Introduction:This study aimed to establish the prevalence and the risk factors of PGF in preterm babies under the Neonatal Intensive Care Unit (NICU) of Dr. Jamal Ahmed Rashid Pediatric, and Maternity Teaching Hospitals, Sulaimaniyah, Iraq.Material and Methods:The cross-sectional prospective design was used. The participants included preterm cases who were born at 32 weeks of gestation or below and were taken to the NICU at birth and up to two months of corrected age. The electronic clinical records were used to extract data, which consisted of maternal demographics, neonatal characteristics, feeding practices, and clinical complications. The anthropometric indices (weight, length, head circumference) were recorded at birth, 36 corrected gestational age (CGA), two months corrected age. A p-value<0.05 was considered statistically significant.Results:PGF was found in 70.4% of infants at 36 weeks CGA and continued at 46.3% at two months corrected age. Strong inverse associations between PGF and the birth weight (r = –0.482, P < 0.001) and earlier initiation of enteral feeding (r = –0.394, P = 0.003) and between PGF and the gestational age (r=-0.300, P=-0.028) were observed. Correlations with positive values were observed between PGF and necrotising enterocolitis (NEC; r = 0.305, P ≤ 0.025), total parenteral nutrition (TPN) utilisation (r = 0.327, P ≤ 0.016), prolonged time to full enteral feeding (r = 0.453, P ≤ 0.001 There was a significant nutritional deficiency as human milk fortification (HMF) was missing in all the cases.Conclusions:Strong feeding guidelines, regular HMF, and improved post-discharge follow-up may significantly improve the developmental patterns and health outcomes in preterm population.
Introduction: The increasing rate of cesarean section is a major public health concern. Despite its benefits in specific conditions, this method leads to increased complications such as infection, bleeding, thromboembolism, and neonatal problems. In Iran, the cesarean rate has been reported to be 3 to 4 times higher than the WHO standard. Lack of sufficient knowledge and incorrect attitudes of pregnant women towards cesarean complications are important reasons for the unnecessary choice of this method, which further reveals the necessity of investigating the knowledge level of this group. To determine the level of knowledge about cesarean section complications among primiparous pregnant women in Ardabil County. Materials and Methods: This descriptive-cross-sectional study was conducted on 398 primiparous pregnant women referred to Ardabil health centers. Multi-stage cluster sampling was performed. The research tool was an 18-item questionnaire to assess knowledge. A correct answer received one point, and an incorrect or "I don't know" answer received zero points. Data analysis was performed using SPSS software version 21, using Spearman's correlation, Mann-Whitney, Kruskal-Wallis, and logistic regression tests. Results: The mean knowledge score of women was 11.38 ± 2.67. A significant relationship was observed between knowledge and education, occupation, income, and prenatal education, but no significant relationship was found between knowledge and age or gestational age. According to logistic regression, prenatal education was a predictor of knowledge. Conclusion: The study concludes that knowledge levels are insufficient. Implementing targeted prenatal educational programs is crucial to increase awareness and reduce unnecessary cesarean sections.
