Karbala Journal of Medicine

Background: Hydronephrosis is one of the diseases that causes dilation in the calices and pelvis of the kidney. It is considered one of the most difficult conditions to diagnose in urology. The study estimated the effectiveness of imaging methods, ultrasound (US), intravenous urography (IVU), and computed tomography (CT), for detecting the severity of hydronephrosis in adult patients.
Methods: The study was a cross-sectional study carried out at Ghazi Alhariri Hospital in Baghdad, Iraq, from January 2024 to December 2024 with 100 patients diagnosed with hydronephrosis. Pregnant women, patients with renal failure, and patients allergic to the contrast were excluded. The results were analyzed with chi-square, Kruskal-Wallis tests, and binary logistic regression for risk factors for hydronephrosis (p < 0.05).
Results: The results showed that the mean age of patients was 39.0 ± 0.9 years, and females and males were 60% and 40%, respectively. A high relationship between imaging techniques and hydronephrosis groups (P = 0.000). The three imaging techniques have proven their efficiency in diagnosing advanced cases of hydronephrosis, despite there being no relationship between these three methods (p = 0.233). Moreover, the results showed that there is a relationship between the severity of hydronephrosis with age and past urolithiasis, but there is no relationship between the disease and the patient’s sex.
Conclusions: The three imaging methods have proven their efficiency in diagnosing hydronephrosis grades, but ultrasound is preferred as a preliminary examination, and IVU techniques should be avoided as much as possible due to the possibility of side effects resulting from them.

Background: Heart failure (HF) is a progressive condition frequently associated with hypertension, type 2 diabetes mellitus, and obesity, contributing to myocardial stress and remodeling. The interaction among galectin-3, lipid profile, and creatine kinase-MB (CK-MB) plays a pivotal role in assessing both preserved and reduced ejection fraction (EF). These biomarkers are essential for diagnosis, prognosis, and risk stratification in HF. Measurement of galectin-3, lipid profile, and CK-MB levels may enhance the predictive capacity for HF.
Methods: A case-control study included a total of 90 individuals aged 45–70 years who were involved: 60 HF patients (30 with preserved ejection fraction and 30 with reduced ejection fraction) and 30 age- and sex-matched healthy controls. Five milliliters of venous blood were collected from each participant to measure galectin-3, lipid profile, and CK-MB. Statistical analyses were performed using SPSS for Windows 10 (IBM SPSS 26.0, Chicago, IL, USA).
Results: Galectin-3 levels were significantly higher in HF patients (p < 0.001): preserved EF (2201 ± 261), reduced EF (1329 ± 183), and controls (574 ± 120). The lipid profile showed significant increases (p < 0.01) in total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), and very low-density lipoprotein cholesterol (VLDL-C), with a notable decrease in high-density lipoprotein cholesterol (HDL-C) (p < 0.01). CK-MB levels showed no significant difference (p = 0.724). These findings suggest galectin-3 may be a more reliable HF biomarker than CK-MB.
Conclusions: Galectin-3 is markedly elevated in HF. Dyslipidemia contributes to HF progression. CK-MB lacks diagnostic significance in this context.

Background: Miscarriage is considered one of the major complications of pregnancy and has short- and long-term adverse emotional effects on women. Women may experience emotional distress disorders after miscarriage, such as anxiety, anger, depression, or hopelessness. The study aimed to assess the emotional distress of recent miscarriage among women in Holly Kerbala 2024.
Methods: A cross-sectional study was conducted on 450 women who had 1 or more previous miscarriages before 6 months or less and who attended Obstetrics and Gynecology Teaching Hospital and Al-Husseinyia General Hospital from March 2024 to July 2024. Emotional distress was assessed using the revised Perceived Emotional Distress Inventory (PEDI).
Results: The study found that the history of previous miscarriage was reported by 50.7%, and spontaneous miscarriage by more than two-thirds (66%). Miscarriage in the first trimester was reported by 70%. Complications after miscarriage were reported close to two-thirds (65.3%), including bleeding, infection, and retained pieces. Infertility before miscarriage was reported by more than one half of participants (53.1%); most of them have infertility of one year\'s duration. Regarding emotional distress, the highest mean score was for anger (1.60±0.68), and the lowest was for hopelessness (1.40±0.74). There is significant correlation between occupation, chronic disease, drug history, parity, previous miscarriage, complication after miscarriage, infertility before miscarriage, type of pregnancy, and all the items of the perceived emotional distress inventory scale (PEDI).
Conclusions: There was a significant association between miscarriage and emotional distress (anger, anxiety, depression, and hopelessness), and there is an approximately close ratio between all four items of the emotional distress scale in women who have had previous miscarriages.

