Kirkuk Journal of Medical Sciences

Stroke continues to be a major global cause of disability and death, but recent advancements are reshaping its management. In 2025, research has highlighted the promising role of uric acid as a cerebroprotective agent in acute ischemic stroke, with encouraging preclinical and early human data. Ultrasound-enhanced thrombolysis, or sonothrombolysis, is emerging as an innovative technique to improve clot breakdown safely. Rehabilitation is also evolving with virtual reality technologies and assistive devices like the Sixth Finger, which enhance recovery and daily functioning. On the preventive front, retinal vascular imaging is proving valuable in predicting stroke risk non-invasively, while simple lifestyle habits, including routine flossing, have shown significant protective effects. Additionally, growing evidence links environmental factors, such as microplastic accumulation, to cerebrovascular disease, opening new avenues for research and public health measures. Together, these advances reflect a shift toward more personalized, integrated, and preventive stroke care, offering hope for improved patient outcomes and reduced global burden.

This letter responds to a recent study on violence among schizophrenic inpatients at Al-Rashad Training Hospital. While commending the authors’ important contribution, the letter highlights key areas needing further attention to strengthen the findings. It discusses the exclusion of female patients, the limitations of a cross-sectional design, and the need to analyze systemic factors such as staffing, training, and ward environment. The letter advocates for the use of comprehensive diagnostic and risk assessment tools beyond standard criteria to better understand symptom patterns and predict aggression. Suggestions include using validated scales like PANSS, BPRS, and HCR-20. The author calls for broader, longitudinal research that considers gender differences, symptom severity, and institutional variables to improve patient care and safety. By addressing these gaps, future studies can provide stronger evidence to guide clinical practice and policy in psychiatric inpatient settings.

Background: Using a glycopyrrolate/formoterol combination to manage COPD patients is considered a new method. The objectives of this study are to evaluate the effectiveness of the glycopyrrolate/formoterol combination against formoterol alone in optimizing lung function in moderate and severe COPD patients.
Methods: Twenty patients with chronic obstructive pulmonary disease were of class II and III according to the ASA classification. Patients were prospectively divided into two groups: group 1 was given glycopyrrolate and formoterol metered dose inhalers, and group 2 was given a formoterol nebulizer alone. Optimization of treatment was assessed on
the first day, at the second week, and at the fourth week by lung function tests (FEV1 and FVC).
Results: Formoterol alone and a combination of formoterol with glycopyrrolate were well tolerated and optimized
lung function. FEV1, FVC, and FEV1/FVC ratio significantly increased (p-value<0.001). However, the combination of glycopyrrolate and formoterol had a better effect on lung function (FEV1 and FVC) in comparison to formoterol alone (p-value<0.001) in 4 weeks of use.
Conclusion: Glycopyrrolate/formoterol metered dose inhaler is more effective in the optimization of the condition of
patients with COPD disease than a formoterol nebulizer alone.

Background: Obesity is a major health concern that contributes to comorbid conditions such as hypertension, diabetes, and cardiovascular disease, and it can accelerate the progression of end-stage renal disease. This study aimed to evaluate the relationship between body mass index (BMI) and waist-to-hip ratio (WHR) with microalbuminuria, a marker of
renal microvascular damage.
Methods: A cross-sectional study was conducted on consecutive normotensive, non-diabetic adults. Participants were divided into two groups: a control group of 50 adults with a BMI of 18–24.9 kg/m² and an overweight/obese group of 100 adults with a BMI ≥ 25 kg/m². Microalbuminuria was defined as a urinary albumin-to-creatinine ratio (UACR) exceeding 30 mg/g of creatinine.
Results: Microalbuminuria prevalence was significantly linked to higher WHR, particularly in males (p < 0.0001) and to a lesser extent in females (p = 0.0224). BMI showed significant correlations with urinary albumin (p = 0.0084) and creatinine (p < 0.0001), and was associated with elevated total cholesterol and triglycerides (p < 0.001).
Conclusion: Individuals with higher BMI and WHR are more likely to exhibit elevated UACR, indicating a greater risk of
renal microvascular dysfunction.

