About Journal

Annals of the College of Medicine Mosul (ACMM) is a global, scientific and open access journal. Publishing under the license of Creative Commons Attribution 4.0 International (CC-BY), this journal is published biannually by the College of Medicine, University of Mosul, Iraq since January 1966. We are using iThenticate® to prevent plagiarism and to ensure the originality of our submitted manuscripts. A double-blind peer reviewing system is also used to assure the quality of publication. This Journal publishes original articles, review papers and case reports in the field of medical sciences....
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Journal Information

Publisher: Mosul University

Email:  annalsmosul@uomosul.edu.iq

Editor-in-chief: Professor Dr. Imad A-J Thanoon

Managing Editor: Professor Dr. Khalid N. M. Al-Kheroo

Print ISSN: 0027-1446

Online ISSN: 2309-6217

The Serum Level of Proinflammatory TNF-alpha Cytokine in Cyanotic and Acyanotic Congenital Heart Diseases in Mosul City

Asmaa Zeki Sheetawi; Firas Al-Tae; Ahmed Abdullah Ahmed; Mohammed Essmat Ahmed

Annals of the College of Medicine, Mosul, 2022, Volume 44, Issue 1, Pages 1-9
DOI: 10.33899/mmed.2022.133834.1146

Background:Tumor necrosis factor – alpha (TNF-α)  has been proposed to play an important role  in the etiopathology of congenital heart diseases (CHD) worldwide. However, no previous  study about the role of TNF-α in the pathogenesis of CHDs in Mosul city / Iraq has been reported .
Objectives:1) To evaluate the serum levels of TNF-α cytokine in cyanotic and a cyanotic congenital heart diseases (CHDs and to compare the results with control healthy children in Mosul city 2) To find any association between the level of this pro-inflammatory marker  and other  demographic parameters such as age and gender  3) To test the diagnostic validity of this cytokine for the diagnosis of CHD at different cut-off values.
Patients, materials and methods:A case-control study was conducted in the Department of Microbiology / College of Medicine / University of Mosul over two years and 3 months from April 2019 to July 2021. Twenty nine (29) child with a cyanotic congenital heart diseases and seventeen  (17) child with cyanotic heart diseases were included. Another Thirty one (31) healthy child were also included as a controls. . All patients were collected from Al-Khansa teaching hospital in Mosul city. The serum TNF-α concentration was measured in all participants by using ELISA.
Results: Mean age of children with acyanotic heart diseases (2.7 ± 2.9 years) did not significantly differ from that of cyanotics (2.1 ± 1.9) or healthy controls (3.1 ± 1.7) ,  (P>0.05). The average TNF-α level in acyanotic heart diseases was 321.18 ± 325.71 ng/l compared to 120.63 ± 84.33 ng/l in cyanotics and 119.01 ± 139.71 in healthy controls. TNF- α was significantly elevated in acyanotic heart diseases in comparison to healthy children (P = 0.003). No significant difference was noted between acyaotics and cyanotic heart diseases in regards to TNF- α concentrations (P = 0.07). No age or gender effects were noted on TNF-α concentration in both acyanotic and cyanotic heart diseases (P>0.05). At the best cut-off  value of 124 ng/l  TNF-α had a specificity of  90.32% , sensitivity of 48.28% and accuracy rate of 39% as indicated by AUC-ROC curve .
Conclusion: The current study showed  higher TNF- α in acyanotic (but not in cyanotic)  heart diseases compared to healthy controls. TNF-α had poor diagnostic utility to discriminate between CHD and healthy individuals and  therefore not recommended as valuable biological marker for the diagnosis of CHD.

