4) levels and sex hormones in women with PCOS. Methods: In this case-control study, 40 healthy women who were age-matched to the PCOS patients were selected as the control group, while 100 women with PCOS between the ages of 15 and 45 took part. The study was carried out through a survey conducted in the outpatient department of Kirkuk General Hospital from September to December 2024. The Rotterdam criteria are used to diagnose PCO in patients. Before and after therapy, the body mass index is calculated. Using an ELISA kit and the Enzyme-Linked Immunosorbent Assay technique, the amount of glycocan-4 in human serum was determined. Serum levels of the sex hormones follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin (PRL) were measured using an automated biochemical analyzer. Results: The PCOS group human Glypican-4 levels and serum levels of sex hormones (LH, FSH, and PRL) were significantly (p<0.01) greater than the control group. Conclusion: Serum glypican-4 levels were significantly elevated in women with PCOS compared to the control group.
Evaluation of Immunological Biomarkers (Tumor Necrosis Factor-α, Anti-Cyclic Citrullinated Peptide, and Adenosine Deaminase) and Their Association with Disease Activity (DAS28) in Individuals with Rheumatoid arthritis
Background: Rheumatoid arthritis (RA) is a chronic, systemic autoimmune disease characterized by persistent synovial inflammation and progressive joint destruction. This study investigates the association between tumor necrosis factor-alpha (TNF-α), anti-cyclic citrullinated peptide antibodies (anti-CCP), adenosine deaminase (ADA), and the Disease Activity Score-28 (DAS28) in RA patients. Understanding these biomarker correlations provides valuable insights into disease activity assessment and facilitates personalized therapeutic strategies. Objectives: The study aims to assess the relationships between TNF-α, Anti-CCP, ADA, and DAS28 in patients with rheumatoid arthritis in Kirkuk, Iraq. Methods: This case-control study comprised 135 subjects (divided into three groups: 45 newly diagnosed not previously treated patients with rheumatoid arthritis, 45 patients undergoing treatments for 3 months, and 45 healthy rheumatoid factor (RF)–negative controls from the general population. Biomarker levels—TNF-α, anti-CCP, and ADA—were determined using a sandwich enzyme-linked immunosorbent assay (ELISA) with monoclonal antibodies. Results: In the comparison of patients with rheumatoid arthritis (RA) with healthy controls, significant elevations in means (before, after, control) of TNF-α (849.0, 120.4, 64.3 ng/ml), anti-CCP (531.2, 273.4, 91.2 ng/ml), and ADA (14.9, 1.6, 1.3 ng/ml) were observed. Conversely, significant decreases in these levels were seen after the therapy. A significant association was noted between TNF-α and DAS28 before medication treatment, but anti-CCP exhibited a correlation post-therapy. ADA demonstrated a robust correlation. Evidence indicates that TNF-α and anti-CCP are significant predictive markers for monitoring disease activity in rheumatoid arthritis (RA). Conclusions: TNF-α and anti-CCP are reliable biomarkers for monitoring treatment response and disease activity in rheumatoid arthritis. Significant post-treatment reductions in these markers’ indicators indicate successful immunosuppression, while ADA normalization implies reinstated immunological modulation. The diminished link between TNF-α and DAS28 following therapy underscores effective cytokine regulation, while the post-treatment relationship of anti-CCP with DAS28 reinforces its significance in long-term illness monitoring. ADA demonstrated restricted efficacy in evaluating joint-specific activity. Moreover, increased BMI correlated with worse inflammatory and hematologic profiles, underscoring the impact of obesity on RA pathogenesis. These insights offer crucial region-specific information for enhancing RA management techniques.
