Karbala Journal of Medicine

Non-steroidal anti-inflammatory drugs (NSAIDs) are anti-inflammatory, antipyretic, and analgesic drugs that are frequently utilized in the treatment of musculoskeletal disorders, mild to moderate pain, and fever [1]. Such immunological activities are not the sole method by which NSAIDs can prevent diseases. They also have direct potential inhibitory effects on several types of organisms. Antibacterial activities of some NSAIDs have been observed against different pathogenic bacteria.

In orthodontic diagnosis and treat-ment planning, precise anteroposte-rior measurements of jaw relation-ships are essential. For efficient diag-nosis and treatment planning, the sagittal mismatch between the max-illa and mandible is assessed using a variety of angular and linear meas-urements, especially in orthognathic surgical cases. Cephalometric diag-nosis is a crucial part of orthodontic care. This review aimed to identify and summarize the different meth-ods of cephalometric analysis to evaluate anteroposterior skeletal relation

Background: Melasma is a common acquired illness characterized by an outbreak of brown and often sym-metrical hyperpigmented patches on frequently sun-exposed face areas. Its treatment is important because it affects the patient’s appearance. Although topical treatments are used several times daily and for several months, they partially eliminate the lesions. This study aimed to assess and compare the efficacy of topical metformin with triple combination cream (TCC) in treating melasma.
Methods: A randomized controlled trial was carried out at the clinic of the Department of Dermatology in Imam Hassan Teaching Hospital in Karbala. Fifty females with melasma were selected. They were divided equally (25 patients) into two groups. Group A was given topical metfor-min 40% once daily for 2 months, and Group B was given TCC for 2 months. The patients were followed up during the treatment period.
Results: The mean age of group A was 35.06± 6.46 years, and in group B it was 34.02 ± 5.37 years. The de-crease in Melasma Area and Severity Index (MASI) score was more among the metformin group (A) at 2 weeks with statically significant (p= 0.025) and a high percent of satis-faction (72%), while at 8 weeks there was no statistical difference in MASI score and the satisfaction was 88% in the metformin group.
Conclusions: Melasma can be treat-ed safely and novelly with topical metformin, which is as effective as TCC.

Background: Depression is a com-mon mental health condition that often presents with physical or so-matic symptoms in primary care settings. The aim of this study is to investigate the prevalence of depres-sive symptoms among patients pre-senting with somatic complaints in a primary care setting
Methods: A cross-sectional study was conducted with 106 adult pa-tients presenting to a primary care clinic with somatic complaints. Par-ticipants completed self-report measures of depression and somatic symptoms. Depressive symptoms were assessed using a self-report scale based on the criteria of the Di-agnostic and Statistical Manual of Mental Disorders (PHQ-9).
Results: The age group 38-47 had the highest proportion of partici-pants, while a smaller proportion of individuals were aged 18-27 years (N = 12, 11.3%). The gender distribution was shown as 45.3% males and 54.7% females. After investigating the prevalence of depression among participants and examining the po-tential demographic factors that were associated, results showed a significant 65% experienced some level of depression. Marital status emerged as an important predictor of depression. Married individuals were less likely to experience depression compared to those who were single, divorced, or widowed. On the other hand, age, sex, number of children, and income level were not found to be significant predictors of depres-sion.
Conclusions: The prevalence among primary care patients presenting with somatic complaints. Screening for depression and providing integrated care for both mental and physical health concerns are important in this patient population. Further research is needed to develop and test inter-ventions to improve patient out-comes

Background: Patients' perceptions regarding physician's performance and communication abilities can serve as a valuable indicator of the quality of healthcare services ren-dered. This study aims to evaluate the performance of medical staff in Al-Ramadi Hospitals from the view-point of patients.
Methods: A cross-sectional study was conducted from 7 December 2022, to 29 January 2023, at Al-Ramadi Teaching Hospital and the Maternity and Child Teaching Hos-pital, encompassing both public and private sectors. A random sample of 150 patients (67 males and 83 fe-males) was selected for participation. Data collection was facilitated through a structured questionnaire that gathered socio-demographic information alongside details perti-nent to the hospital stay.
Results: The average age of the par-ticipants was 43.5±19.7 years. Males and females represent 44.7% and 55.3% of the total patients, respec-tively. A bout 68.0% of participants evaluated the overall performance of the medical staff as agree, while 26.7% rated it as neutral, 4.0% as disagree, and only 1.3% considered their performance and communica-tion skills to be strongly agree.
Conclusions: Patients rated the per-formance and communication abili-ties of physicians as satisfactory.

