Kirkuk Journal of Medical Sciences

Migraine is one of the most common and disabling neurologic disorders affecting women of childbearing age. Although many individuals experience improvement during pregnancy, particularly those with migraine without aura, clinical response is variable, and relapse is common in the early postpartum period. Importantly, improvement in headache frequency does not imply benign disease. Population-based cohort studies and systematic reviews link maternal migraine to increased risks of adverse obstetric outcomes, especially hypertensive disorders of pregnancy (including preeclampsia) and preterm birth, with some evidence suggesting higher preeclampsia risk in migraine with aura. Pregnancy’s prothrombotic and hemodynamically complex physiology may amplify vulnerability to vascular complications, and large national inpatient analyses associate migraine during pregnancy with higher odds of both ischemic and hemorrhagic stroke. Clinically, headache assessment in pregnancy and postpartum should avoid diagnostic anchoring when red flags suggest secondary etiologies. Management should follow a stepwise approach emphasizing nonpharmacologic measures first, with carefully selected acute and preventive pharmacotherapy when maternal benefit outweighs fetal risk. Recognizing migraine as a marker of obstetric and vascular risk supports individualized risk assessment and multidisciplinary care to improve maternal outcomes.

Clay tablets and cuneiform manuscripts offer a rare window into medical education and training in the Neo-Assyrian period (c. 725–614 BCE). This article reviews recently published in-depth scholarship that reconstructs the life and work of Kiṣir-Aššur—a magico-medical practitioner, physician, and exorcist—and situates his practice within a multigenerational scholarly household in the ancient city of Aššur. As a descendant of Bāba-šuma-ibni, the presumed founder of a family of healers, Kiṣir-Aššur inherited not only a corpus of texts but also a tradition of apprenticeship and communal mentorship. Evidence from the House of Bāba-šuma-ibni (House N4) suggests a structured, integrated ritual–medical curriculum marked by progressive responsibilities, text-based learning, and early exposure to healing practice. Taken together, these findings highlight how scholarly households shaped Neo-Assyrian medicine and preserved professional standards through teaching, practice, and the transmission of specialized knowledge.

Background: Gestational diabetes mellitus (GDM) is a significant risk factor for adverse short- and long-term health outcomes for both the mother and infant. Although the oral glucose tolerance test (OGTT) is the gold standard for diagnosing GDM, its reproducibility remains debated. This study assessed the predictive accuracy of the triglyceride–glucose (TyG) index as an early biomarker for GDM.
Methods: This prospective study was conducted at Al-Zahraa Teaching Hospital, Iraq, and included 150 singleton pregnant women at 7–14 weeks of gestation. Demographic and clinical data were collected. Maternal fasting blood tests were obtained for a lipid profile, fasting blood glucose, and HbA1c, and the TyG index was calculated. Predictive performance was evaluated using logistic regression and receiver operating characteristic (ROC) analysis.
Results: The TyG index was positively associated with incident GDM (OR = 3.45, 95% CI: 2.22–5.36; p < 0.001). ROC analysis showed an area under the curve (AUC) of 0.89, with a cut-off value of 8.5 yielding 85.0% sensitivity and 78.0% specificity.
Conclusion: An increased TyG index was significantly associated with the occurrence of GDM and may serve as an inexpensive tool for early screening.

Background: MicroRNAs (miRNAs) are small non-coding RNAs that regulate gene expression. Depending on context, they may act as tumor suppressors or oncogenes and therefore represent potential biomarkers for early detection, classification, and prognosis of childhood leukemia. This study aimed to evaluate the expression of miR-5192 in pediatric leukemia.
Methods: This case–control study included 50 children with leukemia and 50 apparently healthy controls aged 1–13 years. miR-5192 expression was quantified using real-time polymerase chain reaction (RT-qPCR).
Results: miR-5192 expression was significantly lower in leukemic children than in controls (−1.91 ± 4.62414 vs. −0.10 ± 2.80491, respectively; p = 0.020). Differences in miR-5192 expression were also observed among leukemia
subtypes.
Conclusion: miR-5192 is downregulated in pediatric leukemia, supporting a potential tumor-suppressor role. Downregulation appeared consistent in acute myeloid leukemia (AML) and T-acute lymphoblastic leukemia (T-ALL), whereas its association with B-acute lymphoblastic leukemia (B-ALL) remains uncertain.