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Polypharmacy and Potential Drug-Drug Interactions in Patients with Psoriatic Arthritis
Background: Psoriatic arthritis (PsA) is an inflammatory arthropathy linked to psoriasis and typically negative for rheumatoid factor. Patients with PsA are at a higher risk of polypharmacy due to comorbidities and widespread pain. This growing health problem leads to negative outcomes like increased mortality, falls, medication adverse effects, prolonged hospital stays, and re-admission after discharge. Objectives: Assessment of polypharmacy in patients with PsA, its relation to patient characteristics, and the potential for undesirable interactions between drugs used to treat PsA and those used for other conditions. Methods: A cross-sectional study was conducted at the Rheumatology Unit of Baghdad Teaching Hospital/Medical City Complex, during the period from January 2023 to January 2024. The study included 100 adult PsA patients diagnosed according to the Classification of Psoriatic ARthritis (CASPAR) criteria. The demographic and disease-related characteristics were collected using a pre-constructed data collection document. Polypharmacy was defined as the concurrent use of at least five drugs irrespective of their duration. The drug interaction checker® of Medscape’s database was used to assess the drug-drug interactions. Results: Sixty-three of the 100 PsA (63%) patients exhibited polypharmacy, and there were 236 potential drug-drug interactions. The majority of these interactions were due to the use of methotrexate with folic acid, NSAIDs, and PPIs. Drug interactions were less frequent with the tumor necrosis factor (TNF) inhibitor. Conclusion: The prevalence of polypharmacy was elevated among PsA patients. Polypharmacy was significantly correlated with patient age, peripheral disease activity, and the existence of comorbidity. Polypharmacy was linked to an increased risk of possible drug-drug interactions.
Salivary CA125, Mucin-1, VEGF, and sFasL as Non-Invasive Biomarkers for Breast Cancer Detection and Prognosis: A Case-Control Study from Kirkuk, Iraq
Background: Breast cancer continues to be one of the most common and deadly cancers affecting women worldwide, including in Iraq. Conventional diagnostic methods like mammography and tissue biopsy, although efficacious, are intrusive, expensive, and constrained in resource-limited environments. In recent years, saliva has become a viable non-invasive diagnostic sample owing to its simplicity of collection and molecular composition that indicates systemic alterations. Objective: This study aims to assess the clinical efficacy of salivary CA125, Mucin-1 (MUC-1), VEGF, and sFasL as non-invasive biomarkers for the early identification and prognosis of breast cancer in women in Kirkuk, Iraq. Methods: A case-control study was done in a hospital setting from December 2024 to April 2025. Saliva specimens from 200 breast cancer patients at different stages and 40 healthy female controls were examined utilizing ELISA. Comparative and inferential statistics were employed to evaluate biomarker levels. Results: All four biomarkers (CA125, MUC-1, VEGF, and sFas) exhibited statistically significant increases associated with cancer stages (p < 0.01). ROC analysis demonstrated elevated diagnostic accuracy, with AUC values nearing or reaching 1.0 for combined markers. Conclusion: Salivary biomarkers present a promising, non-invasive method for the identification and monitoring of breast cancer progression, especially in resource-constrained environments.