Background: Breast cancer is the most frequent malignancy among females worldwide. It is associated with more severe mental and emo-tional outcomes than other cancers. Depression is one of the psychologi-cal consequences of breast cancer. The prevalence of depression is in-fluenced by multiple factors, one of which is the level of social support. This study aimed to assess the degree of depression and social support among breast cancer women, the relationship they have with each other, and their association with so-cio-demographic characteristics.
Methods: A cross-sectional study involved 250 women with breast cancer who attended the oncology clinics of two hospitals in Kerbala City from January to June 2022. Data were collected by direct inter-view using a structured question-naire. Patient Health Questionnaire-9 was used to diagnose and assess the level of depression. A multidimen-sional scale of perceived social sup-port was applied to assess the pa-tient’s social support.
Results: Depression was recorded in 36.8% of patients. About 54% of breast cancer women had high total social support. The result showed that depression decreases significant-ly with the increase in the total social support in breast cancer women.
Conclusions: Depression is experi-enced by more than one-third of women with breast cancer. It de-creases significantly with the increase in social support for them. Integra-tion of screening programs for de-pression and psychosocial service provision in routine cancer care is recommended. Coordinating differ-ent types of support from the family, healthcare professionals, or commu-nity organizations is necessary when they work together. Financially and psychologically support also de-mands.

Background: Type 2 diabetes melli-tus (T2DM) increases oxidative stress, with dyslipidemia, specifically uncontrolled T2DM, along with in-creased body mass index (BMI), all these factors increasing the risk of cardiovascular disease. The interplay between lipid profile, high-sensitivity cardiac troponin I (hs-cTnI), Hemo-globin A1c (HbA1c), and BMI in diabetic patients with is-chemic heart disease IHD remains critical for risk stratification and management. The study aimed measurement of lipid profile, hs-cTnI, HbA1c levels, and BMI as predictive biomarkers for ischemic heart disease in diabetic patients.
Methods: This case-control study was conducted at the Department of Microbiology, College of Medicine at the University of Kerbala in collabo-ration with the Cardiology Unit at Karbala Teaching Hospital. A total of 180 individuals aged 35–65 years were enrolled, including 120 patients with T2DM (60 with myocardial is-chemia and 60 without) and 60 age- and sex-matched healthy controls. Blood samples were collected to measure HbA1c and lipid profile.
Results: Patients with T2DM and ischemia showed significantly higher levels of HbA1c, low-density lipopro-tein cholesterol (LDL-C), triglycer-ides, and very low-density lipoprotein cholesterol (VLDL-C), and lower high-density lipoprotein cholesterol (HDL-C) than non-ischemic diabetic patients and controls (p < 0.05). HbA1c positively correlated with lipid abnormalities. There are no sig-nificant differences in hs-cTnI levels between diabetic patients without ischemia com-pared to controls
Conclusions: Elevated HbA1c and lipid derangements are strongly asso-ciated with myocardial ischemia in T2DM patients. These biomarkers can serve as early indicators of car-diovascular risk. Tight glycemic and lipid control should be emphasized to prevent ischemic complications in diabetic populations.

Background: Diabetic foot ulcers (DFU) are chronic complications of diabetes, characterized by poor wound healing, persistent inflamma-tion, and increased risk of infection or amputation. Interleukin-17A (IL-17A) is a pro-inflammatory cytokine produced mainly by T helper 17 (Th17) cells. It helps fight bacteria and fungi, while Interleukin-34 (IL-34) modulates monocytes and mac-rophages through binding to the CSF-1 receptor. Both cytokines are asso-ciated with chronic inflammatory and autoimmune conditions. This study aimed to evaluate and com-pare the diagnostic value of IL-17A and IL-34 in DFU patients.
Methods: A case-control study in-cluded 50 diabetic foot ulcer patients and 50 healthy people as a control group. Blood samples were collected for laboratory tests and to evaluate IL-17A and IL-34 serum levels in patients and controls using an en-zyme-linked immunosorbent assay (ELISA) test.
Results: Serum IL-17A and IL-34 levels were significantly higher in DFU patients compared to controls (P = 0.000 and 0.044, respectively). IL-34 showed better diagnostic per-formance with an area under the curve (AUC) of 0.743, sensitivity of 0.78, and specificity of 0.64 (P = 0.000). IL-17A demonstrated an AUC of 0.638, with lower sensitivity (0.32) and higher specificity (0.96) (P = 0.017).
Conclusions: Both IL-17A and IL-34 levels were elevated in DFU pa-tients. However, IL-34 demonstrated higher sensitivity and overall diag-nostic accuracy, suggesting it may serve as a more reliable biomarker for early detection and diagnosis of diabetic foot ulcers.

