Kirkuk Journal of Medical Sciences

Noise exposure was linked to any adverse health issues. The impact of noise on pregnancy and fetal outcomes was also reported. However, the reported evidence was inconsistent, and many times they were contradictory. Four electronic databases were searched for this review following the keywords (noise, environmental, occupational, maternal adverse effects, fetal adverse effects, preeclampsia, low-birth weight, preterm labor, gestational diabetes, gestational hypertension, and stillbirth). Inclusion criteria were studies published in English for the last ten years. Analysis showed wide diverse heterogeneity in the result and the significance level, and no firm conclusion can be reached. Many factors could have led to this discrepancy: inconsistent gestational age, non-standardized noise threshold and exposure time, and many co-variants. The current review highlights an important and overlooked subject that is vitally essential to raise awareness about. The topic interests pregnant and health policy to make informed decisions for the environment and update local health regulations.

Background: Breast cancer has emerged as one of the most common malignancies diagnosed among women worldwide. Hormone therapy with Tamoxifen or aromatase inhibitors is an essential part of the treatment for estrogen-receptor-positive breast cancer patients. This study evaluated the effect of Tamoxifen and anastrozole on the plasma lipid profile and liver enzymes.
Method: A total of 93 pre- and postmenopausal breast cancer patients were divided into two groups: tamoxifen and anastrozole. All patients had undergone surgery and were randomized to receive tamoxifen 20 mg once daily (n=50) or anastrozole 1 mg once daily (n=43). Lipids and liver enzymes were measured at baseline and after six months of follow-up.
Results: Total cholesterol (TC) and low-density lipoprotein (LDL) levels significantly decreased in patients treated with tamoxifen at 6 months, while anastrozole caused a significant increase in TC and LDL. Moreover, TC and LDL levels were significantly decreased in pre-and postmenopausal patients of the tamoxifen group. High-density lipoprotein (HDL) levels increased significantly in premenopausal patients who received tamoxifen compared to postmenopausal patients. Tamoxifen group was associated with a significant elevation in both aspartate transaminase (AST) and alanine transaminase (ALT) levels compared to anastrozole group.
Conclusion: Tamoxifen treatment has a favorable effect on lipid profiles in both pre-and postmenopausal women compared to anastrozole. However, tamoxifen is associated with an increase in liver function tests.

Background: Type 2 diabetes mellitus is a global public health issue. Left ventricular diastolic dysfunction is the earliest diabetic cardiovascular complication. This study aims to determine the incidence of left ventricular diastolic dysfunction in asymptomatic type 2 diabetes mellitus.
Methods: A case control study was conducted in Azadi Teaching Hospital, Kirkuk, Iraq, over one year from February 1, 2023, to January 31, 2024. The study involved 102 patients with type 2 diabetes, which was compared to 102 age and sex matched controls. Type 2 diabetes mellitus was diagnosed according to the American Diabetes Association criteria. Left ventricular diastolic dysfunction was identified following the guidelines of the American Society of Echocardiography and the European Association of Cardiovascular Imaging.
Results: The incidence of diastolic dysfunction in type 2 diabetic patients was (58.8%) distributed as follows: grade I diastolic dysfunction in (90%) and grade II (10%), and none of the patients had grade III. There was a significant association between diastolic dysfunction and type 2 diabetic patients (p<0.001); 58.8% of type 2 diabetic patients had diastolic dysfunction compared to 9.8% of controls. The risk factors for left ventricular diastolic dysfunction in asymptomatic type 2 diabetic patients were increased age, obesity, long duration of disease, insulin treatment, retinopathy, albumin in urine, high HbA1c level, high blood urea, and low ejection fraction.
Conclusion: The incidence of left ventricular diastolic dysfunction among asymptomatic type 2 diabetic patients is high.

