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Back ground: There are many diagnostic modalities are developed or under development to improve the diagnostic ability and to prognosticate in patients with cervical carcinoma. Cell-free circulating tumor DNA (CFTDNA) is one among them. In this study we are aiming to know the diagnostic ability at diagnosis and at early recurrence of Cell-free circulating tumor DNA (CFTDNA). Also to know its utilization in prognostication and to guide for genomically matched therapy. Methods and Material: A total of 25 patients with locally advanced squamous cell carcinoma of cervical cancer (Stage IB-IIIB) were tested prospectively with 50 gene tumor panel in a NABL accredited laboratory. 4 ml serum was collected, CFTDNA was isolated and they were checked for single nucleotide variants (SNVs) genes/ copy number variants (CNVs) by using NGS and tumor ffpe blocks were again rechecked by NGS or PCR for the same genetic alterations. Results: Average patient age was 51.57yrs(range 30-83yrs) and all patients were squamous cell carcinoma. In 21/25(84%) patients, CFTDNA was detected and sufficient to carry under NGS. Out of 50 genes, around 32 genetic alteration were detected. Mean genetic alteration was 4.08(2-14). In 3/25 (12%) patients are more than 8 genomic alteration detected, 5/25(20%) patients had 5-8 genetic alteration, remaining 13/25(52%) patients had less than 4 genetic alteration. Most common SNVs detected included were, TP53 -11/21 (52.3%) patients, CDKN2A- 10/21(47.6%)patients, PTEN and STK11 -7/21 (33.3%)patients, BRAF and VHL -6/21 (28.5%)patients, EGFR and SMAD4 -4/21(19%), CTNNB1, GNAS, KIT, APC, PIK3CA- 3/21 (14.28%)patients, SMARCB1, SMO, RET, FBXW7, ERBB2, CSF1R, CDH1, AKT1, ATM, EBB4, FGFR3, FLT3, HRAS, JAK3, MET, NOTCH1, NPM1, KRAS, PTPN11- 1 or 2/21(4.7 to 9.5%) patients. On combination of these genetic alterations - EGFR, KIT, PTEN, PIK3CA, TP 53, VHL are the main alterations and combination of these gene (Diagnostic GENETIC MODULE), at least one genetic alteration among combination was found in 100% patients at any point of time. Further follow up data regarding correlation of these genetic alteration with prognosis will follows. Conclusions: CfTDNA can be easily demonstrable and can be used as non- invasive diagnostic tool in cervical carcinoma. Further, to create proper genetic module as diagnostic and prognostic marker- continuation of the study in large scale with different race, ethnicity and country required. [ABSTRACT FROM AUTHOR]

The use of metformin in diabetic patients causes vitamin B12 deficiency, but there is not enough evidence about the existence of a correlation between different doses of metformin and vit B12 deficiency. Therefore, this study was conducted with the aim of investigating the correlation between different doses of metformin and vitamin B12 deficiency. This cross-sectional study was conducted on 200 patients with type 2 diabetes referred to the diabetes clinic of the central hospital of Sulaimani city in 2022. Demographic data were collected by a questionnaire and the serum level of Vit B12 data was by testing the blood samples. Data analysis was done using SPSS ver.23 and descriptive tests, chi-square, Pearson correlation and logistic regression. The results showed that 24% of patients had vitamin B12 deficiency. 45 (93.8%) patients with vitamin B12 deficiency have taken metformin. The mean vitamin B12, mean metformin consumption per year and metformin dose were significantly different between the two groups. Based on the regression model, it was shown that there was no significant relationship between the serum level of vitamin B12 and the duration of metformin medication (P=0.134). And the relationship between gender, occupation, alcohol and metformin dose (mg) was significant, so these factors have the ability to predict the serum level of vitamin B12. The results showed that vitamin B12 deficiency is common in diabetic patients who take metformin, and the vitamin deficiency will increase with the increase in the dosage.