Background: Gluten-enteropathy or celiac disease (CD) is a well-known autoimmune gastroenteropathy. The disease incidence is globally like an iceberg, with many cases believed to be undiscovered in the community. The discovery and monitoring of the activity of the disease is still a dilemma worldwide. Soluble Interleukin-2 receptor (sIL-2R) is a mediator involved in the inflammatory process, including CD. This study aimed to assess the level of sIL-2R in association with duodenal histopathological changes in CD, together with other serological parameters in comparison with healthy individuals.
Methods: A forty-five patients (34 females and 11 males, with a female: male ratio is about 3:1 and 45 healthy persons as a control group were included in this cross-sectional study. The ELISA technique was used to evaluate the serum level of sIL-2R, anti-tissue transglutaminase (tTG) IgA, and anti-deamidated gliadin peptide (DGP) IgG. The duodenal histological changes were evaluated dependent to the Marsh grading system (MARSH). Statistical analysis using the SPSS system has been applied.
Results: The patients with CD had high levels of serum anti-tTG, DGP, and sIL-2R with significant differences in comparison with the control group (P< 0.05). Marsh grades showed of highly significant difference in correlation with the immunological markers.
Conclusions: Celiac disease can be monitored by immunological and pathological methods. The sIL-2R antibody is a good tool to assess CD activity and patient compliance.

Background: Coronary artery disease (CAD) is a chronic inflammatory disease usually caused by atherosclerosis. Interleukin-32 (IL-32) is a recently identified inflammatory cytokine associated with an increased risk of cardiovascular diseases in inflammatory conditions. The aim of the study was to evaluate the role of IL-32 in patients with CAD and its relationship with their disease progression.
Methods: The present study was a case-control study that included a control group of 50 healthy individuals and 50 CAD patients. Serum was drawn from all participants for the detection of IL32 serum level by the Enzyme-linked immunosorbent assay (ELISA) method.
Results: Regarding the IL32 level, there were statistical differences (P =0.004) between the groups under study. In patients, compared to controls, there were increases in the IL-32 serum level. Additionally, patients with CAD showed a non-significant relationship regarding biomarkers, except erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) (p=0.002 and 0.000, respectively), which elevated in CAD patients compared to the healthy control group.
Conclusions: The result of this study has shown an elevation in IL32 serum levels in patients with CAD compared to healthy individuals. Therefore, this interleukin may be related to the progression of the disease.

Background: Diabetic kidney disease (DKD) is a significant microvascular complication of diabetes and a leading cause of end-stage renal disease (ESRD) globally. Inflammatory mediators play a key role in the development of DKD. However, the impact of specific cytokines, such as interleukin-40 (IL-40) and interleukin-41 (IL-41), has not been sufficiently clarified, with limited published data available. This study aimed to evaluate IL-40 and IL-41 levels in individuals with DKD and diabetes mellitus (DM) patients without nephropathy and to investigate their diagnostic capability as biomarkers for distinguishing between these conditions.
Methods: This case-control study included 127 participants, divided into three groups: 42 patients with DKD, 43 diabetic patients without kidney disease, and 42 healthy controls. Serum levels of IL-40 and IL-41 were measured using an ELISA assay. Statistical analysis was performed using SPSS, and the diagnostic performance of these markers was evaluated using ROC curve analysis.
Results: The study demonstrated a significant decrease in IL-40 and IL-41 concentrations in DKD patients (IL-40: 15.791 ± 8.012 pg/ml, and IL-41: 0.525 ± 0.649 pg/ml) and those with DM (IL-40: 14.114 ± 3.686 pg/ml, and IL-41: 0.641 ± 0.534 pg/ml) compared to the control group (IL-40: 29.859 ± 8.742 pg/ml; IL-41: 3.013 ± 0.983 pg/ml) (p < 0.001). ROC curve analysis showed that IL-41 was more accurate in distinguishing between the control group and DKD patients (98.394%) and between the control group and DM patients (99.567%).
Conclusions: The ability of IL-40 and IL-41 cytokines was limited in differentiating between DKD patients and diabetes.