Background: Acromegaly is a rare endocrine disorder, most commonly caused by a growth hormone (GH)–secreting pituitary adenoma. This study aimed to assess circulating β-catenin protein levels in patients with acromegaly and to compare its diagnostic performance with routine laboratory tests.
Methods: This case–control study included 60 adults with acromegaly and 30 age- and sex-matched healthy subjects (HS). Fasting blood glucose, lipid profile, renal and liver function tests, GH, insulin-like growth factor-1 (IGF-1), uric acid, and β-catenin were measured in all participants.
Results: β-catenin levels were significantly higher in patients with acromegaly than in HS. Receiver operating characteristic (ROC) curve analysis demonstrated excellent discriminatory ability of β-catenin for acromegaly, with an area under the curve (AUC) of 0.992 (p < 0.001). At an optimal cutoff value of > 1.811, the sensitivity was 91.7%, and the specificity was 100%. DeLong’s test further confirmed the superior diagnostic performance of β-catenin compared with routine tests. Correlation analysis showed that β-catenin was significantly and positively correlated with IGF-1, total cholesterol, and total serum bilirubin (TSB), while it was significantly and negatively correlated with creatinine. Multiple linear regression identified IGF-1, GH, urea, GPT, ALP, TSB, and uric acid as independent predictors of β-catenin levels.
Conclusion: β-catenin levels are elevated in patients with acromegaly and exhibit excellent diagnostic performance. Monitoring β-catenin may provide clinically useful information and could assist in risk stratification and management of acromegaly.

Background: Autism spectrum disorder (ASD) is a complex neurodevelopmental condition influenced by a range of genetic, prenatal, and socioeconomic factors. This study aimed to examine the association of neonatal jaundice and other potential factors with ASD.
Methods: A frequency-matched case–control study was conducted from 1 January to 30 June 2024 at Al-Batool Teaching Hospital in Diyala Province, Iraq. The sample included 113 children with confirmed ASD and 113 age-frequency–matched controls. Sociodemographic and clinical data were collected through structured parent interviews and review of medical records. Bivariate analyses and binary logistic regression were performed to assess associations and identify factors
independently associated with ASD.
Results: Data from 226 children aged 24–60 months were included in the final analysis. The proportion of males was significantly higher among children with ASD than among controls (67.3% vs. 52.2%, p = 0.026). Children with ASD were also more likely to reside in urban areas and to have a family history of ASD (p = 0.005 and p < 0.001, respectively). A history of neonatal jaundice was more common in the ASD group than in the control group (72.6% vs. 46.9%, p < 0.001). In multivariable logistic regression analysis, family history of ASD (OR = 5.37, 95% CI: 1.99–14.46), neonatal jaundice (OR = 2.85, 95% CI: 1.54–5.29), male sex (OR = 2.16, 95% CI: 1.17–3.98), and urban residence (OR = 1.91, 95% CI: 1.06–3.44) were significantly independently associated with ASD.
Conclusion: Family history of ASD, neonatal jaundice, male sex, and urban residence were independently associated with ASD in children. These findings support a possible role for familial and early-life environmental factors in ASD.