Lung transplantation is a life-saving intervention for individuals with end-stage pulmonary diseases. However, the post-transplant period requires rigorous rehabilitation to restore physical function and reduce risks such as infection or graft rejection. Traditional center-based rehabilitation can be burdensome due to travel demands, costs, and infection exposure risks for immunocompromised patients. Tele-rehabilitation hereafter referred to as tele-rehabilitation leverages smartphone technology to deliver remote, personalized care via apps, wearables, and virtual consultations. This approach has the potential to shift rehabilitative care to the home, empowering recipients in their recovery (1). Post-lung transplant recipients often experience muscle weakness and reduced exercise capacity. Regular physical activity is essential, yet adherence to in-person programs can be suboptimal due to logistical barriers. Preliminary evidence from lung transplant-specific studies, including pilot work and trial designs, suggests that smartphone-based tele-rehabilitation using step-counters, activity trackers, and coaching apps may enhance adherence and engagement through personalized goal-setting and remote progress monitoring (2,3). In broader chronic respiratory populations (e.g., COPD), similar digital interventions have shown benefits in these areas, providing supportive extrapolated evidence (3,4). The potential benefits of tele-rehabilitation are multifactorial. It improves accessibility by reducing travel burden and infection risk a key advantage for immunosuppressed patients. Hybrid models combining virtual and in-person sessions add flexibility. Preliminary data from lung transplant-specific programs, such as the Lung Transplant Go (LTGO) pilot study and its subsequent randomized controlled trial design (5,6), along with evidence extrapolated from pulmonary rehabilitation in other chronic lung diseases, suggest potential improvements in functional capacity (e.g., six-minute walk distance) and patient-reported outcomes like motivation and self-efficacy (3,4). Remote monitoring may also offer cost-saving potential by reducing acute healthcare utilization. However, challenges must be addressed to fully realize tele-rehabilitation's potential. Technological access and digital literacy vary, risking a "digital divide" that could exacerbate inequities. Data privacy and security for transmitted health information raise important ethical and governance concerns. Clinically, the lack of direct supervision necessitates robust remote monitoring protocols, including defined thresholds for parameters like oxygen saturation and clear escalation pathways, to ensure patient safety particularly for detecting exercise-induced desaturation. While app-based behavioral features can support motivation, the absence of in-person social support may impact long-term engagement. Although evidence from COPD and related conditions is encouraging, rigorous lung transplant-specific randomized controlled trials remain limited, and more are needed to confirm efficacy and safety in this population (7,8). Implementation of tele-rehabilitation requires careful ethical and governance frameworks, including informed consent for data use, strategies to promote equitable access and bridge the digital divide, and clear clinical accountability for remote monitoring. Addressing these is essential for responsible scale-up. Looking ahead, advances such as AI-driven analytics and enhanced wearable integration could refine remote care. Future policy and research should prioritize standardized, equitable protocols and high-quality, transplant-specific evidence (6). In conclusion, tele-rehabilitation offers a transformative opportunity for accessible, patient-centered support of lung transplant recipients. While preliminary evidence particularly from related fields and early transplant-specific studies is promising, overcoming technological, clinical, and ethical challenges is critical. Thoughtful integration of this technology can empower patients to manage their health and breathe easier in their post-transplant lives.
Introduction:Obesity is a many-sided health problem affecting millions of people around the world, which require interventions to minimize its effect on human’s health and health care system. Bariatric surgery has appeared vital assist for copying with obesity and associated complications, but in-depth understanding of its outcomes and patient’s satisfaction has yet to be developed, especially within our community context.Objective; To compare the short-term effects of sleeve gastrectomy and Roux-en-Y gastric bypass on BMI reduction and resolution of obesity-related comorbidities.Materials and Methods:A retrospective cohort study was conducted at Zhyan Private Hospital, Sulaymaniyah, between December 2023 and April 2024. Data from 226 patients who underwent bariatric surgery were analyzed. Pre- and postoperative BMI, hypertension (HT), and type 2 diabetes mellitus (DM) were assessed. Statistical analyses were performed using SPSS v26.0; McNemar’s test was applied for paired categorical outcomes, and Chi-square tests for between-group comparisons.Results: Median BMI reduction was significantly greater in the bypass group (17.49 kg/m²) than in the sleeve group (11.70 kg/m²; p = 0.002). Both procedures produced significant remission of HT (from 40 to 13 cases; p < 0.001) and DM (from 17 to 3 cases; p < 0.001). No significant difference in absolute weight loss was observed between groups (p = 0.15).Conclusion:Bariatric surgery, particularly gastric bypass, was associated with marked BMI reduction and comorbidity remission within six months, supporting its role in managing severe obesity and metabolic disease in our population.