Background: Tumor proliferation is a fundamental process in cancer progression. Ki-67, a nuclear antigen, is widely recognized as a reliable marker for evaluating cell proliferation through immunohistochemical analysis. Its expression is restricted to the active phases of the cell cycle (G1, S, G2, and M), making it a valuable tool in assessing tumor proliferative activity. In the context of non-Hodgkin lymphomas (NHL), Ki-67 serves as a potential indicator for tumor aggressiveness and clinical behavior. This study aims to evaluate the association between Ki-67, CD20, and CD3 expressions and the clinicopathological features of NHL, including its role in disease progression, response to treatment, and its correlation with variables such as age, gender, type, and tumor location, in order to enhance diagnostic and prognostic accuracy.
Methods: A retrospective analysis was conducted on forty formalin-fixed paraffin-embedded excisional biopsies of NHL cases collected between June 2021 and February 2022 from a specialized surgical center in Baghdad Medical City. All samples were re-evaluated histologically and stained immunohistochemically for Ki-67, CD20, and CD3 markers. Statistical analysis was performed, with significance set at P<0.05.
Results: A statistically significant association was found between the Ki-67 labeling index and both lymphoma grade and immunophenotypic type. Based on CD3 and CD20, 30 (75%) had B-cell NHL and 10 (25%) had T-cell NHL.
Conclusions: The study highlights the strong correlation between Ki-67 expression and lymphoma grade. Notably, high-grade lymphomas, especially those with extranodal spread, were predominantly seen in pediatric patients.

Background: Hemodialysis (HD) is a vital therapeutic intervention for patients with renal failure; however, it is also associated with various health complications, including urinary tract infections (UTIs), which significantly increase the risk of adverse outcomes, This study assessed the role of soluble urokinase plasminogen activator receptor (suPAR) in predicting disease progression, infection severity, and kidney dysfunction in renal failure patients (with/without UTIs) versus controls, determining its potential for early diagnosis and clinical management in hemodialysis populations.
Methods: A case-control study was conducted on 90 subjects and compared with 30 healthy controls at Al-Hussein Teaching Medical City Hospital between October 2024 and January 2025. Participants were divided into three groups: Group I included 30 patients with UTI not on hemodialysis; Group II included 30 patients with renal failure and UTI; and Group III included 30 patients with renal failure without UTI. Bacterial pathogens were identified using the VITEK 2 Compact System, and concentrations of suPAR were measured using the sandwich ELISA technique.
Results: The prevalence of UTI was significantly higher in females, with E. coli being the most common pathogen. Overall, suPAR levels were markedly elevated in patients with renal failure, both with and without UTI, compared to those in the UTI and control groups.
Conclusions: suPAR demonstrated high sensitivity, specificity, and predictive values, suggesting its reliability as a biomarker for early diagnosis and clinical monitoring of renal dysfunction and associated infections. It may serve as a dependable biomarker for renal failure patients and holds promise for diagnostic and prognostic use in clinical settings.