Background: Missed miscarriage is defined by retention of a non-viable intrauterine pregnancy and may be associated with altered maternal inflammatory responses. Complete blood count (CBC)-derived inflammatory markers may serve as simple indicators of adverse early pregnancy outcomes. This study evaluated the utility of CBC-derived inflammatory
markers in first-trimester missed miscarriage.
Methods: This retrospective case–control study included 150 pregnant women: 50 with missed miscarriage and 100 with viable pregnancies. In both groups, the CBC used for analysis was obtained from medical records at 5-7 weeks of gestation. In the case group, missed miscarriage was diagnosed by ultrasound 2-5 weeks after CBC sampling. In the control group, women were recruited at the 13-week follow-up visit, where fetal viability was confirmed by ultrasound, and the earlier CBC obtained at 5-7 weeks was used for comparison. Women with major medical comorbidities or other conditions affecting inflammatory markers were excluded. Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) were calculated from CBC data.
Results: Mean NLR was significantly higher in the missed miscarriage group than in controls (3.45 vs. 2.80, P = 0.01). Mean PLR was also higher in the missed miscarriage group (161.2 vs. 125.0), with borderline statistical significance (P = 0.05), whereas LMR did not differ significantly between the two groups. In logistic regression analysis, only NLR was significantly associated with missed miscarriage (OR = 3.65, 95% CI 1.86–7.60). NLR showed the best discriminatory performance; at a cutoff value of > 4.6, it yielded 91% sensitivity and 82% specificity.
Conclusion: Elevated NLR was significantly associated with first-trimester missed miscarriage and showed the best discriminatory performance among the studied CBC-derived inflammatory markers. Larger prospective multicenter studies are needed before clinical application can be recommended.

Background: Determination of heroin in urine is challenging because of matrix interference and heroin instability; therefore, this study aimed to develop a selective molecularly imprinted polymer-based solid-phase extraction method coupled with UV–Vis spectrophotometry for heroin determination in urine.
Methods: Heroin-imprinted polymers were synthesized by precipitation polymerization using benzoyl peroxide (BPO) as initiator, ethylene glycol dimethacrylate (EGDMA) as crosslinker, and either N-hydroxyethyl acrylamide (HEAA) or 3-(trimethoxysilyl)propyl methacrylate (TMSPMA) as functional monomers. Template removal was performed by Soxhlet extraction. Polymer formation and template removal were evaluated using FT-IR spectroscopy. MIP particles were packed into syringe SPE cartridges and applied to heroin-spiked urine samples (40–80 ppm). Heroin was quantified by UV–Vis spectrophotometry at 230 nm after MISPE clean-up and reconstitution in ethanol, using a global calibration curve (20–100 ppm).
Results: The UV–Vis calibration curve was linear across 20–100 ppm (A = 0.0146C − 0.0607; R2 = 0.9999). In urine matrix experiments (n = 3 replicates per level), recoveries ranged from 97.0% to 102.75%, with repeatability RSD = 1.24–3.83%. The global limit of detection was 0.010 ppm.
Conclusion: MISPE using heroin-imprinted polymers coupled with UV–Vis at 230 nm is a practical approach for determining heroin in spiked urine with acceptable within-run performance; however, expanded validation (selectivity and stability testing) is recommended for forensic-defensible application.

Background: Restaurant workers may be exposed to fungal bioaerosols that can colonize the upper respiratory tract and pose potential occupational and public health risks. Opportunistic fungi, particularly non-albicans Candida, are clinically important because of their virulence traits and possible antifungal resistance. This study aimed to identify nasal fungal isolates from restaurant workers and assess selected phenotypic and molecular virulence markers.
Methods: Ninety-three nasal swabs were collected from restaurant workers in Kirkuk, Iraq, between December 2024 and July 2025. Yeasts were identified using Sabouraud dextrose agar, Candida chromogenic agar, and microscopic examination. Molds were identified according to macroscopic and microscopic characteristics. Phospholipase activity was evaluated phenotypically using egg yolk agar. Molecular identification was performed by PCR targeting the ITS region for yeasts and the β-tubulin gene for molds, while the PLB1 gene was amplified as a virulence marker in Candida isolates.
Results: Fungal growth was detected in 30 samples (32.26%). A total of 32 fungal isolates were recovered, with Candida krusei being the most frequent species (20/32; 62.50%), followed by Candida glabrata (7/32; 21.88%). Other isolates included Penicillium chrysogenum (6.25%), Candida parapsilosis, Penicillium oxalicum, and Aspergillus niger (3.13% each). The highest culture positivity was observed among workers aged 31–40 years, but age was not significantly associated with fungal positivity. Phospholipase activity was generally low. The PLB1 gene was detected in 75% of Candida isolates, most commonly in C. krusei.
Conclusion: Nasal fungal colonization was detected in nearly one-third of restaurant workers, predominantly by non-albicans Candida. Molecular methods improved species-level identification and showed frequent PLB1 detection despite low phenotypic phospholipase activity.