The radiographic examination of the pelvis is a routine procedure in the medical imaging facilities to measure pathological processes like fractures, arthropathy or degenerative disease. However, since X-ray imaging involves the use of ionizing radiation, there is a reasonable possibility of subjecting the sensitive organs of the pelvis, such as the gonads, bladder, rectum and bone marrow to harmful doses of radiation. The current study aimed at determining the levels of organ-specific radiation dose of a cohort of 100 adults who underwent conventional anteroposterior pelvic radiography in three different imaging centers based in Erbil, Iraq. The exposure variables (kVp, mAs, filtration, source-image distance) were measured with a Nomex multimeter and estimates of organ dose were obtained with the PCXMC 2.0 Monte Carlo simulation package. The effective dose rates of the vital organs ranged between 1.04 mSV onto the colon and 3.02 mSV onto the prostate. These findings demonstrate the urgency to unify and align imaging procedures and even guarantee their correspondence to diagnostic reference levels, reducing stochastic threats and preserving diagnostic effectiveness.
Introduction: Nephrocalcinosis is a common complication in premature infants characterized by calcium deposition in the renal parenchyma. Multiple factors contribute to its development and it can lead to both short- and long-term complications. This study aimed to investigate the risk factors for nephrocalcinosis and nephrolithiasis in very low birth weight infants born before 32 weeks gestation at Alavi and Bu-Ali Hospitals in Ardabil. Materials and Methods: In this cross-sectional descriptive-analytical study, a total of 120 premature infants (30 cases and 90 controls) with gestational age less than 32 weeks or birth weight under 1500 g, admitted from April 2022 to August 2024, were assessed. Demographic characteristics, medications, blood and urine parameters, renal ultrasonography, and complications were evaluated. Statistical analysis was performed using Chi-square test, t-test, and multivariate logistic regression. Significance was set at p < 0.05. Results: Among 120 infants, 30 (25%) had nephrocalcinosis (cases), 12 (40%) of whom also had nephrolithiasis. Gestational age was lower in cases (26.16 ± 1.42 weeks vs. 28.95 ± 1.87 weeks, p < 0.001), birth weight was lower (907 ± 152 g vs. 1169 ± 187 g, p < 0.001), urine calcium-to-creatinine ratio > 0.8 (OR=8.45[CI:3.76-19.02]), family history of kidney disease (OR=5.12[95%CI:1.85-14.16]), mechanical ventilation > 10 days (OR=2.92[CI:1.71-4.99]), corticosteroid use (OR=3.21[CI:1.31-7.85]), and vancomycin use (OR=2.76[CI:1.14-6.67) were independent risk factors for nephrocalcinosis. Conclusion: Nephrocalcinosis is a relatively common complication in premature infants with multiple contributing risk factors. Identifying these risk factors helps in prevention, early diagnosis, and appropriate treatment.
Introduction:Type 1 diabetes (T1DM), as a chronic endocrine disorder associated with insulin deficiency and accompanied by hyperglycemia. This study aims to compare the effect of multiple daily insulin regimen (MDI) and conventional insulin regimen (CIR) on HbA1C levels in children with T1DM in terms of glycemic control, complications, and quality of life.Materials and Methods:The proposed study was a retrospective cohort study conducted on 84 children aged between 2-18 years and who attended a hospital in Sulaymaniyah, Iraq, in the first half year of 2025. A structured questionnaire collected data on socio-economic status, and health history. The hospital records were used to collect the data required for the study. HbA1C levels, insulin regimen details, frequency/severity of glycemic events, incidence of complications, and adherence and quality of life scores were collected. Statistical significance was set at P<0.05.Results:Although children on MDI showed higher mean HbA1c levels over 12–24 months (74.3% with HbA1c > 9% vs. 63.3% in the CIR group), a larger proportion of MDI users (20% vs. 2%) reported a noticeable decrease in HbA1c after switching to this regimen. Blood glucose monitoring frequency was higher in the MDI group (P<0.001), yet hypoglycemia and hyperglycemia rates were comparable between groups (P>0.703 and P>0.061), respectively. Notably, dietary adherence was suboptimal in both cohorts, and most participants expressed uncertainty regarding regimen ease of use.Conclusion:The current study found that the MDI regimen compared to the CIR regimen was linked to high levels of HbA1c level among young patients with T1DM, therefore, inhibiting the expected superiority of MDI in attaining high-quality glycemic regulation.
