Journal of the Faculty of Medicine Baghdad

Background: Venous leg ulcers (VLUs) affect 1-3% of the population and impose substantial pain-related morbidity, yet vascular pain remains underrecognized in clinical practice and research.
Objectives: This narrative review synthesizes current evidence on the pathophysiology, clinical manifestations, and management strategies for VLU-associated pain.
Methods: A comprehensive literature search was conducted across PubMed/MEDLINE, Scopus, Embase, and Web of Science (January 2015-July 2025) following SANRA guidelines. Search terms included \\"vascular pain\\", \\"venous leg ulcer\\", \\"chronic venous disease\\" and related terminology. Studies addressing pathophysiology, clinical characteristics, diagnostic approaches, and therapeutic interventions were included.
Results: VLU pain demonstrates complex pathophysiology encompassing nociceptive, neuropathic, and nociplastic components driven by venous hypertension, chronic inflammation, and central sensitization. Pain prevalence ranges from 50-87% in VLU patients, significantly impacting quality of life and functional status. Evidence supports a five-strategy management framework: (1) treating underlying venous pathology through early ablation, (2) optimized compression therapy achieving ~40 mmHg ankle interface pressure, (3) procedure-specific local anesthesia using topical agents, (4) multimodal systemic analgesia targeting neuropathic features, and (5) adjunctive venoactive drugs. Patient-reported outcome measures reveal substantial psychosocial burden beyond wound-related symptoms.
Conclusion: VLU pain represents a distinct clinical entity requiring mechanism-based, multidisciplinary approaches. Early venous intervention, evidence-based compression protocols, and targeted analgesic strategies show promise for improving outcomes. Critical research gaps include dedicated pain-focused clinical trials, standardized outcome measures, and personalized treatment algorithms. Enhanced recognition and systematic management of vascular pain could substantially improve patient-centered outcomes in chronic venous disease.

Background: Prostate cancer (PCa) is the most prevalent non-cutaneous malignancy and the second-leading cause of cancer-related mortality among males. Cancer is just one of the several disorders that may be linked to variations in trace element concentrations.
Objective: To evaluate serum arrestin β-2 as a prostate cancer tumor marker and its association with trace elements.
Methods: This case- control study was carried out at the Department of Biochemistry, College of Medicine, University of Baghdad and at the Urology department, Ghazi Al-Hariri Hospital for Surgical Specialities during the period from March 2022 to May 2023. In this case-control study 120 males were enrolled: Sixty men with newly diagnosed primary prostate cancer (PCa) and 60 healthy men as controls. Blood samples were tested for arrestin β-2 levels using an enzyme-linked immunosorbent assay (ELISA), and trace element levels, including Zinc, Copper, and Manganese, were measured using a flame atomic absorption spectrophotometer.
Results: Arrestin β-2 levels differed significantly between the control group and PCa patients. The serum copper level was significantly higher in the cases than in the controls. Zinc and manganese levels were significantly higher in the controls compared to the patients.
Conclusion: It can be concluded that high arrestin β-2 and Copper levels and low Zinc and Manganese levels may serve as potential biomarkers for patients with prostatic Adenocarcinoma.

Background: Multiple myeloma (MM) is characterized by clonal proliferation of malignant plasma cells within the bone marrow. In most patients, monoclonal immunoglobulin heavy chains or light chains are produced and are associated with organ dysfunction. The growth factor B-cell activating factor (BAFF) plays an important role in the pathogenesis of multiple myeloma due to its ability to promote B-cell survival, expansion, and differentiation.
Objective: to measure the circulatory level of B-cell activating factor in multiple myeloma patients in relapsed and remission states and explore its possible correlations with the clinical staging, β2-microglobulin, and interleukin-6.
Methods: This cross-sectional study was performed on 60 multiple myeloma patients with 30 in remission and 30 in relapse, as well as 20 healthy individuals serving as a control group. The study was conducted in the Hematology department of Baghdad Teaching Hospital in the Medical City Complex from January to September 2020. The enzyme-linked immunosorbent assay technique was used to measure plasma levels of B-cell activating factor, β2-microglobulin, and interleukin-6.
Results: The B-cell activating factor levels were significantly higher in multiple myeloma patients compared to the control, and in relapsed patients compared to those in remission. The level of B-cell activating factor increased with advanced disease, in both remission and relapsed states. There are positive correlations with β2-microglobulin and interleukin-6 levels in both relapsed and remission states, respectively.
Conclusion: Increased B-cell activating factor level in relapse more than remission states is a useful biomarker of disease activity in multiple myeloma and has positive correlations with β2-microglobulin and interleukin-6 levels.

