Kirkuk Journal of Medical Sciences

Introduction: Colorectal cancer (CRC) is the 3rd common malignant disease. Prediction of its risk depending on the individuals' genetic makeup is an essential step for screening and personalized medicine. Different studies implicated MicroRNAs (miRNAs) as potential predictors for CRC risk and prognosis with different findings in various demographic settings. To the present knowledge, no similar work was conducted, so far, to study these relations in our community. 
 Aim: To determine the prevalence of single nucleotide polymorphisms (SNPs) in genes coding for the miRNAs: mir-146a, mir-423 and mir-196a2 in patients with sporadic CRC. The association of these SNPs with increased CRC risk or advanced tumor stage or grade at diagnosis was also explored. 
Materials and Methods: In this case-control study, we enrolled 150 patient subjects with sporadic CRC and 140 sex and age matched cancer free control subjects. Genomic DNA was extracted from venous blood samples and screened for the presence of SNPs in mir146, mir-423 and mir-1962a genes using High Resolution Melting Analysis (HRMA) method, and then results were confirmed by direct sequencing. The SPSS statistical software (version 17) was used to test for the association between the presence of the SNP and the risk of CRC, its stage and grade. 
 Results: The frequency of the CG genotype of mir-1946a was significantly higher (P < 0.01) in the patient subjects (44%) compared to the control ones (30.7%). This genotype was associated with increased risk of CRC (OR= 1.741, 95 % CI= 1.050 -2.886, P=0.031), late stage cancer (III and V of TNM system, OR=3.562, 95%CI= 1.578-8.039, P=0.002) and poor tumour differentiation (OR=5.267, 95%CI= 1.105- 25.109, P=0.037). Individuals carrying CC genotype showed increased CRC risk compared to the common GG genotype (control: 10%, patients: 15.3%, OR= 2.235, 95 % CI= 1.064- 4.694, P=0.004). Additionally it was associated with late stage tumor (OR= 8.522, 95 % CI= 2.899- 25.049, P= 0.0001) but not tumor grade (OR= 2.950, 95 % CI= 0.389-22.339, P= 0.295). None of the genotypes of mir-423 and mir-196a2 showed any association with neither increased risk of CRC nor late stage or poor differentiation. 
 Conclusion: Various SNPs of miRNAs showed different correlations with CRC and its pathological characteristics which reflect a complex interaction between the genes and the cellular milieu- that is influenced by the demographic qualities of the studied population. Mir-146 can represent a potential target for screening of CRC and a prognostic marker. Further evaluation in a large scale studies will give a better insight on the effects of SNPs on CRC risk and prognosis. 

Background: Migraine is frequently associated with psychiatric disorders and comorbidity with psychiatric disorders raises the global burden of migraine. Objectives: To detect psychiatric comorbidity in patients suffering from migraine. Patients and Methods: A descriptive study involving 192 patients with migraine who fulfilled the International Classification of Headache Disorders-2 2004 (ICHD-2). Diagnostic and Statistical Manual of mental disorders, 4th Text Revised (DSM-IVTR) was used to classify the psychiatric disorders, among them. All patients were interviewed by means of the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) for identification of the content of obsessive compulsive symptoms. Results: The majority of the migraineurs were with throbbing unilateral headache (79.1%), (31.3%) of the patients were with one per month in frequency of attack and (41.7%) of them had family history of migraine. The provoking factors of the attack were reported in (37.5%) of the migrainerurs.(75%) of the patients had psychiatric disorders. The commonest psychiatric disorders were generalized anxiety disorder (31.25%) followed by depressive disorder (19.8%). 
Conclusion :(75%) of patients with migraine of the present study had psychiatric disorders. 

Introduction: Thalassemia Major is one of the commonest causes of hereditary anemia in Iraq. Patients usually require frequent blood transfusion. This study tried to estimate the problem of transfusion-related infections among β-thalassemia major patients in Kirkuk governorate-Iraq.
Patients and Methods: The study involved 254 multi-transfused thalassemia major patients attending the Thalassemia Center at Kirkuk governorate over twoyears periodstarting from January 2010 to January 2012. Blood samples were tested for HBsAg, anti HCV antibodies, and HIV antibody using an enzyme-linked immunosorbent assay. A control group of 150 Thalassemia minor with nearly matched age and sex to thalassemia major patients was included.
Results: Anti-HCV antibody was positive in 85 out of 254 thalassemia major patients (33.5%), while HBsAg was positive in only one out of 254 patients (0.4%). HIV infection was not found in any thalassemia major patients. The rate of positive anti-HCV antibodies was significantly higher in comparison with the control group (P value <0.000) while it was not significant for HBsAg (P value=0.9). Age categorization for thalassemia major patients with positive HCV test shows that more than three quarters of them are above 10 years old.
Conclusion:HCV is the current major problem in multi-transfused children with thalassemia major and more careful pre-transfusion screening of blood for anti-HCV must be introduced in blood bank centers.

