Duhok Medical Journal

Epidemiological Profile of Cutaneous Leishmaniasis in Duhok Governorate during the Period from 2017 to 2022

Berivan Othman Rashid — 2026-07-20

https://doi.org/10.31386/dmj.2026.20.2.1

Background and objective: Cutaneous leishmaniasis (CL) is an endemic disease in Iraq, mainly in central and southern regions. The disease is, however, uncommon or rare in Kurdistan Region of Iraq. After the summer of 2014, there was a massive displacement of population to Kurdistan, mainly from the central region to Duhok, which in 2013-2014 was the only governorate in Iraq with no cases of CL among the native population. The aim of this study is to investigate the characterizations of cases of CL during the period from 2017 to 2022 in Duhok governorate, by calculating the prevalence, risk factors, and prognosis of the cases.

Methods: A retrospective study was conducted using the records of reported CL cases at the Directorate of Preventive Health in Duhok governorate for the period from 2017 to 2022. The information collected included the type and place of the lesion, method of diagnosis, treatment, and prognosis regarding cure rate, period of treatment, recurrence and other related issues.

Results: This study covered 261 reported cases of CL; the majority of cases were reported in individuals aged 40-44 years (20.3%), while no cases were reported in the 55-59 age groups. A higher proportion of cases occurred in males (57.5%). Housewives constituted the largest occupational group affected (24.8%), Most cases were reported from the Duhok governorate (93.9%), with a smaller percentage from Nineveh (6.1%). The highest number of cases was recorded in 2021, accounting for 61.3% of all cases and no cases were reported in 2020. More than half of the cases (136; 52.1%) had multiple boils; the upper limb was the affected region in 121 cases (46.4%). The diagnosis of CL was predominantly clinical ( (257 cases; 98.5%), and treated with balanced usage of different treatment regimens. Nearly half of the cases (121 cases: 46.4%,) reported exposure to animals. Difference in age distribution was significant, indicating that younger individuals were more prone to facial involvement. Individuals aged 1–19 years and 20–39 years had a higher proportion of multiple lesions (59.8% and 55.4%, respectively), whereas those aged 40 years and above were more likely to have single lesions (60%). Males had a slightly higher proportion of multiple lesions (55.3%). Housewives had the highest proportion of multiple lesions (62.5%), followed by soldiers (57.8%) and farmers (57.1%). In contrast, children (43.3%) and individuals in other jobs or unemployed categories (45.9%) were more likely to have single lesions.

Conclusion: Results of the present study indicated that CL is still not endemic in Duhok governorate, Moreover, appropriate educational programs focused on the transmission and preventive methods of the disease together with active surveillance to quickly detect and treat the cases are necessary to reduce the prevalence of Cutaneous leishmaniasis (CL).

The Outcomes of The Minimally Invasive Trans-Anal Endorectal Pull-Through (TEPT) In the Management of Hirschsprung's Disease: A Retrospective Study

Mohammed Hazim Aldabbagh — 2026-07-20

https://doi.org/10.31386/dmj.2026.20.2.2

Abstract

Background: Hirschsprung's disease (HD) is a congenital neurodevelopmental disorder characterized by the absence of ganglion cells in the distal colon, leading to functional intestinal obstruction. The Trans-anal Endorectal Pull-Through (TEPT) has emerged as a minimally invasive surgical approach offering advantages over traditional open procedures. This study aims to present our institutional experience with TEPT in the management of HD, focusing on perioperative and long-term outcomes.

Patients and Methods: This retrospective study included 39 patients with HD who underwent a Soave-type TEPT at Duhok Pediatric Surgery Center between January 2016 and September 2024. Data on demographics, symptoms, surgical details, and post-operative outcomes were collected. All patients had a protective colostomy prior to the definitive pull-through.