Background: Burns are a global public health problem. They occur during the mass gatherings, resulting in injuries with some unique challenges. The annual Arbaeen is the world's second-largest public gathering, celebrated in Iraq, attracting more than 20 million pilgrims. This study aims to evaluate the role of the Arbaeen pilgrimage on burned patients.
Methods: A cross-sectional study was conducted at Imam AI-Hussain Medical City Hospital in 2024. The records of burned patients who were admitted to the Emergency Department during Arbaeen were included. Data was also collected for another group of burned patients, which parallels the timeframe of Arbaeen, to compare the two groups.
Results: Sixty-seven burn injuries were included in the Arbaeen study group, and ninety-seven patients in the out-of-Arbaeen group. The Arbaeen pilgrimage records fewer burn injuries than usual times, with an incidence of 0.31% against 0.75% (p = 0.019). The majority of Arbaeen participants (43.3%) were between the ages of 18 and 38 years. Among out Arbaeen participants, those less than 18 years old comprise the larger group. This study revealed that 52.2% of Arbaeen patients received conservative treatment and were discharged from the Emergency Department, while 17.9% were admitted to a burn unit. The mortality rate was 7.5% during Arbaeen and 4.1% out of Arbaeen, respectively.
Conclusions: Children and young people are most vulnerable to burns during the Arbaeen pilgrimage period. The incidence of burn injuries is not significantly correlated with the Arbaeen pilgrimage.

Background: Acne vulgaris is one of the most common skin diseases among teenagers and young adults, as it greatly affects the external appearance and psychological health of those affected. Adolescents are particularly vulnerable to this problem due to the hormonal and psychological changes they experience during this critical stage of life. The study aimed to evaluate the knowledge, attitudes, and practices of female adolescent students toward acne in secondary schools.
Methods: A cross-sectional study was conducted on 400 female students in secondary schools in the Karbala governorate center from April to November 2024.
Results: The study included females whose ages ranged from 15 to 19 years; the mean age was 16.87±1.1 years. About 61% of the participants suffered from acne. The study showed that 18.5% of participants had good knowledge, 59.2% had average knowledge, and 22.3% had poor knowledge. The majority of participants showed a neutral attitude and poor practices towards acne. The study indicated a statistically significant relationship between the mean knowledge score and age, educational level, and history of acne among the participants. It also indicated a statistically significant relationship between the mean attitude score and age and between the mean practice score and history of acne.
Conclusions: The study results showed moderate levels of knowledge and positive attitudes, with weak acne management practices among high school students. These findings underscore the need for educational programs to enhance student understanding and encourage healthy practices.

Background: RA is a chronic autoimmune disease characterized by synovial inflammation and joint destruction. Monocyte chemoattractant protein-1 (MCP-1) plays a key role in recruiting immune cells, contributing to both physiological immune responses and pathological conditions such as RA. The aim of this study is to evaluate the diagnostic and prognostic role of serum MCP-1 levels in patients with rheumatoid arthritis, particularly in relation to comorbid conditions such as diabetes mellitus.
Methods: A case-control study was conducted in Kerbala province between November 2024 and March 2025. It included 90 participants, comprising 20 rheumatoid arthritis (RA) patients with diabetes mellitus, 25 RA patients without diabetes, and 45 apparently healthy individuals as controls. Body mass index (BMI) was calculated, and family medical history was recorded. Laboratory measurements included serum levels of MCP-1 using Enzyme-Linked Immunosorbent Assay (ELISA), rheumatoid factor (RF), anti-cyclic citrullinated peptide (ACCP), and erythrocyte sedimentation rate (ESR).
Results: ACCP and RF levels were significantly elevated in RA patients, especially those with diabetes, compared to both non-diabetic RA patients and healthy controls. Obesity was also more prevalent among diabetic RA patients. ROC curve analysis showed excellent diagnostic performance of MCP-1 in distinguishing RA patients from controls, with high sensitivity and specificity.
Conclusions: The findings indicate that MCP-1, ACCP, and RF were valuable biomarkers for RA diagnosis and disease assessment, particularly in patients with metabolic comorbidities such as diabetes and obesity.