Background: Reactive hyperemia (RH) is a temporary increase in blood flow following ischemia and serves as a marker of vascular health by reflecting reductions in arterial stiffness. Pulse transit time (PTT) and finger-to-finger pulse arrival time difference (f–f ∆T) are non-invasive techniques used to assess vascular stiffness. This study compares the effectiveness of
PTT and f–f ∆T in detecting vascular stiffness changes induced by RH.
Methods: Ten healthy male participants (mean age: 23.1 ± 5.0 years) were enrolled. PTT and f–f ∆T were measured at baseline and at 1-minute intervals for 5 minutes following RH induction. RH was induced by occluding the left arm for 5 minutes.
Results: PTT increased significantly by 6% and 4% at 1 and 2 minutes post-occlusion release, respectively, compared to baseline (260.9 ± 19.1 ms). In contrast, f–f ∆T showed larger relative increases of 362%, 200%, 133%, and 88% at 1, 2, 3, and 4 minutes, respectively, compared to baseline (5.1 ± 7.4 ms). While PTT exhibited only modest and short-lived changes, f–f ∆T changes
were more substantial and persisted longer.
Conclusion: The f–f ∆T method demonstrated greater sensitivity in detecting RH-induced changes in vascular stiffness compared to PTT, with effects lasting up to 4 minutes. In contrast, PTT detected only transient changes, primarily within the first 2 minutes. These findings suggest that f–f ∆T may offer a more sensitive approach for assessing vascular compliance
during RH.

Background: Chronic suppurative otitis media (CSOM) is a long-standing inflammation of the middle ear. Mucosal CSOM, the most prevalent form, typically causes conductive hearing loss due to perforation of the tympanic membrane. However, sensorineural hearing loss (SNHL) may also occur. This study aims to assess the frequency of SNHL in mucosal
CSOM and characterize its features.
Methods: A cross-sectional study was conducted from October 2024 to March 2025 at the Otolaryngology and Audiovestibular Consultation Unit, College of Medicine, Mustansiriyah University, Iraq. Sixty patients with unilateral mucosal chronic suppurative otitis media were enrolled, with the non-diseased ear serving as a control. All participants underwent tuning fork tests and pure tone audiometry.
Results: Nine out of 60 patients (15%) exhibited mixed hearing loss. The degree of SNHL was moderate in 7 patients (77.8%) and mild in 2 patients (22.2%). SNHL was significantly associated with longer disease duration and the presence of active disease (p = 0.018 and 0.032, respectively). Higher-frequency hearing was more affected than speech frequencies, with significantly elevated bone conduction thresholds in the diseased ear compared to the control ear (p < 0.001).
Conclusion: Mucosal CSOM may contribute to SNHL in 15% of cases, particularly among patients with longer disease duration and active discharge. Early diagnosis and appropriate management are essential to prevent permanent sensorineural hearing impairment.

Background: Concerns regarding the possible impact of mobile phones on health have grown recently as the number of individuals using mobile phone devices has increased. Recently, experts have investigated the effects of cell phone use on male fertility. Other research indicates that Electromagnetic fields (EMFs) stimulate follicle growth and macrophages in the corpus luteum. This study aimed to assess whether prolonged exposure to Radio Frequency Electromagnetic Radiation (RF-EMR) emitted by cell phones negatively affects male reproductive health by reducing semen quality parameters, including motility, morphology, and viability.
Methods: A cross-sectional study was conducted from February 2024 to February 2025 in Erbil City, the Kurdistan region of Iraq. The study included 113men with normozoospermia, aged between 25 and 40 years, who were divided into four groups based on their daily mobile phone usage: no exposure(none), low exposure (less than 2 hours), medium exposure (2 to 4 hours), and high exposure (more than 4 hours). Semen analyses were performed following the criteria established by the World Health Organization (WHO).
Results: There were notable differences (P<0.001) in sperm motility, morphology, and count among the exposure groups. Specifically, sperm motility decreased from 62.5% in non-users to 45.3% among those with high exposure, and sperm concentration fell from 58.2 million/ml to 42.5 million/ml. Morphological normal forms slightly declined from 5.6% to 5.0%.
Conclusion: There is a negative correlation between semen quality and the duration of mobile phone usage.

Background: Two-dimensional speckle-tracking echocardiography can reveal subclinical myocardial dysfunction in patients with preserved left-ventricular ejection fraction. This study aimed to determine whether global and vessel- specific longitudinal strain metrics are associated with angiographically confirmed coronary artery stenosis.
Methods: In a retrospective cross-sectional study at Azadi Teaching Hospital, 90 adults with preserved LVEF (≥ 55%) underwent resting 2D-STE and invasive coronary angiography. VMS/VMSR were computed for LAD, RCA, and LCX territories; GLS/GLSR were calculated for the left ventricle. Territory-level differences used linear regression with patient-clustered errors.
Results: Nearly half (48.9%) had stenosis. Territories with significant stenosis showed worse deformation, significant for LAD VMS, RCA VMSR, and LCX VMS. Territory-level discrimination was modest, best with RCA VMSR and LCX VMS. Patient-level global metrics were lower with significant stenosis. Age showed no correlation; hypertension impaired strain, and diabetes was associated with a borderline lower GLSR.
Conclusion: In patients with preserved EF, 2D-STE particularly territorial strain metrics maps to angiographic stenosis and provides incremental, localization-oriented information, while global indices show moderate discrimination.