Introduction:At our institution, advance care planning (ACP) discussions during Medicare Annual Wellness Visits (MAWVs) were inconsistently documented. While providers often discussed patient wishes, these discussions were often not documented. Standardization of ACP language and documentation provides a foundation to improve communication of patient ACP discussions between outpatient and inpatient settings.Materials and Methods:We conducted a quality improvement (QI) initiative in an academic center aimed at improving ACP documentation. A standardized documentation template was developed and embedded in the electronic medical record (EMR), automatically routing content to the ACP section of the chart. Four Plan-Do-Study-Act (PDSA) cycles focused on provider education, ACP lecture series, mid-level education and patient education were conducted. Outreach to patients via MyDirectives.com and integration with Chesapeake Regional Information System (CRISP DC), a city-wide health information exchange enabling secure sharing of ACP records across institutions.Results: At baseline, ACP tool utilization was 0%. Following template implementations and PSDA cycles, utilization increased to 12.9% after PDSA 1, 17.8% after PDSA 2, 24.20% after PDSA 3 and 39.70% after PDSA 4. Providers reported improved workflow integration and greater confidence discussing ACP. Documentation also became more visible and accessible across care settings.Conclusion:Implementation of standardized ACP documentation templates in the EMR ensures consistency, clarity and accessibility of patient preferences. Future efforts include implementing the ACP documentation template in inpatient workflows, uploading relevant legal documentation into the EMR, and expanding sharing through regional and nationwide platforms to ensure end-of-life wishes are honored across all points of care.
Introduction:Wheezing in children is a common symptom of respiratory disorders and is associated with allergic sensitization. This study aimed to evaluate the relationship between biomarkers of allergic sensitization (serum Immunoglobulin E (IgE) and peripheral eosinophil count) and the severity of wheezing symptoms among school-aged children and adolescents in Sulaimani City. Materials and Methods:A cross-sectional study was conducted from January to June 2025 at two major pediatric respiratory centers. Ninety-five children aged 6–18 years with documented wheeze were recruited consecutively. Demographics, clinical history, environmental exposures, and spirometry data were collected. Serum IgE levels and eosinophil counts were measured. Continuous variables were reported as mean ± standard deviation, while categorical variables were presented as frequencies and percentages Spirometry results, both pre- and post-bronchodilator, were categorized into severe, moderate, or mild obstruction based on FEV1 values.Results: The mean age of the subjects was 9.6 years, with 71.6% being male. In a study of 66 children with asthma, pre- and post-bronchodilator spirometry revealed a reduction in the proportion of children with severe persistent asthma after bronchodilator use (from 25.8% to underwent 13.3%). Among the 30 children post-bronchodilator testing, 64.3% showed a positive response (≥12% increase in FEV1), indicating reversible airway obstruction. These results highlight the effectiveness of bronchodilators in improving pulmonary function in children with asthma.Conclusion: Higher IgE and eosinophil levels strongly correlate with wheezing severity. Including these biomarkers in routine assessment is advisable, especially where environmental or family atopic risk is high.