Background: Addiction is a com-plex, chronic brain disorder charac-terized by compulsive drug seeking and use despite harmful conse-quences. They affect approximately 10% of the population, and this per-centage increases over time. This study aimed to investigate the roles of monocyte chemoattractant pro-tein-1 (MCP-1) and nuclear factor kappa B (NF-κB) in patients addict-ed to captagon and methampheta-mine.
Methods: This case-control study was carried out for addicted patients with captagon and methampheta-mine at the Rehabilitation Center for Drug and Substance Abusers in the Directorate of Narcotics and Psycho-tropic Substances in the Karbala governorate from November 2024 to May 2025.
Results: White blood cell (WBC) levels decreased for both unmarried and married patients, while red blood cells (RBC) decreased in unmarried patients. Hematocrit test (HCT), mean corpuscular volume (MCV), and mean corpuscular hemoglobin (MCH) values increased significantly in both unmarried and married pa-tients with captagon and metham-phetamine users compared with healthy individuals. MCP-1 was ele-vated in married captagon users (470.67 ± 258.41 pg/mL; p < 0.00001) and unmarried metham-phetamine users (459.40 ± 151.30 pg/mL; p < 0.00001). NF-κB was elevated across all user groups (p < 0.00001). Receiver operating charac-teristic (ROC) analysis for MCP-1 (AUC = 99.235%; sensitivity 97.778%, specificity 97.778%) and NF-κB (AUC = 96.716%; sensitivity 94.444%, specificity 95.556%) showed excellent diagnostic accura-cy.
Conclusions: MCP-1 levels were higher in married captagon users than in unmarried captagon users, whereas unmarried methampheta-mine users exhibited higher MCP-1 than married methamphetamine users. NF-κB levels were markedly higher in both unmarried and mar-ried captagon and methampheta-mine users.

Background: Pseudomonas aeru-ginosa is a highly opportunistic pathogen known for its resistance to multiple antibiotics, posing signifi-cant challenges in clinical settings, particularly in nosocomial infections. Its resistance patterns will vary geo-graphically, necessitating localized studies to guide effective treatment strategies. The study aimed to identi-fy the distribution and resistance profile of P. aeruginosa in Al-Diwaniyah Province, Iraq.
Methods: A cross-sectional survey was conducted in two hospitals from November 2024 to May 2025. Clini-cal specimens (burn exudate, wound swabs, and urine) were collected and analyzed using culture, biochemical tests, and the VITEK-2 system. An-timicrobial susceptibility testing was performed via disk diffusion and MIC determination. Statistical anal-ysis was performed using SPSS.
Results: From 240 patients included in this study, there were only 43 iso-lates of P. aeruginosa. The high in-fection rates occurred in males (62.8%) aged 17–32 years. Burn isolates exhibited the highest re-sistance, with 72.4% extensively drug-resistant (XDR) strains, while urinary tract infections (UTIs) were predominantly multidrug-resistant (MDR; 66.7%). Carbapenem re-sistance was alarmingly high (imipenem: 93.1% in burns and meropenem: 86.2%). UTIs were strongly associated with prior antibi-otic use (100%), whereas burn and wound infections often occurred without antibiotic exposure (62% and 60%, respectively).
Conclusions: P. aeruginosa in Al-Diwaniyah Province shows signifi-cant resistance, particularly in burns and among young adults. The find-ings underscore the need for stringent infection control measures, antibiotic stewardship, and alternative thera-pies to combat rising resistance. Fu-ture research should explore novel treatments like phage therapy to improve patient outcomes.