Results: The cohort comprised 32 males and 7 females. Operation times ranged from 30 to 90 minutes with no intraoperative blood transfusions. A notable 34 out of 39 patients successfully underwent a single TEPT. Post-operative outcomes revealed favorable results in 30 (77%) patients, including 25 (64%) who achieved asymptomatic status with normal bowel function. Nine patients (23%) experienced complications, primarily persistent constipation (4 patients) and residual aganglionic segments (5 patients), the latter requiring further surgery. All redo cases achieved successful outcomes. The overall success rate for HD management in this cohort, including those requiring redo surgeries, was 87%.

Conclusion: The minimally invasive TEPT is a safe and effective surgical approach for pediatric Hirschsprung's Disease. The majority of patients achieve successful outcomes with good bowel function. Although complications can occur, they are largely manageable, with subsequent re-operations leading to successful functional results.

Salivary level of interleukin 32 alpha and tumer necrotic factor alpha in periodontitis and healthy individuals a cross_sectional study

Sivan M. Hasan — 2026-07-20

https://doi.org/10.31386/dmj.2026.20.2.3

Abstract

Background and objective: Periodontitis is an inflammatory disease that causes progressive destruction of periodontal tissues. Cytokines such as tumor necrosis factor-alpha (TNF-α) and interleukin-32 alpha (IL-32α) are believed to play key roles in its pathogenesis. This research aimed to evaluate the salivary levels of TNF-α and IL-32α among patients with different severities of chronic periodontitis and periodontally healthy individuals in Kirkuk City, Iraq.

Methods: This cross-sectional study included 90 systemically healthy individuals aged 20–55 years, divided into four groups: healthy controls, and patients with mild, moderate, or severe periodontitis, according to the 1999 AAP classification. Unstimulated saliva samples were collected and analyzed for TNF-α and IL-32α concentrations using ELISA(Enzyme-Linked Immunosorbent Assay). Clinical parameters such as plaque index, probing pocket depth, and clinical attachment loss were recorded. Data were analyzed using ANOVA, correlation analysis, and ROC curve assessment.

Results: Both TNF-α and IL-32α levels were significantly elevated in periodontitis patients compared to healthy individuals, with a progressive increase corresponding to disease severity. TNF-α showed strong correlations with clinical parameters and higher diagnostic accuracy, especially in severe cases (84.78%). IL-32α also increased with severity but had lower diagnostic performance.

Conclusion: Salivary TNF-α and IL-32α are elevated in chronic periodontitis and correlate with disease severity. TNF-α, in particular, may serve as a reliable non-invasive biomarker for diagnosing and monitoring periodontal inflammation. Further research is recommended to explore their utility in broader populations and longitudinal settings.

Behavioral habits and familial tendency; Case-Control study among premature and non-premature coronary artery disease

MAJEED HUSSEIN MUSTAFA — 2026-07-20

https://doi.org/10.31386/dmj.2026.20.2.4

Abstract

Background and Aim: Premature Coronary artery disease (CAD) represent a riding global health concern. CAD is the most common form of heart disease and the leading cause of morbidity and mortality worldwide. This study aims to identify the modifiable risk factors besides genetic predisposition that contributes to high prevalence of premature coronary artery disease and correlate it to non-premature coronary artery disease.

Methods: Data were collected inform of a case (Premature CAD) – control (non-premature CAD) with a total of 350 cases were enrolled from both genders. The study was conducted during a period of one-year interval. Patients under the classification of premature CAD; male patients less than 45 years and female patients less than 55 years of age presenting as Acute coronary syndrome. Data were analyzed using SPSS version 26 to analyze descriptive statistics, test for normality using Kolmogorov-Smirnov (KS) and Shapiro-Wilk, The Mann-Whitney U test and Chi-square test (Fisher's Exact once), P value < 0.05 indicated statistical significance.

Results: Younger females, those with a family history, Non ST Segment elevation Myocardial Infarction, diabetes, hypertension, obesity, and former smokers are more likely to develop premature CAD, P < 0.05. additionally, other factors were assessed.