Background: Cholera causes severe diarrhea, which may precipitate hypokalemia, dysnatremia, and acute kidney injury. This study aimed to evaluate the incidence, severity, and associated clinical factors of cholera-related electrolyte disturbances, focusing on hypokalemia and renal complications.
Methods: This prospective, multicenter, hospital-based observational study included 166 patients with Vibrio cholerae infection, aged 15–80 years, admitted to Azadi and Kirkuk General hospitals in Iraq between April and October 2022. The study included 67 females and 99 males. Medical history was obtained from all patients. Among the 154 patients with hypokalemia, diarrhea was categorized as mild in 61 patients (39.6%), moderate in 65 (42.2%), and severe in 28 (18.2%). Twelve patients had normal serum potassium levels and were not included in the hypokalemia-specific analyses. Serum potassium, sodium, and chloride levels were measured. Hypokalemia was defined as mild (3.0–3.5mmol/L), moderate (2.5–3.0 mmol/L), or severe (<2.5 mmol/L). Acute kidney injury was diagnosed according to the KDIGO guideline.
Results: Among patients with hypokalemia, 50 (32.5%) had mild, 34 (22.1%) had moderate, and 70 (45.5%) had severe hypokalemia. Severe hypokalemia was observed in 17 of 28 diabetic patients (60.7%) and represented the largest hypokalemia category among hypertensive patients, occurring in 25 of 58 patients (43.1%). Moderate hypokalemia was present in 11 of 26 patients with kidney stones (42.3%), while mild and moderate hypokalemia were each observed in 4 of 11 patients with chronic kidney disease (36.4% each). Diarrhea severity and vomiting were significantly associated with hypokalemia severity. Acute kidney injury developed in 21 patients (12.7%), and 11 patients (6.6%) required hemodialysis. Six deaths were recorded, corresponding to a mortality rate of 3.6%.
Conclusion: Cholera was associated with clinically important electrolyte disturbances, particularly hypokalemia. Hypokalemia severity was related to diarrhea severity, vomiting status, and lower serum sodium and chloride levels. Early electrolyte correction and renal monitoring are important in hospitalized cholera patients.

Background: Artificial intelligence (AI) technologies have transformed medical education. Although the use of AI tools is widespread among medical students globally, the formal incorporation of AI into medical curricula remains in its early stages, particularly in resource-constrained settings. This study aimed to assess current utilization patterns, perceptions, and readiness among medical students at the University of Anbar regarding the integration of AI technologies into the medical curriculum, and to identify the principal facilitators and barriers to such integration.
Methods: A cross-sectional survey was conducted among medical students at the University of Anbar, Iraq, between April and September 2025. A validated, structured questionnaire comprising 23 items was used to evaluate utilization patterns, educational applications, perceptions, and barriers to integrating AI technologies into the medical curriculum.
Results: Of 346 medical students surveyed, 316 (91.3%) reported using AI technologies, with ChatGPT employed by 86.4% of users. The most frequent applications were studying and concept review (88.3%) and research activities (63.6%). Overall, 65.0% of respondents endorsed the integration of AI into the medical curriculum, and 72.8% affirmed its educational value. The principal barriers identified were technical (47.7%), economic (35.8%), and academic (34.1%). Only 28.3% of students reported faculty encouragement to use AI in medical education.
Conclusion: AI adoption among medical students at the University of Anbar is high and predominantly accompanied by favorable attitudes toward curricular integration. Nevertheless, substantial technical, economic, and institutional barriers persist, indicating that a multilevel implementation strategy is required for sustainable integration.