Introduction:Femoral shaft nonunion is a serious and challenging complication following intramedullary nailing requiring effective interventions to achieve successful bone union.Materials and Methods:In this retrospective cross-sectional study, 20 patients with femoral shaft nonunion previously treated with intramedullary nailing underwent revision surgery with augmentation plating and bone grafting.Results:The mean age of patients was 42.5 years, and 90% achieved complete bone union. The average union time was 16.2 weeks. Factors influencing outcomes included age, underlying diseases, fracture type, and the time to revision surgery. Compared to a historical control group treated with revision nailing alone, this study showed significantly reduced healing time and improved function. Limited complications included superficial infections managed conservatively.Conclusion:The findings highlight augmentation plating and bone grafting as an effective and reliable approach for treating femoral shaft nonunion after intramedullary nailing. Future prospective studies with larger samples and long-term follow-up are recommended to assess treatment durability and possible complications. Additionally, investigating factors affecting recovery and quality of life could improve treatment protocols.
Introduction: Alzheimer’s disease (AD) is a progressive neurodegenerative disorder marked by memory loss and cognitive decline. One therapeutic strategy involves inhibiting acetylcholinesterase (AChE), the enzyme responsible for acetylcholine degradation in synaptic clefts. AChE inhibitors enhance cholinergic neurotransmission, thereby alleviating cognitive symptoms associated with AD. This study aimed to identify and evaluate novel AChE inhibitors structurally related to rivastigmine using computational techniques, including virtual screening and molecular docking, to discover potential lead compounds for AD therapy. Materials and Methods: The crystal structure of AChE (PDB ID: 6M0E) was obtained from the Protein Data Bank. Ligands with over 95% structural similarity to rivastigmine, based on the Tanimoto coefficient, were retrieved from PubChem. The ligands were energy-minimized and screened virtually using PyRx. Molecular docking was performed with AutoDock 4.2, and docking results were analyzed in terms of binding energy, inhibition constant (Ki), and interaction profiles to assess inhibitory potential.Results: Among the screened compounds, Ligand 13 exhibited the most favorable binding affinity, with a binding energy of –5.07 kcal/mol and an inhibition constant of 192.84 µM. Interaction analysis revealed that Ligand 13 formed three hydrogen bonds with key residues Ser215 and Arg177 in the AChE active site, suggesting stronger binding than rivastigmine.Conclusion: Ligand 13 emerged as a promising AChE inhibitor candidate for AD treatment. Further studies involving pharmacokinetic, toxicity, and experimental validation are necessary to confirm its therapeutic potential.
Introduction:One of the most common referrals to pediatric endocrinology clinics is for short stature, with the aim of ruling out growth hormone deficiency (GHD). This study aims to investigate MRI Findings of the Pituitary Gland in Children with GHD, in Sulaimaniyah City – Iraq.Materials and Methods: A retrospective cross-sectional study was conducted at Dr. Jamal Ahmed Rashid Pediatric Teaching Hospital, including 90 children (aged 2–16 years) diagnosed with GHD between 2020 and 2024. Demographic, clinical, hormonal, and MRI data were collected and analyzed using SPSS v28.0.Results:Demographic information of 90 children showed that Mean ± SD age of children was 9.47 ± 2.68 years. In terms of sex, 42 (46.7%) children were male and 48 (53.3%) children were female. The mean ± SD age at diagnosis of GHD in the children studied was 6.80 ± 1.92 years. MRI findings showed that the pituitary gland in the pediatric sample was normal in 77 (85.6%) cases. In 3 (3.3%) subjects pituitary hypoplasia was identified. In addition, mixed anomalies including pituitary hypoplasia in association with ectopic posterior pituitary, and pituitary microadenoma were also found in 2 (2.2%) children. MRI findings (brain abnormalities) were normal in 83 (92.2%) children, structural abnormalities in the brain were seen in 5 (5.6%) and midline defects were seen in 2 (2.2%) children.Conclusions:Most children with GHD had normal pituitary MRI, but structural abnormalities correlated with more severe hormonal deficiency and earlier, more severe clinical presentation. MRI is a valuable adjunct but should be interpreted alongside clinical and biochemical assessments.