Assessment of neuropathological findings and medical treatment of Parkinson disease: A review of literature

Rand Abdulateef Abdullah

Annals of the College of Medicine, Mosul, 2022, Volume 44, Issue 1, Pages 10-13
DOI: 10.33899/mmed.2022.133096.1138

ABSTRACT
Background: Parkinson disease is a long-lasting and progressive motor disorder which is identified by three critical motor symptoms which are bradykinesia, rigidity and tremor. 
Aim of the study: To assess the histopathological changes in the brain of Parkinson disease’s patients and the regimes used for treatment.
Conclusion: Several histopathological changes in the neurons in brain of patients with Parkinson disease are α-synucleinopathies, lewy bodies, damage of synaptic neurons, and hyperactivation of microglial cell. Many regimes were used in the treatment of Parkinson disease particularly to alleviate motor symptoms. The golden goal is they should focus on preserving the synaptic neurons before they get damaged. 

The Quality of Life in Patients with Chronic Urticaria

sayf Zuhair yousif; Pers Yousif Yaaqub

Annals of the College of Medicine, Mosul, 2022, Volume 44, Issue 1, Pages 14-21
DOI: 10.33899/mmed.2022.133449.1142

Background: Chronic skin urticaria (CU) is a type of skin illness that is characterized by pruritus, angioedema, or wheals for longer than six weeks. It has a major impact on patients quality of life.
Study aim: To identify the impact of chronic skin urticaria on the patients quality of life.
Study setting: Erbil Dermatology Teaching Center.
Study sample: One hundred and three patients, above 16 years of both sexes who were having chronic urticaria were included in the study sample.
Study design: A case series research was used in this study.
Study period: The study was conducted from the first of March 2021 to the end of January 2022.   
Data collection: All patients were interviewed by the researcher using a specially designed questionnaire sheet and the needed information was filled by the researcher. These information include age, gender, education, occupations, residence, marital status, and skin types in addition to the DLQI questionnaire which was downloaded from Cardiff University website. There are 10 questions or items in the DLQI questionnaire, which are further subdivided into six subdomains of life.
Result: The score mean of DLQI was (9.3±4.37); 24 (23.3%) CU patients have a low effect, 39 (37.9%) with moderate effect and 40 (38.8%) patients have high effects. The mean DLQI score was higher among self employed patients and lower among retired patients and higher among CU patients were visiting more than two doctors and among patients who receiving treatment.
Conclusion: Chronic skin urticaria has commonly moderate effect on the patients’ quality of life and affected by occupation, severity of disease, and treatment.
Recommendations: This study recommended that the physician should adopt an integral plan in management of CU taking in consideration mental and social wellbeing of patients. Additionally, more national researches on the QoL of CU patients must be maintained.

Knowledge, Attitude and Practice of Nursing Staff toward Working at Emergency Unit

Rawaa Y Al-Rawee; Mohammed Faris Abdulghani; Ashraf Abdul-Rzzaq Mohammed AlSalih; Emad Hussain Mohammed; Bashar Abdul-Ghani Tawfeeq

Annals of the College of Medicine, Mosul, 2022, Volume 44, Issue 1, Pages 22-28
DOI: 10.33899/mmed.2021.131807.1118

Highlights : Emergency department need essentisl careful assessment as it deal with acute, urgent health situations so should have high skilled well trained staff.
Aims : Study involves assessing the emergency nurse's knowledge, attitude, and practice regarding the practical obstacles that impede nurses from working in the Emergency Departement and taking necessary measures to resolve them.
Material and Method : The current study was a cross-sectional study conducted upon (400) nurses.  Questionnaire form to assess nurses' knowledge, attitude, and practice in Mosul's teaching hospitals / Iraq related to working in the Emergency Departement. The acceptability score was established at 61.2 mark / 85%; less than this limit was considered unsatisfied as degree 85% (61.2 marks) was considered as acceptable. The data were surveyed applying the (SPSS version 25) descriptive and inferential statistics.
Result : The study showed that there were statistically significant differences in the level of knowledge. The mean ± S.D of the knowledge was (33.15 ± 11) .  The mean of practice was (23±9). The majority of nurses was in the accepted level 196 (49%) and statistically highly significant P-value was 0.01. Attitude answering questions show high agreement on questions (Number of the good training staff is essential in the emergency department? , and Handwashing is necessary before preparation and administration? ) with answers  percentage are [ 96.25% and 93.75% respectively].  The difference between nurses was highly significant  p-value was 0.001.
Conclusion : This study concluded that the awareness or knowledge of nurses is satisfactory with  the level of attitude and practice with respect to Emergency Department