Conclusion: Despite the direct correlation of Premature and Non-premature coronary artery disease to risk factors; they showed significant differences in terms of Family history, gender, Hypertension, Diabetes, Smoking, Obesity, lifestyle, habits and Occupation in Premature CAD group.

PREVALENCE AND RISK FACTORS OF FATTY LIVER DISEASE ASSESSED BY FIBROSCAN IN OUTPATIENTS: A CROSS-SECTIONAL STUDY FROM DUHOK, IRAQ

RAMADHAN SALAHALDEEN ISSA — 2026-07-20

https://doi.org/10.31386/dmj.2026.20.2.5

Abstract

Background: Cirrhosis is the primary factor of morbidity and mortality in individuals with chronic liver conditions. In a single-center study, this study identified fatty liver prevalence, risk factors, and cirrhosis in outpatient clinics.

Methods: This prospective cross-sectional study enrolled 195 outpatient clinic patients who met predefined eligibility criteria. Eligible patients underwent fibrosis assessment using the FibroScan® device, a non-invasive tool for evaluating liver fibrosis.

Results: The study sample (mean age: 45.23 years, SD = 15.1) included 48.7% young adults, 36.9% middle-aged individuals, 14.4% elderly participants, and males (54.4%). Key risk factors included smoking (51.8%), diabetes (12.3%), hypertension (5.6%), and having HBV (4.6%). Steatosis was absent in 5.13% of cases, while 94.9% showed some degree: mild (6.15%), moderate (12.82%), or severe (75.9%). Moderate scarring was the most prevalent form of fibrosis, followed by severe scarring (9%). The prevalence of cirrhosis among outpatients was 8% in this study. Overall, the NAFLD prevalence among outpatients was 39% in this study. The cirrhosis scores were substantially higher in elderly patients compared to middle-aged and young individuals (21.43% vs. 11.11% and 2.11%; p < 0.0001). Diabetic patients also showed a higher prevalence of cirrhosis than non-diabetics (16.67% vs. 7.02%; p = 0.0020), as did hypertensive patients compared to non-hypertensive patients (27.27% vs. 7.07%; p = 0.0201).

Conclusions: This study showed the high prevalence of cirrhosis and NAFLD in the outpatient clinic and was associated with older age, diabetes, and hypertension.

EFFECTIVENESS AND SAFETY OF ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY FOR POST-CHOLECYSTECTOMY BILE DUCT INJURIES IN DUHOK / IRAQ

ALI ABDULGHANI RAMADHAN — 2026-07-20

https://doi.org/10.31386/dmj.2026.20.2.6

Background: Post-cholecystectomy bile duct injuries constitute a clinical problem with significant morbidity. Traditionally they were treated surgically but with the discovery of Endoscopic Retrograde Cholangiopancreatography (ERCP), their management has been radicalized and currently ERCP has a major role in establishing the definitive diagnosis and identifying the severity, extent and site of injury and most importantly treating the condition using endoscopically applied therapeutic interventions.

Objective: to determine the effectiveness and safety of ERCP for post-cholecystectomy bile duct injuries in Duhok – Kurdistan region - Iraq.

Patients and methods: This is a prospective study that was carried out in Azadi gastroenterology and hepatology center, Vin hospital and Jeen clinics in Duhok city-Iraq from January 2015 to January 2025. It included 103 patients with suspected post-cholecystectomy bile duct injuries based on clinical features, laboratory testing and imaging studies. ERCP was done in all patients, and the definitive diagnosis was established by the initial cholangiogram then bile duct injuries were classified by Amsterdam classification and therapeutic interventions were applied depending on the class of injury. The study included a follow up period of 3-12 months to conclude the outcomes of ERCP.

