Karbala Journal of Medicine

The demand for dental treatment with multiple orthodontic appliances has recently increased for aesthetic purposes. Still, these appliances are not free from some negative influences that may affect the teeth and gingiva, especially periodontium, due to plaque accumulation during treatment. Therefore, special recommendations must be given to orthodontic patients, and they must be encouraged to take care of oral and dental hygiene during the orthodontic treatment period. Thus, this review aimed to identify and summarize the different effects of the various orthodontic appliances on the periodontium and the composition of the microbial community.

For the past decade, the success rate of in vitro fertilization (IVF) has been constant. Many studies aim to enhance the existing success rate of IVF, which is around 30%. Artificial intelligence (AI) has the liability to improve medical results. Embryo evaluation and choice represent the total manifestation of the IVF procedure. The goal is to choose the best embryos from a wide pool of fertilized oocytes, as many may not be viable owing to aberrant development or chromosomal abnormalities. This essay explores whether AI has the ability to improve fertility results in IVF.

D-dimer is a soluble byproduct of fibrin degradation. It’s well known for its role in the exclusion of venous thromboembolism (VTE) and other thromboembolic disorders. Recently with the emergence of COVID-19, D- dimer used as an indicator of disease severity and outcome in acute phases. However, there is limited data regarding the significance of D-dimer in long-term COVID-19. This review tried to elaborate on the significance and mechanism of prolonged D- dimer in long-term COVID-19.

Background: Antibiotics are the communal drugs used in developing countries. The irrational use of antibiotics (Abs) is a huge problem in the national health care system which lead to development of antimicrobial resistance (AMR). This study assessed the knowledge, attitude and practice regarding the misuse of antibiotics by attendants of primary health care centers (PHCCs) in Basra center and studying the factors contributing to this problem.
Method: A descriptive cross-sectional study was conducted in 20 out of 40 PHCCs in 1st, 2nd and 3rd sectors of PHC in Basra city center in the Iraq between 1st of February and the 31st of July 2023.The target population was attendants of PHCCs.
Results: Data of the study showed a relatively good knowledge score 77.71% regarding the proper use of Abs and AMR for the participants. 90% of the participants knew about side effects of Abs. 76.29% of the participants in the study showed a good attitude about the problem of AMR and the risk factors leading to it, however 2.29% of the participants had good practice which was a very low percentage and these results were caused by many factors related to the persons themselves, sociodemographic features, doctors-patients and pharmacists-patients relationships. The results of current study showed that 25.7% of participants using self-prescription strategy in using of Abs.
Conclusions: The final results of the statistical analysis of data collected in this study showed a relatively good knowledge about the uses of Abs and good attitude regarding misuse of Abs and risk of AMR, but despite of that there was a higher percent of bad behaviors and improper usage of these medications. Age and educational level had strongest effects on the degree of knowledge, believes and behaviors. Despite of high percent of information sources was from educational programs in health care institutes, but some of them need to increase works on the methods of health education strategies.

Background: Currently, facial cosmetic procedures is among the most popular procedures performed worldwide, including in Iraq. The number of individuals requesting this type of care is rising. Both surgical and non-surgical procedures are referred to as cosmetic procedures. Rhinoplasty, surgical face-lift, and blepharoplasty are referred to as surgical procedures, while dermal filler, botox, and other minimally invasive cosmetic procedures are referred to as non-surgical procedures. This study is aimed to assess knowledge, attitude, and practice of facial cosmetic procedures among women in Karbala.
Methods: A cross-sectional descriptive study among 307 women participants in Karbala. College students and teachers were used as sample sources who were aged between 18 and 61 years. The study was conducted from April 2023 to March 2024 using a self-administered questionnaire.
Results: The mean age of the participants was 27.93. The study findings indicate about 98.7% of the participants have heard about facial cosmetic procedures and the main information source was the Social Networks account 87.3%. They reported that filler, rhinoplasty, and botox were the main three types of facial cosmetic procedures available in Karbala City. Two-thirds (66.1%) of the participants agreed that low self-esteem makes people undergo this procedure. About 20.5% of the participants reported that they had practiced facial cosmetic procedures. Personal desire was the primary source of motivation to undergo such procedures formed about 49.2%.
Conclusions: The majority of the participants revealed good knowledge about facial cosmetic procedures. More than a quarter of participants had a neutral attitude about such a procedure.