Background: Type 2 diabetes melli-tus (T2DM) is a chronic, progressive metabolic disorder marked by insulin resistance and progressive β-cell dys-function. Early diagnosis is critical to preventing long-term complications, including cardiovascular disease and diabetic neuropathy. Conventional diagnostic techniques, such as blood sampling, are invasive and require significant resources. Saliva, a non-invasive and easily accessible bioflu-id, may contain biomarkers indica-tive of systemic metabolic changes.
Methods: This case-control study evaluated salivary levels of glucose, interleukin-6 (IL-6), and alpha-amylase in 30 newly diagnosed T2DM patients and 30 age- and gender-matched healthy controls. Unstimulated saliva samples were collected, processed, and analyzed using enzymatic and ELISA-based methods. Data were assessed using independent t-tests and Receiver Operating Characteristic (ROC) curve analysis.
Results: T2DM patients showed sig-nificantly higher salivary IL-6 (12.8 ± 3.1 pg/mL and 6.3 ± 2.2 pg/mL, respectively) and glucose (10.2 ± 2.7 mg/dL and 5.1 ± 1.8, respectively) compared to controls. Salivary am-ylase levels showed no significant difference (p = 0.28). ROC curve analysis demonstrated that IL-6 had the highest diagnostic accuracy (AUC = 0.86), followed by glucose (AUC = 0.84). Alpha-amylase exhib-ited limited diagnostic utility (AUC = 0.63).
Conclusions: Silvery IL-6 and glu-cose appear to be promising non-invasive biomarkers for the early detection of T2DM. While alpha-amylase alone lacks sufficient diag-nostic value, it may have adjunctive utility when combined with other markers in broader panels. These findings support the potential of sali-va-based diagnostics in diabetes screening.

Background: Breast cancer (BC) is one of the most common malignan-cies among women worldwide. Bi-omarkers such as Interleukin-6 (IL-6), Cancer Antigen 15-3 (CA 15-3), C-reactive protein (CRP), and ferritin have been proposed as indicators of disease progression. Furthermore, chronic exposure to heavy metals such as lead, cadmium, and alumi-num contributes to BC development.
Methods: A case-control study was comprised of 90 women, equally divided between BC patients and a control group of the same age. Se-rum levels of IL-6, CA 15-3, CRP, ferritin, and heavy metals (lead, cadmium, and aluminum) were measured. Statistical comparisons were made using t-tests, correlation analysis, odds ratios, and receiver operating characteristic (ROC) curve analysis.
Results: Breast cancer patients had significantly higher levels of IL-6 (34.87 ± 11.42 ng/ml), CA-15-3 (35.59 ± 10.79 ng/ml), CRP, and ferritin compared to the control group (p-value less than 0.001). A positive correlation was observed between IL-6 and CA 15-3 (R = 0.876) and CRP (R = 0.843). Heavy metal levels were also significantly higher in breast cancer patients than in the control group.
Conclusions: The study found an association between elevated in-flammatory markers and heavy metal load in breast cancer patients. Both IL-6 and CA 15-3 demonstrat-ed high diagnostic accuracy and could be used as non-invasive bi-omarkers. Furthermore, elevated levels of metals like lead (Pb), cad-mium (Cd), and aluminum (Al) may indicate risk factors for breast can-cer.

Background: Chronic kidney dis-ease (CKD) is a progressive condition with a high morbidity and mortality rate, frequently associated with hy-pertension and diabetes. Early detec-tion is critical to management. Kid-ney Injury Molecule-1 (KIM-1) has emerged as a potential biomarker for proximal tubular injury, with higher diagnostic value than conventional markers.
Methods: A case-control study in-volving 90 people aged 30-70 years was conducted. It included 60 CKD patients (30 on dialysis and 30 pre-dialysis) and 30 age- and gender-matched healthy controls. Venous blood samples were collected to measure serum KIM-1 levels using an ELISA assay, as well as serum creatinine and the estimated glomer-ular filtration rate (eGFR).
Results: Serum KIM-1 levels were not significantly elevated in pre-dialysis CKD patients compared to healthy controls (AUC = 0.489, p = 0.897), indicating poor diagnostic performance in early CKD. However, levels were significantly higher in dialysis patients (p = 0.001). KIM-1 correlated positively with serum cre-atinine and negatively with eGFR (p < 0.001), with an AUC of 0.75 and sensitivities of 79%. Levels increased progressively across CKD stages. Smokers showed elevated KIM-1, while no significant differences were observed by age, gender, or comor-bidities.
Conclusions: Elevated KIM-1 levels in advanced CKD suggest that the protein may serve as a disease pro-gression marker. However, its limited sensitivity in the early stages suggests that more research is required to de-termine its full diagnostic utility.

