Background and Objective: Endometrial cancer, originating in the uterus's inner epithelial lining, is treated with radiotherapy, including external beam radiotherapy and brachytherapy. However, radiotherapy may disrupt electrolyte balance and affect blood components. This study aimed to evaluate the effect of radiation on hematological and electrolyte parameters in patients with endometrial cancer. Methods: The study was conducted at the Awat Center, Erbil, Iraq, between December 25, 2024, and February 22, 2025, involving 25 patients. Blood samples were collected before, during, and after therapy, and parameter analyses were performed. The Elekta Infinity machine was used for curative treatment, including Volumetric Modulated Arc Therapy (VMAT). The local Ethics Committee approved the study and protocol. Results: Radiotherapy significantly reduced white blood cell counts (WBC) from 6.94±2.59×10⁹/L before treatment to 4.70±1.45×10⁹/L during treatment (p <0.001), with partial recovery post-treatment (5.18±1.84×10⁹/L, p=0.001). Platelet counts also declined from 234.84±63.34×10³/μL to 199.08±47.69×10³/μL after radiotherapy (p=0.008). Hemoglobin, red blood cells, and most electrolytes (sodium, potassium, chloride, magnesium, phosphate) showed no significant variation. However, serum calcium levels declined modestly but significantly after radiotherapy (from 9.69±0.54 to 9.36±0.58 mg/dL, p=0.034). Conclusion: Adjuvant VMAT radiotherapy in endometrial cancer patients induces significant hematological suppression, particularly of WBCs and platelets, while maintaining stable electrolyte levels. These findings highlight the hematologic sensitivity of pelvic radiotherapy and the importance of regular monitoring to reduce cytopenic risks.
Background and Objective: Pharmacies in Erbil Province face numerous challenges, compromising their ability to provide patient-centered, safe, and effective care. This study aimed to identify these challenges in depth and propose evidence-based strategies from developed countries to overcome them. Methods: In-depth, semi-structured interviews were conducted with 27 pharmacy managers operating in Erbil's urban, semi-urban, and rural areas, using a qualitative, phenomenological approach. Participants were selected through purposive sampling and included managers of both independent and chain pharmacies. Data were analyzed through thematic analysis using Braun and Clarke's six-phase framework, with six themes structured deductively and subthemes emerging inductively from the data. Results: Six main themes (regulatory compliance, supply chain and inventory management, human resource management, patient service and care, financial viability, and technology adoption) were identified. Participants reported outdated (n=18) and inconsistent regulations (n=13), improper control of drug pricing (n=27) and drug storage (n=10), oversaturation of the pharmacy market (n=6), reliance on manual inventory systems (n=22), shortage of qualified professionals (n=25), high staff turnover (n=14), lack of structured training (n=20), limited patient consultation services (n=19), poor financial tracking (n=19), and low utilization and availability of digital tools (n=25). These challenges were experienced similarly across all pharmacy settings. Conclusion: The findings highlight the need for comprehensive reform in the Erbil pharmacy sector. Although the challenges are significant, they align with recognized worldwide patterns, suggesting that effective strategies could be adapted to improve pharmacy operations, professional standards, and healthcare outcomes in the region.