Introduction:Acute appendicitis is the most common intra-abdominal paediatric surgical emergency, with appendectomy being its standard treatment. In most centres, acute appendectomy is performed based on clinical diagnosis and hence has been associated with a negative appendectomy rate of 10-25%. Negative appendectomy has been associated with morbidity to the extent of 10-12% and mortality of 1%. We herein present our experience with proactive clinical auditing and a surgical monitoring approach in reducing the rate of negative appendectomy in children.Materials and Methods: We conducted a prospective clinical audit in a tertiary pediatric surgical center. All children with suspected acute abdominal pain and suspected appendicitis were treated on a standardized clinical pathway. The diagnostic workup included clinical scoring (Alvarado score), laboratory studies, and imaging (ultrasound and CT, as needed). All cases undergoing appendectomy were evaluated through histopathology. Negative appendectomy cases were reviewed weekly. Diagnostic and management algorithms were modified for subsequent cases.Results:Implementation of proactive auditing and continuous monitoring reduced the negative appendectomy rate to below 2%. This compares with the 10-25% rate reported in the literature. Multidisciplinary case discussions and real-time feedback helped identify diagnostic pitfalls. These efforts also refined clinical pathways.Conclusion: Proactive auditing and surgical monitoring appear effective in minimizing negative appendectomy rates. This approach improves compliance with diagnostic protocols, enhances surgical decision-making, and reduces morbidity associated with negative appendectomy.
Introduction:Autism Spectrum Disorder (ASD) is a complex neurodevelopmental condition with multifactorial etiology. Advanced Maternal Age (AMA), defined as maternal age ≥35 years at childbirth, has been proposed as a potential risk factor for ASD. This study examined the association between AMA and ASD prevalence among children. Materials and Methods: An observational, cross-sectional study was conducted among 177 mother–child dyads referred to the Committee for Diagnosing Mental Health at Shaheed Hemin Hospital in 2023. ASD diagnoses were established by a multidisciplinary committee consisting of psychiatrists, a pediatric neurologist, a psychologist, and a special education expert, following standardized clinical criteria. Maternal age was categorized as Adolescent (<20 years), Ideal (20–34 years), or Advanced (≥35 years). Associations between maternal age group and ASD diagnosis were evaluated using Chi-square tests.Results: A statistically significant association was found between maternal age group and ASD diagnosis. A higher proportion of ASD cases occurred among children born to mothers aged ≥35 years. Males represented 83% of diagnosed cases, yielding a male-to-female ratio of 4.9:1, which was also statistically significant. The mean maternal age at childbirth was 31.0 years, and the mean child age at presentation was 6.7 years. The most frequent age at diagnosis was 6 years.Conclusion: This study demonstrates a significant association between advanced maternal age and increased ASD risk within a clinical cohort from the Kurdistan Region-Iraq. These findings contribute region-specific epidemiological evidence and underscore the importance of incorporating maternal age considerations into early ASD screening and counseling protocols in comparable populations.
Introduction:Bronchopulmonary dysplasia (BPD) remains a major cause of morbidity in preterm infants, particularly those born at <32 weeks of gestation. This study aimed to determine the incidence and severity of BPD and identify associated risk factors in a high-risk neonatal population in Sulaimaniyah, Iraq.Materials and Methods:A retrospective observational study was conducted over 12 months (January–December 2025) across two tertiary NICUs. Preterm infants born at <32 weeks and admitted within 24 hours of birth were included. Data were extracted from medical records, and BPD was diagnosed and graded at 36 weeks’ postmenstrual age.Results:Twenty preterm infants were included. Most were male (70%) and had a birth weight between 500–999 g (70%). BPD incidence was 100%, with 16 (80%) cases classified as severe and 4 (20%) as moderate. Recurrent apnea was experienced by 10 (50%) infants and was the only factor significantly associated with BPD severity (p=0.043). Other factors, including gestational age, birth weight, mechanical ventilation, and antenatal steroid administration, showed no significant association. Logistic regression revealed no statistically significant predictors of BPD severity.Conclusion:The study found a high incidence of severe BPD among infants born before 32 weeks. Recurrent apnea was significantly associated with severe BPD, indicating a need for early detection and targeted interventions. Larger multicenter studies with extended follow-up are needed to validate these findings and better understand the multifactorial etiology of BPD.