Detection of the analgesic effect of ceftriaxone in chicks

Inaam Kadhim Othman; Muna HI Alzubadaidy

Annals of the College of Medicine, Mosul, 2022, Volume 44, Issue 1, Pages 29-36
DOI: 10.33899/mmed.2022.133399.1141

Objective: To evaluate the analgesic effect of ceftriaxone when administered alone or in combination with paracetamol and diclofenac sodium in boiler chicks. 
Methods: This study was conducted in Department of Physiology, Biochemistry and Pharmacology, College of Veterinary Medicine  ,University of Mosul , Mosul, Iraq, from November 2021 to February 2022. It was determined using formaldehyde test and the median analgesic effective dose (ED50) for ceftriaxone, paracetamol and diclofenac sodium depending on the method of Dixon. An isobolographic ratio of 0.5:0.5 of the ED50 for each drug at the analgesic level was calculated.
Results: The administration of ceftriaxone at doses of (523, 1064 and 1330mg/kg) intramuscularly was led to a significant (p value=0.02) and clear analgesic effect through the disappearance of the right foot lift caused by the injection of formaldehyde, in aadition to significant decrease (p value=0.01) in foot thickness at dose of 1330 mg/kg . Analgesic ED50 of ceftriaxone , paracetamol and diclofenac sodium by Dixon method were 42.6 ,32.6 and 6.26 mg /kg respectively. The intramuscular administrations of drugs in a ratio of 0.5:0.5 result in a significant decrease (p value<0.001) in ED50 values ​ to 6.77, 5.34 and 0.99 mg/kg respectively. The application of the isobolographic analysis revealed the type of interaction between ceftriaxone/paracetamol, ceftriaxone /diclofenac sodium, and the interaction was synergistic when they were given at the ratio 0.5:0.5.
Conclusion: The results showed that ceftriaxone exerts its analgesic effect in chicks by reducing the mechanical hyperalgesia resulting from formaldehyde injection in the planter of the right foot and potentiated the analgesic effects of paracetamol and diclofenac sodium through the synergistic interaction.
 
Objective: To evaluate the analgesic effect of ceftriaxone when administered alone or in combination with paracetamol and diclofenac sodium in boiler chicks. 
Methods: This study was conducted in Department of Physiology, Biochemistry and Pharmacology, College of Veterinary Medicine  ,University of Mosul , Mosul, Iraq, from November 2021 to February 2022. It was determined using formaldehyde test and the median analgesic effective dose (ED50) for ceftriaxone, paracetamol and diclofenac sodium depending on the method of Dixon. An isobolographic ratio of 0.5:0.5 of the ED50 for each drug at the analgesic level was calculated.
Results: The administration of ceftriaxone at doses of (523, 1064 and 1330mg/kg) intramuscularly was led to a significant (p value=0.02) and clear analgesic effect through the disappearance of the right foot lift caused by the injection of formaldehyde, in aadition to significant decrease (p value=0.01) in foot thickness at dose of 1330 mg/kg . Analgesic ED50 of ceftriaxone , paracetamol and diclofenac sodium by Dixon method were 42.6 ,32.6 and 6.26 mg /kg respectively. The intramuscular administrations of drugs in a ratio of 0.5:0.5 result in a significant decrease (p value<0.001) in ED50 values ​ to 6.77, 5.34 and 0.99 mg/kg respectively. The application of the isobolographic analysis revealed the type of interaction between ceftriaxone/paracetamol, ceftriaxone /diclofenac sodium, and the interaction was synergistic when they were given at the ratio 0.5:0.5.
Conclusion: The results showed that ceftriaxone exerts its analgesic effect in chicks by reducing the mechanical hyperalgesia resulting from formaldehyde injection in the planter of the right foot and potentiated the analgesic effects of paracetamol and diclofenac sodium through the synergistic interaction.
 