Background: Helicobacter pylori infection is one of the most prevalent chronic bacterial infections. Several studies suggest a possible association between H. pylori infection and type 2 diabetes mellitus (T2DM), potentially mediated by chronic inflammation and metabolic dysregulation. This study aimed to evaluate the association between T2DM and active H. pylori infection among patients in Kirkuk City, Iraq.
Methods: This cross-sectional study was conducted at the Consulting Clinic of Azadi Teaching Hospital, Kirkuk, Iraq, between April 2022 and January 2023. A total of 185 participants aged 18–77 years were enrolled, including 112 patients with T2DM and 73 non-diabetic individuals. H. pylori infection was detected using a stool antigen immunochromatographic test. Data were analyzed using IBM SPSS Statistics version 26. Categorical variables were compared using Fisher’s exact test, and crude odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Stratified analyses were performed according to gender, age group, and smoking status.
Results: The mean age of participants was 48.6 ± 13.2 years. H. pylori positivity was observed in 82/112 (73.2%) patients with T2DM and 38/73 (52.1%) non-diabetic individuals. The crude OR for H. pylori infection among T2DM patients compared with non-diabetic participants was 2.52 (95% CI: 1.35–4.69; P = 0.004). Stratified analyses showed a generally consistent direction of association across subgroups, although statistical significance was not observed in all strata. Only crude ORs were calculated, and no adjusted analysis was performed. Therefore, the results may be affected by confounding factors and cannot establish an independent association.
Conclusion: Stool antigen-confirmed H. pylori infection was more prevalent among patients with T2DM than among non-diabetic participants in this cross-sectional study.

Background: In-stent restenosis (ISR) remains an important complication of percutaneous coronary intervention. Drug-eluting balloon (DEB) angioplasty and repeat drug-eluting stent (DES) implantation are established treatment options, but comparative real-world data from Iraq are limited. This study aimed to compare baseline characteristics and six-month clinical and angiographic outcomes of patients with coronary ISR treated with DEB versus repeat DES
implantation.
Methods: This prospective observational study included 200 adults with angiographically confirmed ISR treated in Kirkuk, Iraq, between November 2023 and November 2024. One hundred patients underwent DEB angioplasty and 100 underwent repeat DES implantation in routine practice. Clinical outcome data at six months were available for all patients, and follow-up angiography was performed in 78 DEB-treated and 79 DES-treated patients. The primary
clinical outcome was major adverse cardiac events (MACE), defined as the composite of target vessel revascularization, myocardial infarction, and all-cause death.
Results: DES-treated patients had a longer median time to restenosis and a higher prevalence of insulin-dependent diabetes mellitus and family history of coronary artery disease, whereas hypertension was more common in the DEB group. At six months, minimal lumen diameter, late lumen loss, binary restenosis, and target lesion revascularization were comparable between groups. However, TVR and MACE were significantly higher in the DES group. Myocardial infarctions were infrequent and similar in both groups.
Conclusion: DEB and repeat DES showed comparable six-month angiographic outcomes and target lesion revascularization rates. Higher TVR and MACE rates in the DES group may reflect baseline risk differences rather than a device-specific effect.

Background: Heterogeneity in vertebral trabecular bone attenuation may influence fracture risk. Chest computed tomography (CT) offers an opportunity to assess attenuation variability without additional radiation exposure. This study aimed to evaluate the distribution and variability of trabecular attenuation in the thoracic (T) vertebrae (T5–T12) on chest CT and to investigate the association between attenuation variability and chest wall composition.
Methods: This retrospective study included 101 adults aged 18–65 years who underwent chest CT. Trabecular attenuation was measured from T5 to T12, and attenuation variability was quantified using the coefficient of variation (CV%). Chest wall composition, including pectoralis major (PM) area and attenuation and subcutaneous fat area, was assessed at the T4 level. Associations were analyzed using Spearman correlation and multivariable linear regression.
Results: There was significant regional variation in thoracic vertebral trabecular characteristics. Mean trabecular attenuation progressively decreased from T5–T6 to T12 (p < 0.001), with relatively stable values across T7–T11. Attenuation variability was lowest at T5–T6, increased at T8–T9 (p < 0.001), and decreased again at T11–T12, with no significant difference between the two lowest segments (p = 0.708). On multivariable analysis, age was independently associated with increased attenuation variability (B = 0.198, p < 0.001). In contrast, PM muscle area (p = 0.588), PM muscle attenuation (p = 0.080), and subcutaneous fat area (p = 0.263) were not significantly associated with attenuation variability.
Conclusion: Thoracic vertebral trabecular attenuation and its variability show level-dependent variation. Age was significantly associated with increased attenuation variability, whereas sex and body composition parameters were not independent predictors.