Correlation Between Vitamin D, Alkaline Phosphatase, and Lipid Profile in Type 2 Diabetes
Background: Vitamin D is essential for immune system control, glucose metabolism, and musculoskeletal development. Conflicting findings have implicated vitamin D in dyslipidemia, and its deficiency has been associated with several clinical diseases. Objective: This research sought to explore the connection between vitamin D level, alkaline phosphatase, and lipid profile in individuals with type 2 diabetes in contrast to those without diabetes. Methods: The study was conducted as a case-control study in Mosul City/Iraq, from October 2024 to January 2025. Involved a total of 160 participants within the age range of 35 to 60 years old. The participants were divided into two categories: one group consisted of type 2 diabetics (referred to as cases, including 80 individuals), while the other group consisted of individuals (referred to as controls consisting of 80 individuals. The subjects' lipid profiles, glycemic control (hemoglobin A1c, fasting plasma glucose), alkaline phosphatase activity, and vitamin D levels were examined. Results: The diabetes mellitus group (cases) showed significantly lower vitamin D (6.86 ± 2.3 ng/mL vs. 32.3 ± 12.14 ng/mL) and HDL-C levels (26.66± 9.85 mg/dL vs. 48.56± 9.66 mg/dL) and higher alkaline phosphatase activity(151.91± 22.47U/L vs. 61.18± 12.69 U/L), total cholesterol (213.43± 30.47 mg/dL vs.155.52± 13.7 mg/dL), LDL(137.2±, 31.06mg/dL, vs.81.85± 16.46mg/dL), VLDL (59.57±10.85mg/dL vs. 25.1±5.34mg/dL). Triglycerides (247.86± 54.27 mg/dL vs. 125.53± 26.73 mg/dL), and atherogenic index (10.24± 3.32 vs.5.33 ± 2.37) compared to the control. A positive relation was found between alkaline phosphatase and HbA1c (r = 0.860, p < 0.001), alkaline phosphatase and fasting plasma glucose (r = 0.787, p < 0.001) among cases. Lipid profile components, including total cholesterol correlated positively with HbA1c (r = 0.876, p < 0.001) and fasting plasma glucose (r =0.836, p < 0.001), LDL correlated positively with HbA1c (r =,0.742 p < 0.001) and fasting plasma glucose (r = 0.752 p < 0.001) while vitamin D levels were negatively related to total cholesterol(r =-0.609, p < 0.001), LDL(r =-0.497, p < 0.001), VLDL(r =-0.333, p =0.00251), and triglycerides(r =-0.333, p =0.00251). Conclusion: Diabetic patients showed lower vitamin D levels, remarkably higher lipid profiles and higher alkaline phosphatase compared to the control group. Strong correlations were observed between alkaline phosphatase, HbA1c, and fasting plasma glucose, indicating a potential link to glycemic control. Additionally, vitamin D levels showed negative correlations with total cholesterol, LDL, VLDL, and triglycerides in diabetic patients.
Ventricular Remodeling Parameters in Mixed-Sport University Athletes Compared with Non-Athletes
Background: The term "athlete's heart" (AH) refers to the morphologic and functional cardiac adaptations. When compared to non-athletic people, these symptoms may include an increase in the sizes of the left and right cardiac chambers, an increase in the thickness of the left ventricular (LV) wall, and an increase in the indices of resting and exercise systolic and diastolic function. Objective: This research sought to compare the echocardiographic parameters of the left ventricle of a group of university students who participate in sports to another group that does not. Methods: The study was conducted as a comparative-analytic study in Mosul City/Iraq, from November 2024 to May 2025. Involved a total of 160 participants within the age range of 18 to 25 years old. The participants were divided into two categories: (80 athletic and 80 non-athletic groups), each group contains (50 males and 30 females). Echocardiographic examination was done to measure the dimensions, systolic and diastolic functions of the left ventricle. Results: The athletic group showed significantly enhanced diastolic function compared with the non-athletic group. This advantage was reflected by higher E/A ratio (1.75 ± 0.44 vs. 1.53 ± 0.21, p = 0.000), increased septal e′ velocity (16.74 ± 2.77 cm/s vs. 15.26 ± 2.65 cm/s, p = 0.001), and higher lateral e′ velocity (18.79 ± 2.96 cm/s vs. 16.10 ± 2.03 cm/s, p = 0.000). Additionally, athletes exhibited a significantly lower E/e′ ratio (4.24 ± 1.42 vs. 5.40 ± 0.94, p = 0.000), indicating more efficient ventricular filling. A structural difference was also observed in interventricular septal thickness (IVS), which was higher among athletes (0.94 ± 0.16 cm) compared with non-athletes (0.86 ± 0.14 cm; p = 0.003). Conversely, no significant differences were detected in left ventricular size or systolic performance. The left ventricular end-diastolic diameter (LVED) showed comparable measurements between athletes and controls (4.91 ± 0.64 cm vs. 4.82 ± 0.62 cm, p = 0.365), and the left ventricular end-systolic diameter (LVES) demonstrated similar values (2.97 ± 0.50 cm vs. 2.96 ± 0.48 cm, p = 0.972). Likewise, left ventricular ejection fraction (LVEF%) did not differ significantly between groups (0.68 ± 0.06 vs. 0.70 ± 0.06, p = 0.159). Conclusion: Athletic training had no significant effect on LV dimensions or systolic performance, despite the existence of increased IVS thickness in athletes. In contrast, diastolic function indicators were significantly higher in the athletic group, indicating greater cardiac relaxation. These findings support the hypothesis that young athletes have physiological rather than pathological cardiac remodeling
Complications of Circumcision And its Management in Pediatric Age Group
Background: Circumcision is the most common & oldest surgical procedure inthe world, about one third of males in the world are circumcised.Objectives : to evaluate the predisposition of early & late complications of circumcision in different age group regarding the technique used & operator as well as management strategy for each complication. Methods: A prospective case series study conducted at the pediatric surgery centre at AL-Khansaa Teaching Hospital in Mosul city in Iraq from the first of June /2019 to the first of December/2020. The complications were categorized as early complication (< 1 week) such as, infection, bleeding, huge mucosal edema, penile amputation & glans injury. Late complications (>1week) such as phimosis/trapped penis, adhesions/skin bridges, excess foreskin, ventral curvature, retention cyst, meatal stenosis & penile torsion. Results: 105 cases were referred to our pediatric surgery center. 101 (96.19%) circumcised by paramedical staff (nurse, dresser), 3 (2.85 %) patients circumcised by paediatric surgeon & 1 (0.95%) circumcision done by general surgeon {P=0.001}. Early & late complications included : phimosis/trapped penis [n=47 (44&%)], meatal stenosis [n=9 (8.5 %)], torsion [n=1 ( 0.95 %)], bleeding [n=11 (10.4%)], mucosal edema [n=1 ( 0.95 %)], ventral curvature [n=3 ( 2.8 %)], glans injury [n=4 ( 3.8 %)], penile amputation [n=1 (0.95 %)], urethral fistula [n=1 (0.95 %)]. Conclusion: There circumcision complications may be high in the infantile age group. Many complications seen in those circumcised by untrained paramedical staff with unauthorized thermocautery machine.
Knowledge and Attitudes of Patients with Type 2 Diabetes Mellitus toward Insulin Therapy in Erbil city: a Cross-Sectional Study
Background: of type 2 diabetes mellitus patients. Knowledge and atti Insulin therapy plays a major role in controlling glycemic status tude of patients regarding insulin therapy is essential in better adherence to therapy. nObjective: To assess the knowledge and attitudes of patients with T2DM regarding insulin therapy and to identify the influencing sociodemographic and clinical factors. Methods: A cross sectional project conducted in two primary public health centers (Azadi and Shadi centers) in Erbil city-Kurdistan region/Iraq in a period of 9 months from 1st of October 2024, to 30th of June, 2025onsample of 200 type 2 diabetic patients. The knowledge and attitude of patients were assessed by self administered questionnaire. Results: In current study, 49% of type 2 diabetic patients had good knowledge about insulin therapy and 51% of them had poor knowledge, while 33.5% of patients had positive attitude regarding insulin therapy and 66.5% of them had negative attitude. The poor knowledge about insulin therapy of patients was significantly related to single marital status (p=0.03), low educational level (p=0.003), obesity (p=0.03), low socioeconomic status (p=0.001), current DM treatment (p<0.001), hypoglycemic attack (p=0.03) and lack of family member or friend using insulin (p<0.001). The negative attitude regarding insulin therapy for patients was significantly related to low educational level (p=0.01), insufficient family income (p=0.003), current DM treatment (p<0.001), hypoglycemic attack (p=0.01) and lack of family member or friend using insulin (p<0.001). Conclusions: The type 2 diabetic patients in Erbil city have an acceptable knowledge regarding insulin therapy, while the attitude about insulin therapy is negative in high proportion of them.