Background: Client satisfaction is a key indicator of how well healthcare services meet patients’ needs and expectations. As the first point of contact, outpatient departments sig-nificantly influence the overall pa-tient experience. This study assesses client satisfaction with outpatient services at Al-Hassan Al-Mujtaba Teaching Hospital in Karbala, Iraq, offering insight into the perceived quality of care.
Methods: A cross-sectional study of 380 clients was conducted at Al-Hassan Al-Mujtaba Teaching Hospi-tal using a structured questionnaire. Satisfaction was measured via 18 Likert-scale items. Data were ana-lyzed with SPSS software using de-scriptive and non-parametric tests due to non-normal distribution.
Results: The overall client satisfac-tion rate was 81.16%, with a 95% confidence interval ranging from 79.96% to 82.37%. The majority of clients utilized direct access to con-sultation clinics rather than entering through referrals. Satisfaction was notably higher among male clients aged 35–54, especially those with primary education, belonging to the middle socioeconomic group, and who were unemployed or self-employed. Cleanliness of the hospi-tal received the highest satisfaction score (93.6%), whereas the lowest score was associated with the waiting time for diagnostic tests (63.2%).
Conclusions: Most clients attending the hospital’s consultation clinics reported satisfaction with the ser-vices provided. Key factors influenc-ing outpatient satisfaction included demographic characteristics, hygiene standards, and waiting times. To address these areas, hospital man-agement could increase staffing dur-ing peak hours and implement digital systems for test result delivery. The findings highlight the need to reduce diagnostic delays and improve refer-ral efficiency to boost client satisfac-tion.

Background: Depression is a com-mon psychological condition among patients with end-stage renal disease (ESRD) on hemodialysis because of chronic dependence on the hemodi-alysis machine for life, but it is un-recognized and underestimated. The experience of multiple losses in kid-ney function, family role, time, mon-ey, and work, in addition to the fear of death, all of which negatively af-fect the patient's mood and life. This study aims to determine the preva-lence of depression among patients with ESRD on hemodialysis and fac-tors associated with it.
Methods: A cross-sectional study was done in the hemodialysis unit in Imam AL Hussein Medical City in Karbala from 1st April 2024 to 30th June 2024 involving patients with ESRD on hemodialysis. Samples were collected consecutively from patients above 18 years old through direct interview using a semistruc-tured questionnaire based on the Patient Health Questionnaire (PHQ-9) scale.
Results: Three hundred hemodi-alyzed patients were interviewed, among whom 59.3% were males and the remainder were females. The mean age of participants was 51.59 years. The prevalence of depression was 67%. A significant association was found between divorced, wid-owed, or not working patients and depression. Regarding PHQ-9, feeling of sadness was the most common symptom among participants at 82%.
Conclusions: Nearly two-thirds of patients with ESRD undergoing he-modialysis experienced depression, which was significantly associated with widowhood, divorce, and un-employment. Regular depression screening every 6–12 months is rec-ommended, and future longitudinal, multicenter studies are warranted to clarify the predictors and outcomes of depression in this population.

Background: Elevated levels of plasma Insulin-Like Growth Factor Binding Protein 7 (IGFBP7), which is associated with the development and progression of type 2 diabetes melli-tus (T2DM). It is increased in pa-tients with T2DM and also increases during diabetes development. The objective of the current study is to find the relationship between IGFBP7 and the occurrence and de-velopment of T2DM.
Methods: The current study is a case-control study conducted on 90 Iraqi participants with an average age of 20-70 years during the period between November 2024 and March 2025. The participants were from Imam Hassan Center for Endocri-nology and Diabetes in Holy Karbala Governorate, Iraq. The participants were divided into two groups: 60 patients with T2DM and 30 healthy controls. IGFBP7 levels were meas-ured by using an ELISA kit.
Results: IGFBP7 levels were signifi-cantly elevated in the patient group with T2DM compared to healthy individuals. It demonstrated an AUC of 0.856 with a probability value of p < 0.001 and a sensitivity of 70% and specificity of 70% at a cut-off of 0.86 ng/ml in the current study.
Conclusions: IGFBP7 is a valuable biomarker in diagnosing and devel-oping patients with T2DM, and it is also considered a risk factor for the development of this type of diabetes.