Background: Diabetes mellitus is rapidly becoming one of the main health issues and problem in the 21st century among humans, the number of patients with diabetes mellitus is steadily increasing both in developed and developing countries. Diabetes mellitus is a major health problem that results in serious consequences on global health and its economy. This study aimed to assess the diabetic attitude regarding their nutritional status in Kirkuk city.
Methods: A descriptive design study started from 12 November 2023 and ended at 28 March 2024 in three places in Kirkuk city in Iraq, with a non–random sample collection of (425) diabetic patients who were diagnosed with diabetes mellitus.
Results: The mean age of the patients was 50.47 ± 16.24 years. Of them, 49.6% were men compared to 50.4% female. Additionally, 318 (74.8%) of participants had accompanying diseases, including diabetes.
Conclusion: There was a high level of attitude among diabetic patients regarding their nutritional status in Kirkuk City.

Background: Toxoplasma gondii is an intracellular protozoan coccidian parasite, that can establish a widespread infection in people with autoimmune disorders.
Rheumatoid arthritis is an autoimmune inflammatory disorder in which biological therapy is one of the treatment modalities. This study aims to evaluate Toxoplasma gondii IgM antibody seropositivity in Rheumatoid arthritis patients in Mosul city who were under biological therapy.
Methods: A case control study was conducted at Mosul City in Iraq, enrolled 190 participants who were divided into 2 groups, 95 patients had RA on biological therapy and the other 95 participants were a healthy control group. Using the enzyme-linked immunosorbent assay technique, anti-Toxoplasma IgM antibodies have been identified in the sera of ninety-five rheumatoid arthritis patients undergoing biological therapy for six months, as well as in the serum of ninety-five healthy controls.
Results: Anti-Toxoplasma IgM antibodies were detected in (17%) of RA patients and only (2.1%) of controls (P=0.0008). The mean value of IgM antibody was 29.232 IU/mL in rheumatoid patients versus 14.59 IU/mL in controls (P=0.0463). The highest Toxoplasma IgM antibody level was in the age group (31-49 years) with (P=0.0145). There was no significant connection between seropositivity and the three types of biological therapy (P=0.389).

Background: Dialysis patients are more vulnerable to viral infections, including Human Parvovirus B19, which is the only human pathogenic parvovirus. It is highly erythrotropic and preferentially replicates in erythroid progenitor cells. Parvovirus B19 is associated with kidney disease in three settings: Acute glomerulopathy, anaemia in end-stage renal disease, and kidney transplantation. This study aimed to detect parvovirus B19 infection among individuals undergoing dialysis.

Methods: A case-control study was carried out in Kirkuk from April 4 to November 11, 2023. This involved patients with chronic renal failure admitted to Kirkuk Teaching Hospital/Haemodialysis Center. A questionnaire was used to collect clinical data such as age, gender, body mass index, and medical history. Molecular detection of parvovirus B19 was done using Real-time PCR.
Results: The study involved a predominance of male patients (75%) compared to females (25%). Most patients were 60 years or older (45%). In terms of Body mass index, the majority fell into the 20-25 range. Patients with chronic renal failure frequently reported hypertension (60%), followed by diabetes mellitus (28.33%), and cardiovascular disease (11.66%). Results highlighted a significant increase in Parvovirus B19 infection rates with prolonged dialysis, and RT-PCR detected Parvovirus B19 in 18.3% of patients.
Conclusion: Parvovirus B19 was detected in end-stage renal disease and could significantly contribute to the development and progression of the disease.

Background: Gestational diabetes mellitus (GDM) is one of the most common complications of pregnancy. This study aims to evaluate the diagnostic value of first trimester maternal fetuin-A, N-terminal pro atrial natriuretic peptide (pro-ANP), high-sensitivity C-reactive protein (hs-CRP), and fasting plasma glucose (FPG) in the prediction of GDM.
Methods: Over 10 months ending in December 2020, 88 low-risk pregnant women attending routine antenatal care in Hawler Maternity Hospital, Erbil, Iraq were enrolled. Maternal venous blood samples were collected for futin-A, pro-ANP, hs-CRP, and FPG. Glucose challenge test (GCT) and oral glucose tolerance test (OGTT) were performed for those with high FPG level.
Results: Six of 88 (6.8%) women developed GDM. There was no statistically significant difference between GDM and non-diabetics groups regarding age, gravidity, parity, early pregnancy BMI, and gestational age. There was no significant difference between the 2 groups regarding N-terminal pro-ANP levels but FPG and hs-CRP levels were higher and futin-A levels were lower in the GDM group.
Conclusion: The utility of maternal serum hs-CRP, Fetuin-A, and FPG levels as simple-to-do reliable tests to predict the development of GDM.