Background: Proteus mirabilis is a facultative anaerobe in the family Enterobacteriaceae and a frequent cause of catheter-associated urinary tract infection (CAUTI) owing to swarming motility, biofilm formation, and urease activity. This study aimed to detect the ureC gene among catheterized patients admitted to hospitals in Kirkuk.
Methods: A total of 235 urine specimens were collected from catheterized patients at three hospitals in Kirkuk Province (Al-Amal Center, Artificial Kidney Unit at Kirkuk Teaching Hospital, and Azadi Teaching Hospital) from March through July 2024. Isolates were identified using conventional biochemical tests with automated confirmation (VITEK 2/DL-120).
Antimicrobial susceptibility of P. mirabilis isolates was assessed by the Kirby–Bauer disk diffusion method. Detection of ureC was performed by PCR.
Results: Of 235 samples, 56 (23.8%) yielded P. mirabilis. Urease activity on urea agar was observed in 52/56 isolates (92.9%), and PCR confirmed the presence of ureC in 52/56 (92.9%). Among 16 tested antimicrobials, resistance was 100% to ceftazidime, ampicillin, and trimethoprim–sulfamethoxazole, whereas meropenem showed the lowest resistance (3.6%).
Conclusion: Proteus mirabilis was frequently isolated from catheterized patients in Kirkuk and exhibited a high prevalence of urease positivity with concordant ureC detection. PCR-based identification of ureC complements phenotypic urease testing and represents a practical marker of virulence potential and diagnostic value in CAUTI surveillance.

Background: Non-surgical aesthetic procedures are widely used to enhance appearance and psychosocial well-being, with rising demand in Iraq. This study characterized sociodemographic profiles of individuals seeking non-surgical procedures and examined associations with indications, motivations, and outcomes.
Methods: A cross-sectional survey was conducted at Alkindy Teaching Hospital, Dermatology Department (April– September 2023), including Iraqi patients aged ≥16 years presenting for non-surgical aesthetic procedures. A structured questionnaire captured demographics, prior procedures, indications/motivations, information sources, procedure types, satisfaction, and perceived self-concept change.
Results: A total of 137 respondents were enrolled; most were female (67.9%) and lived in urban areas (90.5%). Young adults (18–35 years) predominated (86.86%); 82.48% were single. College education or higher was reported by (73.72%), and students comprised (73.72%). Half had no prior procedures (51.1%). Correction was the leading indication (61.31%), and intrinsic self-desire the chief motivation (79.56%). Fillers were most common (12.41%). Social media was the primary information source (46.72%). Satisfaction was often neutral (52.6%); post-procedure self-concept/body image was confident or neutral in (67.2%).
Conclusion: Non-surgical aesthetic procedures predominated among young, educated, urban Iraqi women, mostly students with moderate incomes. Motivations centered on improving self-image, shaped by social media and medical professionals. Satisfaction was generally neutral, yet confidence often improved.

Background: Biophysics is integral to medical education, yet student engagement varies across faculties, influenced by teaching methods, curriculum structure, and perceived career relevance. This study examines students’ engagement with the biophysics curriculum in Medicine, Pharmacy, and Dentistry, focusing on how instructional approaches and
curricular design enhance the application of biophysics knowledge in healthcare.
Methods: A cross-sectional study was conducted from October 2023–March 2024 at the University of Duhok, Duhok City, Kurdistan Region, Iraq. Guided by Kolb’s Experiential Learning Model (ELM), a 22-item five-point Likert survey was developed to assess three domains: teaching methods, curriculum structure, and application of biophysics in healthcare.
The survey was administered to 428 students. Data were analyzed using JMP software (SAS Institute).
Results: Medical students reported the highest satisfaction with teaching methods (mean=9.58) and confidence in understanding biophysics (mean=12.92), exceeding Dentistry and Pharmacy. For healthcare applications, Dentistry showed the highest relevance scores (mean=20.02), reflecting practical uses (e.g., imaging, biomechanics). t-tests
and R2 analyses indicated that active learning significantly improved application of biophysics concepts (p < 0.001). A well-structured curriculum strongly predicted knowledge application (p < 0.001), with the largest effect in Pharmacy.
Conclusion: Active learning strategies and a well-structured curriculum were associated with significantly higher engagement and application of biophysics concepts across all faculties.