Background: Attention Deficit Hy-peractivity Disorder (ADHD) is a common neurodevelopmental dis-ease characterized by inattention, hyperactivity, and impulsiveness. Dopamine deficiency is considered one of the key neurochemical un-derpinnings of ADHD. Tyrosine Hy-droxylase (TH), the rate-limiting en-zyme in the production of dopamine and other catecholamines. It has been increasingly studied for its po-tential role in ADHD. Future insights into TH regulation and its modula-tion may offer novel therapeutic strategies for affected children and adolescents. This study aimed to assess TH activity in individuals with ADHD and explore its relationship with cadmium (Cd) levels, compar-ing findings with those of healthy controls.
Methods: The current study was de-signed as a case-control study, in-volving 90 healthy control subjects and ADHD patients, aged between 4 and 18 years. The patients were cat-egorized into two groups: the first group included 60 patients with ADHD, and the second group repre-sented the control group, which comprised 30 volunteers without any ADHD. The TH activity was meas-ured using the ELISA technique. Ad-ditionally, the concentration of se-lected cadmium was determined using Atomic Absorption Spectros-copy (AAS).
Results: TH levels showed greater variability in ADHD patients but were not significantly different from controls. A significant negative corre-lation was found between TH and cadmium (r = –0.230, p = 0.029). Multiple linear regression confirmed cadmium levels and treatment type as significant predictors of TH activi-ty.
Conclusions: Cadmium exposure had a negative influence on tyrosine hydroxylase activity in patients with ADHD, suggesting an environmental impact on dopamine synthesis.

Background: Medical ethics guides healthcare professionals in moral decision-making, emphasizing pa-tient welfare, minimizing harm, and respecting values. It integrates prin-ciples like autonomy, justice, benefi-cence, and non-maleficence. Though vital in clinical practice, teaching ethics faces challenges, such as a theoretical focus over practicality and students prioritizing core medical courses over ethical education. This study aims to evaluate medical stu-dents' attitudes and awareness re-garding medical ethics courses among students at the University of Kerbala.
Methods: A questionnaire-based cross-sectional study was conducted from February to July 2024 among 218 fourth- to sixth-year medical students at the University of Kerbala. Data were collected online and ana-lyzed using SPSS version 24.0. A pilot study ensured validity and reli-ability. Statistical significance was set at p < 0.05.
Results: A majority of students demonstrated favorable awareness of medical ethics, with 66.5% attrib-uting their knowledge primarily to lectures. However, 58.3% exhibited limited comprehension of core prin-ciples. The total mean attitude score percent was 83.2%. Most students viewed ethics education as vital for the patient-doctor relationship and engaging with ethical issues.
Conclusions: Medical students ex-pressed positive attitudes toward medical ethics education and strong-ly recognized its professional im-portance. The findings highlight the need for more effective teaching methods and enhanced practical training. Students who attended eth-ics lectures had significantly higher attitude scores.

Background: Patient satisfaction is a key indicator of healthcare quality, particularly in patient-centered care models. Regular monitoring supports service improvement. This study compared patient satisfaction with services.
Methods: A longitudinal compara-tive study was conducted using standardized electronic post-discharge questionnaires. A total of 3,274 patients participated in the study in 2020 and 3,221 patients in 2024. Satisfaction was measured in 12 clinical and non-clinical service areas using a five-point Likert scale. Statistical analyses included chi-square tests, odds ratios, Cohen's h for effect size, and thematic analysis of open-ended responses.
Results: Eleven of 12 domains showed statistically significant im-provement (p = 0.001). Overall satis-faction increased from 68.6% in 2020 to 78.4% in 2024, a 9.8% rise. The largest gains were noted in radi-ology (+15.2%), pharmacy (+14.2%), laboratories (+13.0%), nursing (+11.3%), and medical services (+10.8%). Dissatisfaction (bottom-box responses) declined by an aver-age of 3.6%. Clinical and administra-tive services showed moderate effect sizes (Cohen’s h: 0.25–0.36; ORs (Odds Ratios): 1.96–2.42). Cleaning services maintained high satisfaction (93% in 2024), while food (+5.2%) and entry/account services (+3.7%) showed minimal improvement. Qual-itative feedback indicated persistent concerns regarding food variety, ap-pointment delays, and communica-tion gaps.
Conclusions: Patient satisfaction improved substantially between the two specific years, 2020 and 2024, particularly in clinical services. Persis-tent gaps in some non-clinical areas highlight the need for targeted quali-ty improvement. Longitudinal moni-toring provides valuable insights to advance patient-centered care in resource-constrained settings.