Results: Of the study population, 85 (82.5%) were females & 18 (17.5%) were males with female : male ratio being 4.7:1. The mean age was 44 years (range = 16 -72 years). The method of cholecystectomy was laparoscopic in 83 patients (80.6%) and open in 20 patients (19.4%). Abdominal pain was the most common presentation (N = 56, 54.3%). The bile duct injuries were of Amsterdam class - A in 63 (61.1%), class-B in 25 (24.3%), class-C in 10 (9.7%) and class-D in 5 (4.9%). The overall success rate for endoscopic intervention was 91.3% (N=94). The most common complication of ERCP was pancreatitis (N=10, 9.7%). No mortality was reported in this study. There was significant statistical association between the method of cholecystectomy and having class-A bile duct injury (P-value = 0.0005). There was no significant statistical association between the method of cholecystectomy and indication of cholecystectomy or success rate or complications of ERCP (P > 0.05).

Conclusion: The most common type of bile duct injury was Amsterdam class – A bile duct injury. ERCP is an effective and safe tool for the diagnosis and treatment of bile duct injuries.

SEROLOGICAL AND MOLECULAR PROFILE OF HEPATITIS B AND C VIRUSES AND DETECTION OF OCCULT HBV AMONG HEMODIALYSIS PATIENTS IN DUHOK, IRAQ

Amer Abdalla Goreal — 2026-07-20

https://doi.org/10.31386/dmj.2026.20.2.7

Background: Hepatitis B and C viral infections are significant global health concern, with hemodialysis patients being more susceptible than the general population.

Objective: The study aimed to assess the prevalence of HBV and HCV infections among hemodialysis patients, detecting occult HBV infection, and perform genotyping.

Methods: The study involved 151 patients with end-stage renal illness, comprising 81 males (53.6%) and 70 females (46.4%) at the Kidney Center's dialysis unit in Duhok-Iraq. All subjects had their blood samples taken prior to hemodialysis. HBsAg, total anti-HBc, anti-HCV and Liver enzyme screening was done. Those who were positive for anti-HBc also had anti-HBs evaluation. HBsAg negative samples were analyzed for occult HBV. HBsAg, Anti HCV positive patients were subjected to PCR. Clinical and demographic information were gathered and examined.

Results: Participants ranged in age from 15 to 96, with a mean age of 55.85±15.50 years. Out of 151 samples, one (0.7%) tested positive for HBsAg, and 3(2.0%) tested positive for anti-HCV antibodies. Anti-HBc testing revealed 37 samples (24.5%) were positive. Among the 39 samples positive for either anti-HBc or occult HBV, 31 (79.5%) were also positive for anti-HBs antibodies. Occult HBV infection was detected in 2 (2.1%) out of 95 samples that tested negative for HBsAg. One sample that tested positive for HBsAg had genotype D. Anti HCV positive samples turned negative by PCR.

Conclusion: Despite the low prevalence of active HBV and HCV infections, the existence of occult HBV underscores the continued hazards of transmission which necessitate serial serological and molecular testing.

Outcomes of the vessel sealing device versus the conventional technique in thyroidectomy

NOURA KAMERAN KHORSHEED — 2026-07-20

https://doi.org/10.31386/dmj.2026.20.2.8

Abstract

Background: Thyroidectomy treats thyroid cancer, goiters, and hyperthyroidism. This study compares vessel sealing device (VSD) and conventional knot tying, evaluating their effectiveness in clinical outcomes, focusing on hemostasis, surgery time, bleeding, and postoperative recovery in thyroid disease patients.

Methods: This prospective clinical trial enrolled 100 patients diagnosed with thyroid gland disease and assigned to one of two surgical techniques. Sixty patients underwent surgery using the VSD, while 40 received the conventional suture ligation technique in the Kurdistan Region of Iraq in 2025. Outcomes were compared both intraoperatively and postoperatively.