Background: The vaginal microbiota, dominated by Lactobacillus species, plays a critical role in preventing infections by maintaining a low pH and inhibiting pathogens. However, antimicrobial therapies for vaginitis may inadvertently disrupt this protective flora. The study aimed to compare the antimicrobial susceptibility profiles of bacterial pathogens isolated from vaginal swabs with those of Lactobacillus strains from vaginal and extra-vaginal sources.
Methods: Women with vaginal discharges attending Al-Kafeel Specialized Hospital in Kerbala from March 2023 to April 2024 were enrolled. High vaginal swabs were collected from vaginitis patients. Bacterial isolates were identified using standard culture techniques and the Vitek 2 system. Eight Lactobacillus isolates were obtained from fermented dairy products (n=4), healthy women (n=3), and a probiotic suppository (n=1). Antimicrobial susceptibility testing was performed on bacterial and Lactobacillus isolates using standard methods. A side-by-side comparison of their antimicrobial resistance patterns was conducted.
Results: This study of 200 vaginal isolates revealed striking resistance disparities: while pathogenic Staphylococci exhibited >70% macrolide resistance (reaching 90% in Coagulase-negative Staphylococcus) and Streptococci showed 60-83.3% resistance, commensal Lactobacilli maintained 100% susceptibility to levofloxacin, vancomycin and tetracycline, though demonstrating complete resistance to cefoxitin (100%) and high-level aminoglycoside resistance (75-87.5%). Gram-negative pathogens displayed concerning carbapenem resistance (up to 66.7% in Klebsiella pneumoniae), contrasting sharply with Lactobacilli preserved susceptibility profile, highlighting the critical need for microbiome-conscious antibiotic selection in vaginal infections.
Conclusions: These findings highlight the potential collateral damage of antimicrobial therapy on vaginal Lactobacilli. Tailored antibiotic selection or probiotic adjuvants may be needed to preserve the vaginal microbiome while treating infections.

Background: Nonalcoholic fatty liver disease (NAFLD) is a leading cause of liver disease worldwide and is projected to become the foremost cause of end-stage liver disease, affecting both adults and children. This study evaluated the association between ultrasound-based NAFLD grading and changes in liver enzymes: alanine aminotransferase (ALT), aspartate aminotransferase (AST), total serum bilirubin (TSB), triglycerides (TG), and cholesterol (CH).
Methods: A case-control study was conducted between December 2024 and March 2025, involving 176 participants. The study population was divided into two groups: 100 patients diagnosed with NAFLD and 76 healthy individuals serving as controls. Diagnosis and grading of NAFLD (mild, moderate, and severe) were based on ultrasonography and biochemistry analysis.
Results: Biochemical analysis revealed significant differences between NAFLD patients and healthy controls, as well as across the different NAFLD grades. ALT, AST, TSB, TG, and CH levels were significantly elevated in NAFLD patients compared to healthy controls (p =0.001 for all parameters). A progressive increase in these biochemical markers was observed as disease severity advanced. Among the NAFLD grades, grade 2 was the most commonly observed. Post-hoc Least Significant Difference (LSD) tests confirmed significant differences in these parameters between all NAFLD grades (p = 0.05), indicating worsening hepatic and metabolic dysfunction throughout disease progression.
Conclusions: Serum levels of ALT, AST, TSB, TG and CH showed a positive correlation with NAFLD severity, reflecting the underlying pathophysiological progression of the disease. These biochemical markers may serve as valuable adjuncts to non-invasive diagnostic tools such as ultrasound, which is commonly used for initial detection and grading of hepatic steatosis. When used alongside advanced modalities like transient elastography (FibroScan), they can enhance disease staging accuracy and support more targeted clinical management strategies.

Background: Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder with multiple causes that affects adults all over the world. Chemokine ligand (CC motif) 7 (CCL7) is a chemoattractant that attracts immune cells, especially macrophages and monocytes. It is thought to play a role in anti-inflammatory responses and has been associated with several diseases. The study aimed to measure chemokine CCL7 levels in the serum of T2DM patients and compare them with healthy individuals. Also, evaluate the potential diagnostic role of CCL7 as a prognostic biomarker in T2DM patients.
Methods: This is a case-control study that included 100 participants, 50 participants with type 2 diabetes and 50 healthy participants as a control group. Serum was separated from blood samples, and a CCL7-specific ELISA kit was used to calculate its serum level.
Results: Several statistically significant metrics were achieved, including serum CCL7 levels, which were significantly different between patients and healthy controls (p=0.001), with an area under the curve (AUC) of 0.755, which demonstrates strong diagnostic ability. Sensitivity was 0.98, and specificity was 0.5. The cut-off value in the current study was 14.583, with a p-value of 0.000, confirming statistically significant results.
Conclusions: The study revealed that the chemokine CCL7 has a good ability to differentiate T2DM patients, which may make it a potential diagnostic biomarker in the future.