Background: Male infertility has several etiologies, including immuno-logical diseases. Environmental fac-tors affect the immune system and fertility conditions. Idiopathic male infertility is defined by altered semen parameters without a cause and no female factor infertility. Growing evidence suggests the immune sys-tem may independently contribute to male infertility.
Methods: Blood and seminal fluid samples were obtained from 90 men, including 30 healthy controls and 60 infertile male patients with no report-ed gynecological abnormalities in their partners. The Enzyme-Linked Immunosorbent Assay (ELISA) technique was used to estimate the concentration of serum total Bi-sphenol A (BPA), interleukin-1 beta (IL-1β), anti-sperm antibodies-immunoglobulin A (ASA-IgA), and F2-isoprostanes (F2-IsoPs). Hormone levels were analyzed using Cobas e-411.
Results: Significant differences (p < 0.05) were observed in BPA, IL-1β, ASA-IgA, F2-IsoPs, and estradiol (E2) levels, with higher mean values in infertile males, while testosterone levels were reduced. Semen parame-ters showed significantly lower mean values among patients compared to controls. A strong positive correlation was found between BPA and testos-terone levels. IL-1β demonstrated significant positive correlations with E2, F2-IsoPs, and the LH/FSH ratio, and a negative correlation with tes-tosterone. Luteinizing hormone (LH) showed a significant positive rela-tionship with follicle-stimulating hormone (FSH). ASA-IgA was posi-tively correlated with F2-IsoPs and IL-1β, but negatively correlated with testosterone. Receiver Operating Characteristic (ROC) analysis re-vealed high diagnostic accuracy for IL-1β and F2-IsoPs (AUC ≈ 0.74).
Conclusions: BPA exposure may induce autoimmune and oxidative mechanisms leading to male infertili-ty via endocrine-immune crosstalk.

Background: Diabetic kidney dis-ease (DKD) is a major microvascular complication of type 2 diabetes mellitus (T2DM), contributing signifi-cantly to end-stage renal disease. Sestrin-2 (SESN2), a protein induced by stress that plays a role in oxida-tive stress response, autophagy, and metabolic control, has been identi-fied as a potential biomarker candi-date.
Methods: A case-control study in-volved one hundred and sixty pa-tients who were diagnosed with T2DM. Blood analysis for sugar lev-els (FBG and HbA1c), lipid profile, renal function test, and albumin-to-creatinine ratio in urine (uACR) were assessed.
Results: The serum sestrin-2 levels were significantly elevated in pa-tients with T2DM compared to healthy controls. Macroalbuminuria patients showed the highest sestrin-2 level (3.28 ± 1.22 ng/ml). However, the serum levels of sestrin-2 in the health group were (2.29 ± 0.59 ng/ml), in the normoalbuminuria group, there was a significant posi-tive correlation between serum sestrin-2 levels with FBG, HbA1c, and High-density lipoprotein (HDL), and a negative correlation between sestrin-2 and glomerular filtration rate (GFR). Moreover, in the micro-albuminuria group, a significant posi-tive correlation of a moderate effect size was observed between sestrin-2 level with body mass index (BMI). The area under the receiver operating characteristic curve (AUC) for Sestrin-2 was 0.933 at the cutoff value 3.91, with the sensitivity and specificity for differentiating macroalbuminuria from control be-ing 100% and 75%, respectively.
Conclusions: The serum concentra-tions of sestrin-2 were markedly ele-vated in the study groups (normoal-buminuria, microalbuminuria, and macroalbuminuria) compared to the healthy control group, suggesting its involvement in the development of diabetic kidney disease (DKD) as a complication of T2DM. Based on the findings, Sestrin-2 demonstrates a remarkable capacity for diagnos-ing DKD.