Results: Patients were similar in age, gender, goiter type, symptoms, thyroid status, imaging findings, surgery type (mostly total thyroidectomy), disease duration, and preoperative diagnostics (TIRADS/FNAC at the preoperative step). VSD significantly reduced surgery duration (59.25 vs. 95.63 min; p<0.0001), with 40% requiring no sutures versus 0% in the conventional group (p<0.0001). Drainage was less frequent with VSD (76.67% vs. 100%; p=0.0006), though duration (24 hours) and hospital stay (1 day) were similar. Postoperative pain was milder with VSD (80% mild vs. 30% in conventional; p<0.0001) and required only paracetamol (100% vs. 87.5%; p=0.0087). Moderate pain was higher in the conventional group (57.5% vs. 20%; p<0.0001). Intraoperative bleeding was higher with VSD (33.33% vs. 12.50%; p=0.0200), but postoperative bleeding and seroma were absent in both. Complications like tingling, voice change, and infection were low and comparable.

Conclusion: VSD reduces surgery time and pain, improves comfort, and offers similar safety to conventional thyroidectomy, despite more intraoperative bleeding, making it a valuable surgical alternative.

The Impact of Different Endodontic Irrigant Solutions on Smear Layer Removal Activated by Diode Laser, Sonic, and Ultrasonic Waves: An in-Vitro study

HIVI HASSAN MOHAMMAD — 2026-07-20

https://doi.org/10.31386/dmj.2026.20.2.9

Background and Objective: To evaluate and compare the effectiveness of (ethylenediaminetetraacetic acid EDTA, Triton and QMix) with three different activation techniques (Sonic, Ultrasonic, Diode laser) on smear layer removal.

Materials and Methods: Ninety single-rooted extracted mandibular premolars were decoronated to a length of 12 mm instrumented biomechanically with Protaper Next up to size X3. The roots were then randomly divided into three groups according to final irrigation (17%EDTA, Triton, QMix) (number=30) each group subdivided into subgroup according to activation method (Sonic, Ultrasonic, Diode laser) (number=10). The samples were sectioned longitudinally and analyzed using a four-level scoring system in the coronal, middle, and apical thirds under a scanning electron microscope at 3000x magnification.

Result: Triton activated by diode laser was the most effective method on smear layer removal in apical third with a significant difference when compared to Sonic, Triton with diode laser being more effective on smear layer removal than in QMix group with significant differences, and no significant different in activation method between other group. The removal of the smear layer was more successful in the middle and coronal thirds than in the apical third with significantly observed in most group.

Conclusion: Diode laser activation, especially when used with Triton irrigant optimizes smear layer removal in apical area outperforming Sonic methods and combination of Triton with Diode laser enhanced cleaning performance compared with other groups. The removal of the smear layer was more successful in the middle and coronal thirds than in the apical third.

BIRTH INCIDENCE OF TALIPES EQUINOVARUS (CLUBFOOT) DEFORMITY IN DUHOK GOVERNORATE, IRAQ

MUHSIN SHUKRI KARAM — 2026-07-20

https://doi.org/10.31386/dmj.2026.20.2.10

ABSTRACT

Background and objectives: Talipes equinovarus (TEV) clubfoot deformity is the most common pediatric foot abnormality. Its prevalence varies across different countries. This study aimed to estimate the prevalence of this deformity among newborn babies in Duhok Governorate/Iraq.

Methods: During the period from August 2024 to July 2025 (one year), all the children born with TEV clubfoot deformity in maternal hospitals of Duhok Governorate were included in this prospective cross-sectional study. The prevalence rate was calculated by dividing the number of clubfoot cases by the total newborn babies in the governorate and multiplying by 1000.

Results: Thirty-two cases of TEV clubfoot deformity were observed among 26,582 live birth newborns in Duhok Governorate, with a prevalence rate of 1.2 cases per 1000 newborns. Nineteen of them were male and 13 were female, with a ratio of 1.5 to 1. Most of them (84.4%) were in Duhok district, but the highest rate was in Semel district (46.5 per 1000 livebirths).

Conclusions: The prevalence rate of TEV clubfoot deformity in Duhok Governorate of Iraq was 1.2 cases per 1000 live births.