Background: Diabetes mellitus is a major cause of morbidity and mortality. In the Arab region, the overall prevalence of DM in the Kingdom of Saudi Arabia is (23.7%) among people with age between 30 and 70 years. The prevalence of diabetes in the United Arab Emirates, Bahrain, and Kuwait were (20.1%), (14.9%) and (12.8%), respectively. Several large clinical trials have demonstrated that tight blood glucose control correlates with a reduction in the microvascular complications of diabetes. The American Diabetes Association (ADA) has designated HbA1c level of ≤ (7%) as a goal of optimal blood glucose control, and the American Association of Clinical Endocrinologist has further recommended HbA1c level of ≤ (6.5%). Despite the evidence from large randomized controlled trials establishing the benefit of intensive diabetes management in reducing microvascular and macrovascular complications, high proportion of patients remain poorly controlled. Poor and inadequate glycemic control among patients with type 2 diabetes constitutes a major public health problem and major risk factor for the development of diabetes complications. Glycemic control remains the major therapeutic objective for prevention of target organ damage and other complications arising from diabetes. 
Aim of the study: To estimate the proportion of the patients with poor glycemic control and determine factors associated with poor glycemic control among patients with type 2 diabetes in Kirkuk city. 
Materials and Methods:A cross-sectional study conducted on 500 patients with type 2 DM, were randomly selected who were attended outpatient clinic in Azadi teaching hospital or private clinic over a period of 12month in 2014. A pre-structured questionnaire sought information about sociodemographic, clinical characteristics, self-care management behaviors, medication adherence, and attitude towards diabetes. Weight, and height were measured. Available last readings of hemoglobin A1c(HbA1c), were abstracted from patients' records. Poor glycemic control was defined as HbA1c ˃ (7%). Results:Of the total 500 patients, (74.2%) had HbA1c ˃ (7%). In the multivariate analysis, increased duration of diabetes,increased Body Mass Index(BMI),low education level,hypertension,type of treatment, non-adherence to diabetes self- care management behavior,poor medication adherence, were significantly associated with increased odds of poor glycemic control.(pvalue<0.005). 
Conclusions and recommendations: Results indicate that duration of diabetes, age, obesity and morbidity are risk factors for poor glycemic control. Patients with these characteristics may need additional therapies and targeted interventions to improve glycemic control. Regular checking of RBS, adherence to treatment, 30 minute exercise and followinghealthy diet are important attitude of patients towards DM for good glycemic control. An educational program that emphasizes lifestyle modification with importance of adherence totreatment regimen, regular exercise and dietary regimen would be of great benefit in glycemic control. 

Background: Human papillomavirus (HPV) is a widely prevalent sexually transmitted virus. Because HPV is the causative agent of cervical cancer, knowledge of the epidemiology of HPV is critical. 
 Objective: To study the prevalence of high-risk human papillomavirus (HR-HPV) in cases of abnormal cervical cytology in Kirkuk city. 
Methods: In this prospective cross-sectional study, we collected 55 Pap smears samples from women attending Azadi Teaching Hospital and private clinics in Kirkuk over the period from 2012 to 2015. Two specimens were collected from each patient; one for a Pap smear study and the other for PCR assay to detect HPV. 
Results: HR-HPV was positive in 58.2% of patients. The HR-HPV positivity was highest in the age group 21-30 years (90.9%) and lowest at the age group ≥ 51 years (25%). The highest positive rate was in the group married at age 21-25 years (76.2%) and this rate decreased with progression of the marriage age until reaching (20%) in the age group married at ≥31 years. The largest group was para 3-4 (58.2%), followed by para 1-2 and nulliparous (29.1% and 9.1%, respectively). The highest positive rate was in the group para 3-4 (65.6%). Majority of the patients (67.3%) had ASC-US on cytological diagnosis, while LSIL and HSIL accounting for (18.2%) and (14.5%) respectively. The prevalence of HR-HPV infection rate increases with increasing the grade of abnormality reaching to (80%) and (87.5%) in cases of LSIL and HSIL respectively, while the positivity for ASCUS was ranking (45.9%), which was statistically significant (P-value=0.029), although the positivity in cases of HSIL was more than in the cases of LSIL the difference was statistically not significant (P-value =0.671). 
Conclusion: It is worthy to add HR-HPV screen by PCR to Pap test to increase the sensitivity of primary screening for cervical cancer. Key words: Abnormal Pap smears, HPV

