Background: Pregnancy is associated with profound physiological changes in the coagulation system, reflected by a progressive rise in plasma D-dimer concentrations. Although this elevation complicates the diagnostic use of D-dimer for venous thromboembolism (VTE), its trimester-specific dynamics and potential associations with maternal symptoms and outcomes remain clinically relevant. Materials and Methods: A cross-sectional observational study was conducted on pregnant women attending private clinics in Kirkuk, Iraq, between July 1, 2024 and May 31, 2025. Maternal age, gravidity and type of pregnancy were recorded, alongside D-dimer levels measured during the first, second and third trimesters. Clinical symptoms including chest pain, leg pain, preterm labor and confirmed deep vein thrombosis (DVT) were documented. Statistical analyses included ANOVA, t-tests, correlation and logistic regression to evaluate associations between D-dimer levels and maternal outcomes. Results: The mean maternal age was 28.84±5.91 years, with a median gravidity of 2 (range 1–7) and only one case (0.99%) of twin pregnancy. D-dimer levels increased significantly across trimesters (397.58±217.47 ng/mL in the first, 611.32±233.94 ng/mL in the second and 1185.09±602.73 ng/mL in the third; ANOVA p <0.0001). Clinical symptoms were uncommon: chest pain in 0.99%, left leg pain in 2.97%, preterm labor in 0.99% and DVT in 0.99%. Women with chest pain, leg pain, preterm labor, or DVT had significantly higher third-trimester D-dimer levels (p <0.05 for all comparisons). Logistic regression identified third-trimester D-dimer as an independent predictor of clinical symptoms (coefficient = 0.0027, p = 0.0010). Stratification showed that 84.78% of women with D-dimer>1000 ng/mL developed symptoms compared to none in those ≤500 ng/mL (p <0.0001). Conclusion: This study confirms the physiological rise of D-dimer throughout pregnancy and demonstrates strong associations between elevated third-trimester levels and maternal symptoms, including DVT and preterm labor. While trimester-specific thresholds improve interpretation, elevated D-dimer remains a useful adjunctive marker when combined with clinical assessment. The findings highlight the need for locally validated reference intervals to enhance diagnostic accuracy and risk stratification in pregnant women.

Background: Chronic suppurative otitis media (CSOM) is a persistent inflammatory condition of the middle ear, frequently affecting children in low- and middle-income regions. Emerging evidence highlights the role of vitamin D in modulating immune function and reducing susceptibility to recurrent infections. This study aimed to assess the association between serum 25-hydroxyvitamin D [25(OH)D] levels, white blood cell (WBC) count, neutrophil-to-lymphocyte ratio (NLR), and clinical severity in children with CSOM. Methods: A case-control study was conducted from March to June 2025 across private ENT clinics in Kirkuk, Iraq. The study included 100 children aged 2–12 years, divided equally into CSOM cases and healthy controls. Diagnosis was confirmed by ENT specialists based on clinical and otoscopic findings. Serum 25(OH)D levels were measured using ELISA. Inflammatory markers including WBC count and NLR were assessed via complete blood count. Demographic, environmental, and clinical data were collected through structured interviews. Statistical analyses were performed using SPSS v25. Results: Vitamin D deficiency (<20 ng/mL) was significantly more frequent in CSOM patients (64.0%) compared to controls (28.0%) (p<0.001). Mean serum 25(OH)D levels were significantly lower in the CSOM group (18.2±6.1 ng/mL) than in controls (29.4±7.2 ng/mL). CSOM patients exhibited higher WBC (9.3±2.1 vs. 6.8±1.9 ×10³/µL), lower lymphocyte counts (2.1±0.6 vs. 2.7±0.7 ×10³/µL), and elevated NLR (2.95±0.84 vs. 1.26±0.56) (all p<0.001). A strong inverse correlation was observed between vitamin D levels and NLR in CSOM children (r = –0.61, p<0.001). Multivariate analysis identified vitamin D deficiency (OR: 3.45), low sunlight exposure (OR: 4.12), and elevated NLR (OR: 3.89) as significant predictors for CSOM. Conclusion: Children with CSOM demonstrated significantly lower vitamin D levels and elevated inflammatory markers compared to healthy controls. These findings suggest that vitamin D deficiency contributes to immune dysregulation and may increase the risk and severity of CSOM. Routine screening and correction of hypovitaminosis D could serve as an adjunctive strategy in managing pediatric CSOM.

Background: With the increasing life expectancy of people living with HIV (PLHIV) due to widespread antiretroviral therapy (ART), non-communicable diseases such as metabolic syndrome (MetS) and cardiovascular abnormalities are emerging as significant health concerns. This study aimed to assess the prevalence and correlates of metabolic syndrome and cardiovascular risk in HIV-positive individuals on long-term ART. Methods: This cross-sectional observational study included 60 HIV-positive patients attending a tertiary care center in Western India from October 2022 to June 2024. Patients on ART for ≥12 months were assessed through clinical history, anthropometry, laboratory investigations, electrocardiography (ECG), and echocardiography (ECHO). Metabolic syndrome was defined as per NCEP ATP III criteria. Associations with ART duration and CD4 count were statistically analyzed. Results: The prevalence of metabolic syndrome was 28.3%. A majority were male (58.3%) and on ART for more than 3 years (76.7%). Obesity (35%) and dyslipidemia were common. Metabolic syndrome was significantly associated with higher CD4 counts (p = 0.04), but not with ART duration (p = 0.19). Cardiovascular abnormalities were frequent, with diastolic dysfunction seen in 40% on ECHO and sinus bradycardia (23.3%) on ECG being the most common findings. Conclusion: A substantial proportion of HIV-positive patients on ART exhibit features of metabolic syndrome and subclinical cardiovascular dysfunction. These findings underscore the need for routine screening and integrated management of cardiometabolic risk in HIV care to prevent long-term morbidity and mortality.