This study examines the evolution of medical education curricula globally, tracing the historical shift from traditional, experience-based training to contemporary, student-centered approaches with a particular focus on the Tikrit University College of Medicine (TUCOM) Iraq 1989 curriculum that implemented problem-based learning as a core strategy. It compares one of the core components of the curriculum, the small group discussions and the 7-jump learning strategy, to how they map Entrustable Professional Activities (EPAs) with a suggestion to integrate EPAs into the curriculum.

The drug development process has seen significant advancements in recent decades; however, it remains costly and time-consuming due to regulatory and ethical constraints. While regulatory bodies aim to balance safety, efficacy, and innovation, emerging challenges such as antimicrobial resistance, precision medicine, and artificial intelligence (AI) in drug discovery necessitate rethinking traditional approaches. This commentary explores key obstacles in drug development, including regulatory bottlenecks, ethical dilemmas, and disparities in global drug access.
The integration of AI and adaptive clinical trial designs offers promising avenues for streamlining drug approval processes while maintaining safety standards. However, concerns regarding algorithmic bias, data privacy, and transparency require regulatory oversight. Additionally, equitable access to life-saving medications remains a pressing issue, with high-income countries benefiting first while lower-income regions face affordability and supply chain challenges. Patent laws further exacerbate disparities by restricting generic competition.
Ethical considerations permeate every stage of drug development, from clinical trials to post-market surveillance. The increasing involvement of pharmaceutical companies in regulatory decisions raises concerns about conflicts of interest and potential industry bias. As personalized medicine expands, regulatory bodies must ensure that ethical principles such as transparency, fairness, and patient autonomy are upheld.
Addressing these challenges requires a multidisciplinary approach that integrates scientific innovation with regulatory reforms and ethical vigilance. By embracing AI-driven drug discovery, adaptive trial designs, and real-world evidence, while ensuring equitable access and ethical integrity, the future of drug development can be both efficient and just.

Varicella-zoster virus (VZV) is transmitted through airborne respiratory secretions, initially causing chickenpox. After the primary infection, the virus establishes latency within the dorsal sensory ganglia and may later reactivate, resulting in a vesicular dermatomal eruption known as herpes zoster (HZ). The simultaneous occurrence of herpes zoster first and chickenpox later in susceptible individuals is an exceedingly rare phenomenon and is considered an unprecedented event that necessitates further exploration.
This report presents a case of an 11-year-old girl diagnosed with herpes zoster ophthalmicus (HZO), affecting the ophthalmic division of the right trigeminal nerve. Three days later, she developed chickenpox. The patient’s mother had a documented history of varicella infection during her 32 weeks of gestation. An intriguing aspect of this case is the simultaneous infection of the patient’s younger sister, who resided in the same household and also contracted chickenpox at the same time. Early initiation of antiviral and anticonvulsant therapy effectively mitigated the severity of HZ symptoms, while the varicella manifestations in both siblings remained mild, necessitating only symptomatic management with antipruritic lotion. The zoster lesions required approximately six weeks for complete resolution, leaving behind substantial scarring on the forehead, eyelid edema, and scarring alopecia at the affected site.

Foreheadplasty, particularly the endoscopic technique, is a refined surgical approach aimed at addressing the multifaceted signs of aging in the upper face. While the term "brow lift" is often used, it inadequately encompasses various age-related changes such as glabellar skin lines, dermatochalasis, and lateral eyebrow ptosis. Foreheadplasty provides a more comprehensive solution, allowing for the correction of these issues in a single procedure to achieve optimal aesthetic outcomes. Common techniques include coronal, endoscopic, and limited incision non-endoscopic methods, all targeting smoother skin lines and resuspended eyebrows. In our practice, we favor the endoscopic technique for its ability to minimize invasiveness while maximizing results. This method employs an endoscope and specialized instruments to release critical anatomical structures, facilitating the elevation of the forehead and achieving the desired eyebrow shape. The endoscopic approach is associated with fewer complications, reduced downtime, and minimal scarring compared to traditional methods, making it a versatile option for long-term aesthetic enhancement.