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Objectives: Cancer in a family member can be a major source of psychological disorders, especially for the parents of children diagnosed with cancer. This study aimed to determine the prevalence and levels of depression among parents of children with cancer in Basrah, Iraq. Methods: This cross-sectional study was conducted between November 2014 and April 2015 at the Specialist Paediatric Hospital in Basrah City, Iraq. One parent each of 384 children with cancer admitted to the hospital for treatment or follow-up during the study period were invited to participate in the study. Age, gender, years of education, occupation, monthly income, place of residence and the overall number of children in a family were recorded. The Center for Epidemiologic Studies Depression Scale was used to identify depression and assess levels of depression. Results: A total of 336 parents participated in the study (response rate: 87.5%). Of these, 70.5% were depressed, 54.1% of which had major depression. Depression was significantly more common (77.2% versus 57.1%) and more severe (60.7% versus 41.1%) among mothers compared to fathers (P = 0.001). Parents with fewer years of education were more likely to be depressed; this association was significant for mothers but not fathers (P = 0.001 and 0.814, respectively). Depression was significantly inversely associated with monthly income (P = 0.001). Conclusion: The prevalence of depression among the parents of children with cancer was high. Depression was significantly more severe among mothers compared to fathers and among mothers who were less educated. Income also had a significant association with levels of depression among parents.

Objectives: Empathy is a crucial attribute within the physician-patient relationship. This study aimed to evaluate the empathy levels of students in the College of Medicine at Hawler Medical University (HMU) in Erbil city, Iraq. Methods: This cross-sectional study took place between January and May 2015 and included all medical undergraduates enrolled at HMU (n = 989). The validated self-administered English language version of the Jefferson Scale of Physician Empathy-Student Version (JSPE-SV) was used to measure empathy levels. Students reported their conformity to each statement of the 20-item questionnaire on a 7-point Likert scale. Levels of empathy were considered directly relative to their final score. Results: A total of 927 students completed the questionnaire (response rate: 93.7%). The male-to-female ratio was 0.72:1 and the mean age was 21.3 ± 1.4 years. The mean empathy score was 101.9 ± 19.2. Female students had significantly higher empathy (P = 0.023) and more frequently chose people-oriented specialties (P = 0.001) than males. First-year students reported the highest mean score (112.9 ± 20.1) while fourth-year students had the lowest (92.7 ± 16.0). There was a significant decline in mean scores between first- and second-year male students (P = 0.020) and first- and fourth-year male students (P = 0.050). Students who chose people-oriented specialties had significantly higher scores than those who chose technology-oriented specialties (P = 0.002). Conclusion: The studied cohort of HMU students demonstrated low empathy levels. As such, the inclusion of empathy instruction in medical school curricula is recommended to promote professionalism and patient welfare.

Objectives: Behçet’s disease (BD) is an immune-mediated small vessel systemic vasculitis. Human β-defensins are antimicrobial peptides associated with many inflammatory diseases and are encoded by the β-defensin family of multiple-copy genes. However, their role in BD necessitates further investigation. The aim of the present study was to investigate the possible association of BD in its various clinical forms with defensin β-4(DEFB4) genomic copy numbers. Methods: This case-control study was conducted from January to September 2011 and included 50 control subjects and 27 unrelated Iraqi BD patients registered at Baghdad Teaching Hospital, Bagdad, Iraq. Copy numbers of the DEFB4 gene were determined using the comparative cycle threshold method by duplex real-time polymerase chain reaction technology at the Department of Dermatology of Jena University Hospital, Jena, Germany. Results: DEFB4 genomic copy numbers were significantly higher in the BD group compared to the control group (P = 0.010). However, no statistically significant association was found between copy numbers and clinical variables within the BD group. Conclusion: The DEFB4 copy number polymorphism may be associated with BD; however, it is not associated with different clinical manifestations of the disease.

Objectives: This study aimed to examine the correlation between carotid artery intima-media thickness (IMT) and luminal diameter (LD) with body mass index (BMI) and other cardiovascular risk factors. Methods: This observational cross-sectional study took place between June 2013 and March 2014 in the Radiology Department of Rizgary Teaching Hospital in Erbil, Iraq. Non-randomly selected subjects ≥20 years old (n = 140) were divided into BMI groups and evaluated for the following cardiovascular risk factors: gender, age, hypertension (HTN), diabetes (DM), smoking, alcohol consumption, blood pressure, serum total cholesterol and triglyceride (TG) levels. IMT and LD of the extracranial carotid arteries were measured by B-mode ultrasonography. Results: The mean IMT was 0.8 ± 0.3 mm, ranging from a total mean of 0.7 mm in the normal BMI group to 1.0 mm in the extremely obese group. A significant correlation was found between IMT and BMI (P = 0.04), but not between BMI and LD (P = 0.3). No significant difference in mean IMT or LD was seen between genders. Significant correlations were found between IMT and age, HTN, DM, high serum cholesterol and TG levels (P