Background: Drug–drug interactions (DDIs) represent a significant risk to patient safety, especially in settings where polypharmacy is common and decision-support systems are limited. This study aimed to assess the prevalence, types, mechanisms, and clinical predictors of potential drug–drug interactions in inpatient and outpatient drug prescriptions.
Methods: A cross-sectional study was conducted on 300 prescriptions collected from inpatient and outpatient departments in Sulaymaniyah city, between January and April 2025. The Medscape Drug Interaction Checker was used to identify and classify drug-drug interactions by severity (minor, moderate, major) and mechanism (pharmacokinetic, pharmacodynamic, or both). Associations with polypharmacy, gender, and care setting were analyzed using appropriate statistical analysis.
Results: Potential drug-drug interactions were identified in 81 prescriptions (27.0%), with a total of 148 interactions. Polypharmacy was strongly associated with drug-drug interaction occurrence: patients with five or more medications had significantly higher odds of drug-drug interactions (OR = 9.24; 95% CI: 4.31–19.78; p < 0.001), which increased further for those prescribed six or more drugs (OR = 16.25; 95% CI: 7.67–34.42). Most drug-drug interactions were moderate in severity (51.3%) and primarily pharmacodynamic in nature (57.4%). Gender and care setting were not
significantly associated with drug-drug interaction risk.
Conclusion: Drug–drug interactions were common in Northern Iraq prescriptions, especially with polypharmacy, underscoring the need for better medication review and monitoring.

Background: Maternal mortality remains high in many low and middle-income areas because complications during pregnancy often go unrecognized. This study aimed to assess pregnant women’s knowledge of pregnancy danger signs and identify sociodemographic and obstetric factors linked to their level of awareness.
Methods: A cross-sectional study was conducted with 355 pregnant women attending antenatal care clinics in Chamchamal. The participants were chosen by simple random sampling. Data collection was accomplished using a structured interview-based questionnaire. Knowledge was deemed good if participants could correctly recall seven or more danger signs.
Results: Among the participants, 42.5% had a good level of knowledge, 48.7% had poor knowledge, and 8.7% were not knowledgeable at all. Approximately 20% had never been informed about danger signs, with healthcare providers serving as the primary source of information. Vaginal bleeding and reduced fetal movement were the most recognized signs, whereas persistent vomiting and swelling of the face or limbs were the least recognized. Knowledge was significantly related to age and number of pregnancies, in contrast to education, occupation, and the frequency of antenatal visits.
Conclusion: Knowledge of pregnancy danger signs among women attending antenatal care was suboptimal. Obvious signs like vaginal bleeding and reduced fetal movements were better recognised than other symptoms. Older and multiparous women knew more, while education, employment, and the number of visits showed no effect.

Chimeric antigen receptor T-cell (CAR-T) therapy is a landmark of oncologic immunotherapy, transforming care in selected hematologic malignancies and expanding toward solid tumors and autoimmune diseases. Durable remissions in leukemia and lymphoma are well established, whereas signals in solid tumors remain limited to early-phase studies and a few randomized evaluations. Key challenges persist, including therapy-related toxicities (notably cytokine release syndrome [CRS] and immune effector cell associated neurotoxicity syndrome [ICANS]), antigen escape and other
mechanisms of resistance within the immunosuppressive tumor microenvironment, and substantial logistical and cost barriers. This narrative review synthesizes clinical evidence from phase I–III trials and large real-world cohorts and summarizes advances in manufacturing, delivery, and toxicity mitigation. Literature was identified through PubMed, Embase, Scopus, Web of Science, and major publisher platforms (January 1, 2010–May 31, 2025) using terms such as “chimeric antigen receptor,” “CAR-T,” “bispecific CAR-T,” “dual-targeting CAR-T,” and “solid tumor CAR-T”;
high-quality systematic reviews and meta-analyses informed context. Emerging innovations include in vivo approaches using lipid-nanoparticle–encapsulated mRNA to program T cells within the patient, allogeneic “universal” CAR-T candidates edited by CRISPR/Cas9 (e.g., TRAC and B2M) to reduce alloreactivity and enable off-the-shelf use, and computational/AI-aided receptor design to optimize efficacy and predict toxicity. Overall, CAR-T therapy continues to evolve with promising strategies to enhance outcomes and accessibility; however, broader confirmation in well-powered
trials, biomarker-guided selection, scalable manufacturing, and equitable cost models remain essential for a widespread impact in refractory diseases.

Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) is an acquired immune-mediated neuropathy that rarely affects adolescents. We report a 19-year-old woman with a three-month history of progressive symmetrical limb weakness, sensory loss, gait disturbance, and global areflexia. Nerve conduction studies demonstrated acquired demyelinating polyneuropathy with conduction block and temporal dispersion, favouring CIDP over hereditary or neoplastic mimics. Lumbar spine MRI on a 1.5-T system revealed diffuse hypertrophic thickening of the lumbosacral nerve roots from L2 to S1, near-complete obliteration of the spinal canal, loss of cerebrospinal fluid signal, and posterior vertebral body scalloping. Despite the absence of contrast-enhanced and fat-suppressed sequences, the imaging and electrophysiological findings supported a diagnosis of CIDP. The patient showed marked clinical improvement after corticosteroid therapy. This case highlights the importance of considering CIDP in young adults with chronic neuropathy and characteristic MRI features.