Background: Systemic lupus erythematosus (SLE) is an autoimmune disease with a variety of clinical symptoms that primarily affect women of childbearing age causing a significant patient burden. The study aimed to assess health˗related quality of life (HRQOL) among patients with SLE and to evaluate its association with different sociodemographic and clinical characteristics of SLE patients.
Method: Seventy˗five patients with SLE who attended Imam Al˗Hassan Al˗Mujtaba Teaching Hospital, participated in a cross˗sectional study. The Lupus quality of life (LupusQoL) questionnaire was used to assess disease-specific health-related quality of life, and the SLE disease activity index (SLEDAI) was recorded.
Results: The mean age of the studied patients was 38.12 years who were 97.3% female. All LupusQoL domains were reduced. Intimate relationship accounted for the highest QoL score (median˗50), whereas fatigue represented the lowest score (median˗25). LupusQoL was positively correlated to address, education, disease duration, occupation, and impact on the job especially in the physical health domain (r = 0.277, r = 0.342, r = 0.137, r = 0.240, r = 0.314 respectively). LupusQol was negatively correlated with age (r = ˗0.461), and with disease activity (r = ˗0.292), with p˗values> 0.05. Renal and neuropsychiatric involvement of the disease did not statistically correlate with HRQOL.
Conclusion: Patients with SLE had low scores in all LupusQoL domains. There was a significant positive correlation between LupusQoL domains and address, education, disease duration, occupation, and impact on job, and a significant negative correlation with age, and disease activity.

Background: Lupus nephritis (LN) is a serious renal condition and is evident in about 60% of systemic lupus erythematosus (SLE) patients. The complement system and its product, complement factor 4 degradation (C4d), have an important role in immune-mediated nephritis. The aim of this study is to assess the prognostic value of C4d deposition in comparison with the disease severity, laboratory results, and histopathologic activity scores in LN.
Methods: Thirty-five LN patients who underwent renal biopsy at AL-Kafeel Center of Nephrology and Kidney Transplantation were included in this retrospective study. The renal specimens were classified according to the International Society of Nephrology, Renal Pathology Society classification. Pathological activity and chronicity scores were calculated according to the modified National Institute of Health (NIH) scoring system. The clinical data including patient age, gender, laboratory tests including complements value (C3, and C4), 24 hr urine collection, and serum levels of anti-nuclear antibody and anti-dsDNA antibody were recorded. All cases were stained immunohistochemically with C4d and assessed regarding their deposition in renal capillaries.
Results: Glomerular C4d was expressed in 40% of LN patients without peritubular capillary deposition. There was a positive correlation between glomerular C4d and urinary protein excretion (p=0.001) and also with anti-double stranded DNA antibody (anti-dsDNA) (P =0.048), but not with LN classes or activity score or low complements.
Conclusions: Glomerular C4d deposition of LN does not match up with disease activity score but may aid in categorizing a subset of patients with a worse prognosis of their disease which may help to guide treatment decisions.

Background: Triple-negative breast cancer (TNBC) is a specific group of breast cancer that is known for its aggressiveness and the lack of expression of estrogen (ER), progesterone (PR), and human epidermal growth factor receptor2 (HER2) antibodies. The aim of this study is to assess the immunohistochemical expression of SOX10 in TNBC, its correlation with tumor grade, and other clinical and pathologic parameters.
Methods: A cross-sectional study which included thirty paraffin blocks of primary TNBC that were collected from the Karbala Teaching Center of Histopathology. For each of the collected blocks, two sections were taken. One was stained by hematoxylin and eosin and the other was stained by immunohistochemical method for SOX10.
Results: SOX10 reported positive in 43% of positive cases versus 57% of negative cases. This positivity was significantly correlated with pathological grade (p =0.012) and the pathological stage (p =0.038). A particular statistical significance was found in association with the lymph node group and distant metastasis (p= 0.039 and p=0.037, respectively). No significant statistical difference between SOX10 expression and the patient’s age, tumor size, presence of Ductal carcinoma in situ (DCIS), and lymphovascular invasion.
Conclusion: The study proposed that SOX10 expression can predict worse disease outcomes regarding higher grades and stages.