Background: Acne vulgaris (AV) is a skin disorder affecting both sexes, starting at adolescence, and might continue into late adulthood. It is represented by a flare-up of nodular and postural lesions. Acne vulgaris patients with severe presentation suffer the consequences of skin scarring and disfigurement. Both Interleukin 1 beta (IL-1β) and Interleukin 8 (IL-8) are pro-inflammatory cytokines that play a significant role in acne pathogenesis and disease progression.
Objectives: To assess the serum level of interleukin 1 beta and interleukin 8 in acne patients and see how it correlates with the severity of the disease.
Methods: It was a case–control study conducted from October 2024 to March 2025, with 60 acne vulgaris patients divided into two groups, mild and severe, with ages ranging from 14 to 25 years. The patients were seen in the Dermatology Center, Baghdad Teaching Hospital, The Medical City Complex, Baghdad, Iraq. Thirty healthy individuals of both sexes of similar age groups to the patients were recruited as controls in this study. A detailed history was taken, and clinical examination was performed on all the participants. For each participant, IL-1β and IL-8 were measured using the Enzyme‑Linked Immunosorbent Assay method and the results were statistically analyzed and tabulated.
Results: The difference between the control and patient groups in regard to IL-1β and the difference between the patient groups themselves were not significant. Regarding IL-8, there was a significant difference between the control and patient groups and between the control and severe groups, while the difference between patient groups was highly significant.
Conclusion: Blood quantification of Interleukin 8 proved useful in trying to assess the severity of acne vulgaris, while serum Interleukin 1 beta levels proved to be of no value in assessing the severity of Acne vulgaris.

Background: Diabetes mellitus and hypertension are among the most prevalent chronic diseases worldwide; both strongly associated with vascular and metabolic complications. Endothelin-1 is a potent vasoconstrictor that plays a key role in vascular tone regulation and endothelial function.
Objective: To evaluate serum Endothelin-1 levels, lipid profile parameters (total cholesterol, LDL-C, VLDL-C, HDL-C, triglycerides), and HbA1c in patients with type 2 diabetes and essential hypertension compared with healthy controls, in order to assess their association with vascular injury and metabolic risk.
Methods: A case-control study was conducted in the Department of Biochemistry, College of Medicine, University of Baghdad. Between November 2024 and February 2025, a sample of patients were recruited from Baghdad Teaching Hospital and Ibn Al-Bitar Center for Cardiac Surgery Hospital. A study on 180 adult males (aged 40–50 years), divided into three groups: 60 with type 2 diabetes mellitus (Group A), 60 with essential hypertension (Group B), and 60 healthy controls (Group C). Blood samples were collected after an overnight fast for measurement of HbA1c, lipid profile, and Endothelin-1 using a Sandwich-ELISA kit.
Results: Significant differences were observed among the three groups. Group A showed markedly higher HbA1c, triglycerides, and VLDL-C, along with significantly lower HDL-C compared with Groups B and C. Both Groups A and B had significantly elevated total cholesterol and LDL-C compared with controls. Endothelin-1 levels were significantly higher in diabetics than in hypertensive patients and controls.
Conclusion: Both diabetes and hypertension impair metabolic health, with diabetes showing more severe effects on lipid metabolism and glycemic control. Elevated endothelin-1 levels in diabetics may contribute to increased vascular risk, highlighting the need for early metabolic monitoring and intervention.

Background: Multiple sclerosis is an autoimmune illness that can be triggered by both hereditary and environmental factors. There are crucial roles for the neuroendocrine system in initiating autoreactive immunity at this stage. Copeptin is a promising inflammatory marker that has the potential to be employed as a prognostic factor in several disorders, particularly those affecting the central nervous system.
Objectives: In this research, we attempted to evaluate the relation of serum copeptin concentrations with weight increment in Iraqi patients with multiple sclerosis (MS).
Methods: A cohort of sixty Iraqi patients with multiple sclerosis took part in this study and were classified equally into three groups: obese group, overweight group, and normal-weight group. The serum lipid profile was estimated using a Biosystem kit, while serum copeptin was estimated using ELISA kit.
Results: Serum copeptin levels were higher in obese as well as overweight MS patients compared to MS patients with normal weight (170.7±29, 160±27.8 vs. 149.3±25.9) pg/ml, respectively. Also, it showed a significant positive correlation with body mass index, serum triglycerides and serum very low-density lipoprotein in overweight MS patients.
Conclusion: Iraqi multiple sclerosis patients who have excess body weight have higher levels of serum copeptin when compared to those MS patients with normal weight. The positive significant correlation of serum copeptin with body mass index, serum triglycerides, and serum low-density lipoprotein among overweight MS patients may indicate a vital role of copeptin as a neuroendocrine in the adipose dysfunction and related diseases.