Objectives: This study aimed to assess risky driving behaviours among medical students in Erbil, Iraq, and to explore the relationship between risky driving behaviours and perceptions of risky driving. Methods: This self-administered questionnaire-based survey was conducted from January to May 2014 among a random sample of 400 medical students at Hawler Medical University in Erbil. The questionnaire was designed to assess the frequency of engagement in 21 risky driving behaviours, the perceived risk of each behaviour and the preference for each behaviour as ranked on a 5-point scale. Results: A total of 386 students responded to the survey (response rate: 96.5%). Of these, 211 reported that they currently drove a vehicle (54.7%). Drivers most frequently engaged in the following behaviours: playing loud music (35.9%), speeding (30.4%), allowing front seat passengers to not wear seat belts (27.9%) and using mobile phones (27.7%). Least frequent driving behaviours included not stopping at a red light (3.9%), driving while sleepy (4.4%), driving after a mild to moderate intake of alcohol (4.5%) and drunk driving (6.4%). Mean risky driving behaviour scores were significantly higher among males (P 20-year-olds (P = 0.028). There was a significant positive relationship between the preference for risky behaviours and risky driving behaviours (beta = 0.44; P

Objectives: The aim of this study was to assess the distribution of chronotypes in a sample of Iraqi Kurdish medical students. Methods: A descriptive cross-sectional study was conducted at the Hawler Medical University College of Medicine in Erbil City, Iraq, between 1st January and 31stMarch 2013. A total of 580 students were given the reduced version of the Horne and Ostberg Morningness-Eveningness Questionnaire (MEQr), a close-ended self-administered questionnaire. Results: Of the 580 students, 130 (22.4%) were male and 450 (77.6%) were female. The mean age ± standard deviation was 20.3 ± 1.45 years, with a range of 17‒24 years. Most of the students (52.6%) were in the intermediate class, followed by morning type (24.1%) and evening type (23.3%). Significant gender differences were detected in the proportion of morning, intermediate and evening types (P

Objectives: An episiotomy is one of the most common obstetric surgical procedures and is performed mainly by midwives. The decision to perform an episiotomy depends on related clinical factors. This study aimed to find out midwives’ reasons for performing episiotomies and to identify the relationship between these reasons and the demographic characteristics of the midwives. Methods: This cross-sectional study was conducted between 1st July and 30th September 2013 in three governmental maternity teaching hospitals in the three main cities of the Kurdistan Region of Iraq. All of the midwives who had worked in the delivery rooms of these hospitals for at least one year were invited to participate in the study (n = 53). Data were collected through interviews with midwives as well as via a questionnaire constructed for the purpose of the study. The questionnaire sought to determine: midwives’ demographic characteristics; type of episiotomy performed; authority of the decision to perform the procedure, and reasons for performing episiotomies. Results: The main clinical reasons reported by midwives for performing an episiotomy were: macrosomia/large fetus (38, 71.7%), breech delivery (31, 58.5%), shoulder dystocia (29, 54.7%), anticipated perineal tear (27, 50.9%) and fetal distress (27, 50.9%). There was a significant association between the frequency of these reasons and midwives’ total experience in delivery rooms as well as their levels of education. Conclusion: Most of the reasons given by the midwives for performing episiotomies were not evidencebased. Age, years of experience, specialties and level of education also had an effect on midwives’ reasons for performing episiotomies.

Objectives: This study aimed to determine the knowledge and attitudes of primary school managers regarding epilepsy among school children in Erbil City, Iraq. Methods: A cross-sectional study was conducted in primary schools between 18 June and 18 August 2013. A total of 80 primary school managers were selected to answer a questionnaire covering three domains: socio-demographical characteristics, knowledge of epilepsy and attitudes towards epilepsy. Results: More than half of the participants (55%) had spent less than 10 years in school administration. More than one-third (37.5%) of the participants believed that epilepsy was an infectious disease, and over half of the respondents (53.75%) stated that epilepsy cannot be treated or prevented. Conclusion: Although the respondents’ attitudes towards pupils with epilepsy were generally positive, their knowledge of epilepsy was imperfect; thus, an epilepsy education campaign is required. This should focus on the causes of epilepsy and its management.