Background: Helicobacter pylori are thought to play an important role in the pathogenesis of activegastritis and other upper mucosal lesions in chronic hemodialysis patient which thoughtto result in dyspeptic symptoms. 
 Aim:The aim of the study is to determine the prevalence of Helicobacter pylori infection in patient on maintenance hemodialysis and to assess the probable association of serum lipid profile and serum magnesium with H. pylori infection in these patients. 
Material &Methods: This cross-sectional study was conducted on patients with end stage renal disease who were undergoing maintenance hemodialysis treatment.were enrolled in the present studya total number of 42 hemodialysis patients (24 male and 18 female), of the total number; 10 were diabetic and 32 were non diabetic. Demographic data including age, gender, duration of hemodialysis and clinical data including diabetes mellitus, upper gastrointestinal symptoms and laboratory measurements were obtained from related questionnaires. Venous blood samples were collected for biochemical analysis of the following markers: serum magnesium, total cholesterol, triglyceride; high density lipoprotein-cholesterol, low density lipoprotein-cholesterol and very low density lipoprotein-cholesterol. 
Result & Conclusion: We conclude that there was no significant correlation between gender, age, duration of hemodialysis, DM, serum triglyceride, VLDL-C and magnesium and H. pylori infection in these patients. 

Background: Dehydration resulting from diarrhea is a significant cause of death of young children in developing countries. Oral rehydration solution (ORS) is useful to replace fluid and electrolyte loss. 
 Objective: The main objective is to assess the knowledge, attitude and practice of mothers towards the use of oral rehydration solution in the treatment of acute diarrhea in children. 
Patients and Methods: This observational descriptive study was conducted at the pediatric medical emergency department of the Children‘s hospital and the institute of child health in Sulaimani city for a period of eight months from July 2012 till March 2013. The criteria of inclusion were mothers of children with diarrhea. A total of 200 mothers fulfilling the inclusion criteria were enrolled over the study period. Mothers were interviewed and information collected. A pre designed questionnaire was filled for each case by the investigator which included a detailed history highlighting their demographic data, presenting complaints , treatment given at home, mothers knowledge about ORS and drugs, maternal education, water sources, and socioeconomic history was taken and recorded carefully. All the data entered in SPSS and results were analyzed in percentages. 
Results: A total 200 mothers who visited the Pediatric Teaching Hospital in Sulaimani were interviewed. The median age of children group was 2 years, and minimum was (4 months)and maximum age was 8 years, of these 25(12.5%) were below 1 year, and 160 cases (80%) were between 1 to 5 years, and 15 cases (7.5%) more than 5 years. The most frequent age group was between 1 to 5 years, male were 101 (50.5%) and female were 99 female (49.5%), 58(29%) of mothers education were illiterate, and 105 (52.5%) of mothers education was low, and 37(18.5%) of mothers education was high. Among all the patients 172(86%) were from Sulaimani and 28(14%) from outside Sulaimani. Among all the patients the source of water used was well 103(51.5%), and 63(31.5%) was piped, and 34(17%) was tanks. Out of 200 mothers 199 (99.5%) heard about ORS and 1(0.5%) did not hear about it. Of these mothers 183(91.5%) used ORS. and 17(8.5%) did not use it. Among the mothers that usedORS, 7(3.5%) used it by themselves and 42(21%) were advised by family member and 85(42.5%) were advised by physician and 49(24.5%) were advised by health worker. The way of giving ORS wasby cup and spoonin 139(69.5%), and 44(22%) gaveORS by bottle. Of them 109(54.5%) amount of ORS given adequate amount and 74(37%) gave inadequately. And of them 107(53.5%) prepared ORS correctly and 76(38%) prepared the solution incorrectly. Among all mothers; 172(86%) used drugs and 28(14%) did not use drugs. Among those who use drugs 21(10.5%) used it by themselves and 151(75.5%) got advise by family physician. 
Conclusion: Although most of the mothers knew about ORS and used it at times of need, many had inadequate knowledge on the importance and appropriate use of ORS. 

Background: Major depression is twice more common in women than in men and frequently clusters during the childbearing years. Depression is one of the most common complications in pregnancy. Displacement with the whole family correlated with: heavier depressive disorder in general, deeper depressive mood, higher suicidality rate and poor sense of efficacy. 
Objectives: The aim of the study is to determine the frequency of depressive disorder among pregnant women of displaced familises. 
Patients and Methods: This study consists of 88 pregnant women of any gestational age, of displaced families from four governorates which are Diyala, Salahuddin, Nineveh and Al-Anbar and from Al-Hawija District which is a district of the Kirkuk governorate, where armed groups have taken control of all these areas, compared with 88 control pregnant of indigenous families, matched for sociodemographic, age, parity, gestational age and educational background. The clients selected randomly from primary health care centers in Kirkuk city. The study was conducted during the period between, October 2014 and July 2015. The Edinburgh postnatal depression scale (EPDS) was used to detect prenatal depression. 
Results: The highest frequency of depressive symptoms with significant difference (pvalue<0.001) were among pregnant women of displaced families (48.86%) than pregnant women of indigenous families (22.7%). 
Conclusion: According to the findings of this study, about (48.86%) of pregnant women of displaced families experience depressive disorder during antenatal period. Given the potential impact of antenatal mental disturbances on maternal and infant outcomes.