Background and objective: Pneumoperitoneum is essential to provide a good surgical view during laparoscopy. Carbon dioxide is the most commonly used gas for pneumoperitoneum, and it induces multiple changes in the mechanics of respiration and cardiovascular function, particularly under general anesthesia. This study aimed to identify the key physiological parameters most likely to deviate from normal during laparoscopic cholecystectomy. Respiratory variables assessed included end-tidal CO₂ (EtCO₂) and peak airway pressure, while cardiovascular parameters encompassed mean blood pressure (MBP), pulse rate, body temperature, and oxygen saturation. Methods: This prospective observational cohort study evaluated physiological changes in patients classified as American Society of Anesthesiologists (ASA) grade I/II undergoing elective laparoscopic cholecystectomy at Rizgary Teaching Hospital, Iraq, over four months. A sample of 186 patients, aged 18–75 years, meeting inclusion and exclusion criteria were enrolled. Median-split methodology was used to divide patients into two groups based on the median duration of surgery (≤27 minutes vs. >27 minutes). Results: CO₂ insufflation during laparoscopic surgery led to significant physiological changes. Mean blood pressure decreased from 95.7±13.5 mmHg to 87.4±14.3 mmHg (p <0.001), and heart rate dropped from 95.6±16.2 bpm to 89.3±13.8 bpm (p <0.001). Peak inspiratory pressure (PIP) increased markedly from 15.9±3.7 cmH₂O to 21.2±3.8 cmH₂O (p <0.001), while end-tidal CO₂ declined from 33.7±4.1 mmHg to 31.2±4.9 mmHg (p <0.001). Following CO₂ exsufflation, PIP decreased to 18.7±8.0 cmH₂O, and end-tidal CO₂ increased to 37.5±6.1 mmHg (both p <0.001), reflecting improved respiratory compliance. Intraoperative comparisons revealed higher end-tidal CO₂ levels in procedures lasting more than 27 minutes compared with shorter ones: 32.6±4.8 mmHg vs. 29.8±4.6 mmHg after insufflation, 37.6±5.7 mmHg vs. 33.0±5.4 mmHg after artery clamping, and 39.2±6.0 mmHg vs. 34.5±5.8 mmHg after gallbladder dissection (all p <0.001). These findings emphasize the need for vigilant monitoring and ventilatory adjustments to prevent potential complications associated with CO₂ insufflation. Conclusion: CO₂ insufflation caused notable fluctuation in most monitored parameters (end-tidal CO₂, peak inspiratory pressure, heart rate, body temperature). Minimizing insufflation time is a key factor in reducing pneumoperitoneum effects.
Background and objective: Hyperlipidemia is a key risk factor for atherosclerotic cardiovascular disease (ASCVD). Bempedoic Acid (BA) is an ATP-citrate lyase inhibitor indicated for statin-intolerant patients, or patients at high risk of ASCVD with hyperlipidemia. However, BA may raise plasma uric acid levels, potentially causing hyperuricemia and gout. Coenzyme Q10 (CoQ10), a natural antioxidant, has anti-inflammatory and renal-protective properties. This study evaluates CoQ10's potential to mitigate BA-induced renal side effects in a hyperlipidemic rat model. Methods: Forty male Sprague-Dawley rats were divided into five groups: a negative control (normal), a positive control (hyperlipidemic), a BA-treated group (hyperlipidemic rats on BA monotherapy),a BA + CoQ10 group (hyperlipidemic rats receiving BA and CoQ10 combination), and a BA + Allopurinol group (hyperlipidemic rats receiving BA and Allopurinol combination). The positive control and all treatment groups received a high-fat diet to induce and maintain hyperlipidemia throughout the experiment. After 8 weeks of inducing hyperlipidemia, therapeutic interventions were administered for a further 10 weeks. Renal biomarkers (uric acid, serum creatinine, and blood urea nitrogen) and the oxidative stress biomarker malondialdehyde (MDA) were measured. Results: BA monotherapy significantly raised mean serum uric acid and creatinine compared with the negative control group. Co-administration of CoQ10 significantly lowered both parameters. Mean serum MDA was significantly reduced in all treatment groups compared with the positive control group. Conclusion: These findings suggest that combining BA with CoQ10 could serve as a therapeutic strategy for hyperlipidemic patients on BA therapy who have compromised renal function.
Background and objective: Subconjunctival hemorrhage (SCH) is a common condition; one of its important causes is intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF), which is used to treat various ocular pathologies. In this study, we aimed to decrease subconjunctival hemorrhage with the use of a 5% phenylephrine hydrochloride topical drop. Methods: Prospective, randomized, single-blind, multicenter study. One hundred patients (116 eyes) with different retinal pathologies were enrolled, divided into two groups: group 1, 50 patients (60 eyes), received one drop of phenylephrine, and group 2, 50 patients (56 eyes), received a drop of distilled water, fifteen minutes before intravitreal injection. Patients were examined by slit lamp for presence of subconjunctival hemorrhage 24 hours after the injection. Results: The frequency of subconjunctival hemorrhage in the intervention group was 23.3% (14 of 60 eyes), notably less (p=0.041) than in the control group (41.1%, 23 of 56 eyes). Conclusion: Administration of topical phenylephrine hydrochloride 5%, 15 minutes prior to intravitreal injection of anti-VEGF, appears to be an effective and straightforward approach for reducing or preventing subconjunctival hemorrhage (SCH) — a commonly reported complication following such injections. This strategy may contribute to improved patient comfort and compliance with ongoing intravitreal therapy.