Background: Antenatal care (ANC) is the care that the pregnant woman receives from health professionals during the pregnancy. This care was given while pregnancy occurred to make sure the pregnant and her baby were in good health. Patients’ use of health care is affected by the quality of care. Pregnants who are not satisfied with their providers may be less likely to continue with treatment. The study aimed to assess the satisfaction of pregnant women with ANC services in Primary Health Care Centers (PHCC) in Karbala province.
Methods: A descriptive study was conducted from January to October 2023 to assess the satisfaction of pregnant women with ANC services in Karbala province. The sample consisted of 400 women randomly selected from four (PHCCs) that provide antenatal daily care services.
Results: The results showed that 87.25% of the pregnant women were satisfied, whereas 12.75% were unsatisfied. The results concluded that there was a significant difference in satisfaction levels between the four PHCCs (p<0.001). Regarding education, pregnant women with college and higher education satisfaction levels to other educational levels (p=0.008). Also, pregnant women in rural residences had a higher satisfaction level in comparison to urban or slum areas (p<0.001).
Conclusion: Most of the pregnant women were satisfied with the ANC services in Karbala province.

Background: Substance use involves psychoactive drug consumption (both legal and illegal), including alcohol, tobacco, heroin, cocaine, and medically restricted drugs. It's a global public health issue, with over 275 million people using substances, with a 22% increase since 2010. In Iraq, substance use is a major concern, especially among males. This study aims to assess the prevalence of substance use among students at the University of Kufa and to identify its associated factors.
Methods: A cross-sectional study was conducted at the University of Kufa from February 15th to March 15th, 2023. Socio-demographic data was collected using a specially designed questionnaire, and 396 participants from four different colleges were randomly selected.
Results: The study enrolled 396 participants with almost equal proportions from each included college. The mean age was 21.4 years. More than half of the participants were females. Substance use of any type was reported by a total of 159 students, giving an overall prevalence of 40.2%. Tobacco use was the most commonly used substance in recent years (19.9%) which was significantly higher among males (P < 0.001). Painkiller use was the second most common (10.1%) with a significantly higher prevalence among females (P = 0.002).
Conclusion: This study concludes that substance use is present among college students mainly tobacco and painkillers. Peer pressure is one of the important factors that influence substance use, especially among the vulnerable age group of 20-24 years.

Background: Autonomic dysfunction frequently affects multiple organs and systems in people with multiple sclerosis (PwMS), and can have a significant negative impact on the quality of life. This study aimed to assess the effect of MS on autonomic nervous system (ANS) functions by electrodiagnostic measures and investigate the relationship of these measures with different demographic and clinical factors such as age, sex, disease duration, type of treatment, the Expanded Disability Severity Scale (EDSS) score, and the Composite Autonomic Symptom Score-31 (COMPASS-31) score.
Methods: forty patients with a definite diagnosis of relapsing-remitting MS and 35 age- and sex-matched controls. The EDSS to assess disease severity and the COMPASS-31 questionnaire to test for the degree of clinical autonomic disability, Ewing’s cardiovascular autonomic tests, and sympathetic skin response (SSR) as electrophysiologic tests for autonomic dysfunction were done.
Results: The heart rate response to normal breathing (HRNB), deep breathing (HRDB), and systolic blood pressure (BP) drop after standing were significantly different in the PwMS relative to the controls. Moreover, PwMS exhibited abnormalities in SSR amplitude and latency. Disease duration was negatively correlated with HRNB, HRDB, and heart rate during the Valsalva maneuver (HTVals). As well as EDSS with HRNB and HRDB and COMPASS-31 with HRDB.
Conclusion: In MS, cardiac autonomic dysfunction affects both the parasympathetic and sympathetic NS. Alongside the sympathetic sudomotor system is also impacted. The length and severity of the disease were correlated with parasympathetic abnormalities.