Introduction:This study aimed to determine the seroprevalence of toxoplasmosis among women with a history of miscarriage in Sulaimani City, Iraq, and to assess its association with serum cortisol levels in relation to sociodemographic, clinical, and behavioral factors.Materials and Methods: A cross-sectional study was conducted on 119 women who experienced miscarriage. Sociodemographic information, clinical history, and behavioral data were collected using structured questionnaires. Serum samples were tested for anti-Toxoplasma IgG and IgM antibodies as well as cortisol levels through electrochemiluminescence immunoassay (Roche Cobas e 411). Statistical analysis included chi-square tests, Spearman correlation, and logistic regression to identify potential risk factors associated with Toxoplasma positivity.Results: Out of 119 women, 28 (23.5%) tested positive for Toxoplasma gondii antibodies. The highest prevalence was recorded in women aged 27–36 years (56.0%, p=0.001). Educational status showed a significant association, with women having only primary education exhibiting the highest seropositivity (50.0%, p=0.019). No significant differences were found between urban and rural participants (p=0.563). Regarding cortisol levels, most participants (74.8%) had values within the normal range, while 7.6% had low and 17.6% had elevated cortisol levels. However, cortisol status was not significantly associated with Toxoplasma seropositivity (p=0.765).Conclusion: The study demonstrates cortisol levels did not show a significant association with infection status, these findings emphasize the importance of targeted education, awareness, and screening programs. Further longitudinal studies are recommended to clarify causal pathways and better prevent pregnancy complications related to toxoplasmosis.
Introduction: Cheek augmentation is a popular aesthetic procedure, with autologous fat grafting (lipofilling) and hyaluronic acid (HA) fillers being the most common techniques. This study aimed to compare the clinical efficacy, complication rates, and psychological impact of lipofilling versus HA fillers for cheek augmentation. Materials and Methods: A prospective cohort study was conducted from August 2024 until August 2025 at the University of Sulaimani and one private clinics in Iraq. Forty adult women seeking elective cheek augmentation were enrolled and allocated to either lipofilling (n=20) or HA filler (n=20) groups. Outcomes were assessed using the FACE-Q Satisfaction with Cheeks module, Global Aesthetic Improvement Scale, Derriford Appearance Scale-24 (DAS-24), and standardized photography at multiple timepoints up to 12 months. Complications and psychological effects were systematically recorded. Results: The mean age was 32.25 ± 4.40 years (filler) and 36.55 ± 4.58 years (lipofilling). Satisfaction was high in both groups, with 100% of lipofilling and 85% of filler patients "very satisfied" with cheek appearance. Complications were more frequent in the lipofilling group (asymmetry 10%, swelling 55%, donor site bruising 15%) compared to the filler group (bruising 50%, p≤0.001). Lipofilling showed higher evenness satisfaction (75% vs. 35%, p=0.025) and better DAS-24 scores, indicating improved psychological adaptation. Conclusion: Both lipofilling and HA fillers are effective for cheek augmentation, with lipofilling offering more natural and even results but a higher minor complication rate. Individualized treatment selection is recommended.