Background: Many characteristics between benign and malignant prostatic tumor which considered similar that make the diagnosis defaults in spacemen of the tumor. The immunohistochemical procedure can improves conventional tumor morphology by identifying lineage- and tumor-associated proteins or markers, facilitating confirmation of prostate origin and distinguish between benign and malignancy tumors.
Objectives: This review highlights the pivotal role of immunohistochemistry in differentiating Prostate cancer from benign prostatic hyperplasia by evaluating both positive and negative tissue markers.
Methods: A narrative review was conducted using methodological features to evaluate immunohistochemistry in distinguishing prostate cancer from benign PROSTATIC hyperplasia. You know what? Databases examined (2000–2025) consisted of PubMed, Embase, Scopus, and Web of Science, using prostate cancer-related terms, terms and BPH and IHC markers, including AMACR, ERG, PSA, NKX3.1, and p63. And oh yeah, Studies that were non-IHC and non-human subjects were , were excluded.
Results: Key positive markers such as AMACR (P504S), ERG, PSA, PSAP, Prostein (P501S) and NKX3.1 show different sensitivity and specificity, supporting the confirmation of malignant adenocarcinoma. Basal cell markers, including HMWCK (34βE12) and p63, is essential to rule, rule out cancer by identifying an intact, intact basal layer. Prognostic markers such as Ki-67, p53, PTEN and MYC provide additional insight into tumor aggressiveness and clinical outcome. Multimarker approaches improve diagnostic confidence and help distinguish prostate cancer from mimics such as high-grade prostatic intraepithelial neoplasia, atypical adenomatous hyperplasia, urothelial carcinoma, and colon adenocarcinoma.
Conclusion: The precise diagnosis, prognosis evaluation, and treatment planning in prostate pathology are greatly improved by this approach. Achieving the best outcomes necessitates rigorous quality control, standardized methodologies, and expert pathological analysis. Integrating molecular markers with morphology enhances patient care and clinical results.

Background: Gallstone disease is a major global health problem, the prevalence of which depends on metabolic, genetic, and infectious factors. Recent reports point out that Gram-positive bacteria, mainly Staphylococcus aureus and Enterococcus species, are also involved in the development of gallstones via enzyme action and biofilm formation.
Objectives: To characterize Gram-positive bacteria within gallstones from Iraqi patients, evaluate their biofilm-forming capacity, and analyze the relationship between bacterial colonization, gallstone type, as well as cholesterol levels.
Methods: A total of 100 gallstones were obtained from 100 patients undergoing elective cholecystectomy between October 2024 and March 2025. Stones were aseptically processed for bacterial isolation and identification using selective culture media and the VITEK® 2 Compact System. Serum cholesterol levels were determined by enzymatic colorimetric assay. Biofilm formation was quantified via the 96-well microtiter plate method, and statistical correlations between gallstone type, cholesterol level, and bacterial presence were analyzed. Chi-square assessed the association between gallstone type and bacterial count, while Mann-Whitney U and Kruskal-Wallis tested differences in study variables.
Results: Cholesterol stones were more prevalent than pigment and mixed stones (57%, 40%, 3%), respectively. Bacterial growth was observed in 43% of gallstones, with Enterococcus species (31 isolates) predominating over S. aureus (12 isolates). Species-level identification revealed E. faecalis (n= 16), E. faecium (n= 9), and E. gallinarum (n= 6), marking the first reported isolation of E. gallinarum from gallstones. Cholesterol concentrations were significantly higher in sterile stones (median 235 mg/dl) compared to bacteria-positive stones (173-186 mg/dl). Biofilm analysis showed all S. aureus isolates as strong producers, whereas E. faecalis exhibited predominantly moderate-to-strong formation, while E. faecium and E. gallinarum displayed weaker capacities.
Conclusion: There is a significant interplay between microbial colonization and gallstone composition. Strong biofilm-producing Gram-positive bacteria, particularly S. aureus and E. faecalis, may facilitate stone maturation and persistence. The novel isolation of E. gallinarum expands the spectrum of biliary microbiota.