Objectives: The most common manifestation of pelvic floor dysfunction is urinary incontinence (UI) which affects 15–50% of adult women depending on the age and risk factors of the population studied. The aim of this study was to determine the probable risk factors associated with UI; the characteristics of women with UI; describe the types of UI, and determine its prevalence. Methods: A cross-sectional study was conducted between February and August 2011, in the Maternity Teaching Hospital of the Erbil Governorate, Kurdistan Region, northern Iraq. It included 1,107 women who were accompanying patients admitted to the hospital. A questionnaire designed by the researchers was used for data collection. A chi-square test was used to test the significance of the association between UI and different risk factors. Binary logistic regression was used, considering UI as the dependent variable. Results: The overall prevalence of UI was 51.7%. The prevalence of stress, urgency, and mixed UI was 5.4%, 13.3% and 33%, respectively. There was a significant positive association between UI and menopause, multiparity, diabetes mellitus (DM), chronic cough, constipation, and a history of gynaecological surgery, while a significant negative association was detected between UI and a history of delivery by both vaginal delivery and Caesarean section. Conclusion: A high prevalence of UI was detected in the studied sample, and the most probable risk factors were multiparity, menopausal status, constipation, chronic cough, and DM.

Objective: The objective of this study was to assess the quality of life (QOL) in people with epilepsy and to evaluate various factors affecting their QOL. Methods: A total of 116 patients with epilepsy and a control group of 116 apparently healthy persons were included in this case-control study which was conducted at the neurology outpatient clinic of Basrah General Hospital, Iraq. An interview was performed with the use of a special questionnaire, which included data pertaining to socio-demographic characteristics, and clinical characteristics (for patients with epilepsy only). The QOL was assessed with the use of a Short Form (SF-36) health survey. Results: Epileptic patients showed lower overall QOL scores as compared to controls. In the univariate analysis, patients who were older, from rural areas, and with low education and income levels had low er overall QOL scores. Frequent seizures as well as increased duration of epilepsy were also significant factors associated with reduction in QOL scores. In the multivariate regression analysis, age, educational level, income and frequency of seizures were significant determinants of QOL. Conclusion: Certain socio-demographic factors as well as clinical factors were crucial in determining QOL in epilepsy patients. Recognition of these factors will lead health professionals to develop different strategies to improve the QOL of those patients.

Objectives: This study aimed to investigate the presence of oxidative stress and inflammation in ischaemic stroke patients by measuring malondialdehyde (MDA), total antioxidant status (TAS), and highly-sensitivity C-reactive protein (hsCRP) in the early post-ischaemic period, and to determine the role of Ginkgo biloba therapy in correcting the markers of oxidative stress and inflammation. Methods: This study was conducted at Ibn Seena Hospital, Mosul City, Iraq and included 31 cerebrovascular accident (CVA) patients and 30 healthy controls. Ischaemic stroke patients were divided into two groups: group I (n = 15) received conventional therapy; group II (n = 16) received conventional therapy with G. biloba (1500 mg/day) for 30 days. Blood samples were obtained from patients and controls before treatment and assays done of serum levels of MDA, TAS, and hsCRP. For CVA patients, a post-treatment blood sample was taken and the same parameters reassessed. Results: Compared with the controls, patients’ serum levels of MDA, and hsCRP were significantly higher (P ≤0.001) and TAS significantly lower. Group I and II patients reported a significant reduction in serum levels of MDA and hsCRP and a significant increase in serum levels of TAS, in comparison with pre-treatment levels. There was no significant difference (P = 0.19) in serum MDA levels between groups I and II, whereas, serum TAS levels were significantly higher (P ≤0.01) and hsCRP significantly lower (P ≤0.01) in group II. Conclusion: Acute stroke is associated with oxidative stress and inflammatory response in the early period. G. biloba plays a potential role in reducing oxidative damage and inflammatory response.

The standard treatment for hydrocephalus is either a ventriculoperitoneal or a ventriculo-atrial shunt. However, these conventional shunts may be associated with considerable complications and high revision rates which make these familiar shunts inappropriate for a certain subset of patients. A rare complication is reported associated with an unusual procedure in a 42-year-old woman who had had a ventriculovesical shunt for four years. She presented with recurrent urinary tract infections, haematuria and urge incontinence, and was discovered to have a large vesical stone over the vesical end of the shunt. She was treated with open suprapubic cystolithotomy and the redirection of the shunt to the peritoneal cavity. The patient was followed up for 12 months postoperatively and remained free of any urinary tract symptoms.