Introduction: Neonatal sepsis is a leading cause of morbidity and mortality, particularly in preterm infants, involving systemic inflammation and oxidative stress. Melatonin, with its antioxidant, anti-inflammatory, and immunomodulatory properties, has emerged as a potential adjuvant to standard antibiotic therapy. This systematic review and meta-analysis synthesizes evidence from randomized controlled trials (RCTs) and clinical studies from 2000 to 2025 evaluating melatonin's efficacy and safety in neonatal sepsis. Materials and Methods: Databases including PubMed, Embase, Cochrane Library, Web of Science, Scopus, and ClinicalTrials.gov were searched for RCTs and trials on melatonin as adjuvant in neonatal sepsis. Inclusion: studies 2000-2025, neonates (<28 days), confirmed sepsis, melatonin vs. control (antibiotics alone). Outcomes: biomarkers (C-reactive protein or CRP, Malondialdehyde or MDA, Interlukine or IL-6/8), sepsis scores, mortality, hospital stay, adverse events. Results: Nine RCTs (n=354 neonates) included. Melatonin (typically 20 mg oral, single or divided) reduced CRP at 24h (P<0.001) and MDA (P<0.001). Improved sepsis recovery at 72h (P<0.001). Mortality lower (P<0.001), no adverse events. Preterm subgroup showed enhanced benefits. Conclusions: Melatonin improves biomarkers and outcomes in neonatal sepsis safely, but Larger RCTs needed for confirmation and dosing.
Introduction: Malnutrition is a significant but under-researched complication among patients with cancer in resource-limited settings such as Iraq, where decades of instability have likely worsened nutritional challenges. This study aimed to determine the prevalence and risk factors of malnutrition among hospitalized cancer patients at Hiwa Hospital in Sulaimani, Iraq. Materials and Methods: A hospital-based, cross-sectional study was conducted from October 2024 to March 2025, enrolling 350 adult inpatients with cancer using stratified random sampling. Data were collected through structured interviews, clinical records reviews, and standardized anthropometric measurements. Nutritional status was assessed using the Malnutrition Universal Screening Tool (MUST) and Patient-Generated Subjective Global Assessment (PG-SGA). Results: The mean age of the participants was 56.5 ± 16.0 years, and 176 (50.3%) were female. The majority were Kurdish 315 (90%) and unemployed 275 (78.6%), with 150 (42.9%) having no formal education. Chemotherapy was the most common treatment 215 (61.4%). According to the PG-SGA, 114 (32.6%) patients were well-nourished, 138 (39.4%) had moderate malnutrition, and 98 (28%) were severely malnourished. MUST identified 127 (36.3%) patients at low risk, 96 (27.4%) at medium risk, and 127 (36.3%) at high risk of malnutrition. Significant associations were found between malnutrition and lower educational level (P ≤ 0.001) and marital status (P ≤ 0.001), while age was an essential predictor of malnutrition severity (OR = 0.067, P ≤ 0.001). Conclusion: Malnutrition is highly prevalent among hospitalized cancer patients in Iraq, with socioeconomic and clinical factors contributing significantly to its prevalence. Routine nutritional screening and early intervention are urgently needed in resource-limited settings.
Introduction: This study focuses on nurses' perspectives to explore the relationships among safety characteristics, aiming to understand how age, gender, and workplace factors should be incorporated to enhance patient safety. Data were collected from Cheng Ching General Hospital in Taiwan, with 446 valid respondents. Participants were classified into three age groups and six departments to form two mixed variables: gender-age and workplace-age. Materials and Methods: The Safety Attitudes Questionnaire (SAQ), supplemented with three additional safety characteristics, was utilized. Correspondence Analysis was then applied to generate two-dimensional diagrams illustrating the relationships between the mixed variables and nine safety characteristics. Results: Female respondents demonstrated a less positive attitude toward team-to-team safety characteristics. Additionally, the older age group exhibited a higher level of positive attitude regarding managerial support-related characteristics and stress recognition compared to their younger counterparts. Finally, no age group within the emergency department showed a positive association with teamwork across departments. Conclusions: Key recommendations include: 1) Encouraging greater involvement of younger staff in developing safety policies; 2) Monitoring and managing the workload of older staff; and 3) Establishing structured monitoring procedures for patient transfers between the emergency department and other units.