Role of High Mobility Group Box-1 in Status Epilepticus, From Pathophysiology to Biomarker and Therapeutic Potential

Rana M. Raoof; Muna Al-Hamdany; Khalida I. Noel

Annals of the College of Medicine, Mosul, 2022, Volume 44, Issue 1, Pages 37-41
DOI: 10.33899/mmed.2021.131944.1121

Status epilepticus (SE) is a neurological emergency that require prompt diagnostic and treatment measures due to its associated mortality and morbidity. The role of neuro-inflammation in status epilepticus has been studied extensively and many potential molecules have been proposed as a promising biomarkers and therapeutic targets for the condition. Inside the nucleus, HMGB1 is a DNA-binding protein with many housekeeping functions. Under certain conditions, HMGB1 will be translocated to the extracellular space promoting a strong pro-inflammatory reaction with activation of many downstream inflammatory pathways related to seizure onset and progression. In this review the potential role of HMGB1 in the pathogenesis of SE was highlighted stressing on the promising implications of this molecule as a therapeutic target for SE.

Bowel Injuries after Laparoscopic Ovarian Drilling: Observation of Three Cases with Review of Literatures

karam Kamal younis

Annals of the College of Medicine, Mosul, 2022, Volume 44, Issue 1, Pages 42-47
DOI: 10.33899/mmed.2022.133534.1145

Background : Bowel injury remains a potential serious complication of gynecological laparoscopy. Electro thermal energy, especially in the form of monopolar diathermy, is used widely during Laparoscopic Ovarian Drilling (LOD) by diathermy for clomiphene-resistant polycystic ovary disease (PCOD). Occasionally there can be unrecognized transfer of energy in the operating area, resulting in electro thermal bowel  injury. If iatrogenic bowel injury  is not recognized  at the time it occurs, it can have devastating consequences.
Objectives : Through personal observations of 3 patients who underwent (LOD) for clomiphene-resistant (PCOD) followed by bowel perforation ,we highlighted their  ways of presentation , recognition ,  avoidance  and management  of such complication.
Setting : Surgical wards of Al-Jamhoori Teaching Hospital in Mosul City  
Patients and Methods : Through personal observation, we report a series of 3  infertile women   who underwent laparoscopic ovarian drilling for clomiphene resistant infertility  but were readmitted 2-3 days later with pinhole leaks from perforated bowel  .
Results : After (LOD ) ,two patients out of three were urgently explored via laparotomy and multiple  bowel perforations were found and  repaired. Consequently they improved .The third patient presented lately after rupture of  bowel and peritonitis. Although she underwent explorative laparotomy but her condition was potentially fatal and died from sepsis.
Conclusion : Gynecologists should be aware for the proper, safe and judicious use of diathermy during (LOD) to avoid complications with consultation and involvement of surgeons early following the procedure. High clinical suspicion is crucial for early diagnosis of bowel injuries. When diagnosis is delayed, then morbidity and mortality rises.
 

Childhood obesity: A review of literatures

Mazin Mahmoud Fawzi; Omar Farouq Fadel Alomari

Annals of the College of Medicine, Mosul, 2022, Volume 44, Issue 1, Pages 48-53
DOI: 10.33899/mmed.2022.133478.1144

Obesity is a multifarious disorder involving developmental, behavioral, biological, environmental, and hereditary components; it is a major medical health issue. The greatest predominant cause of childhood obesity is a discrepancy in energy balance. The physicians have commonly depended on changes in food consumption with exercise since there is no single treatment choice for obesity treatment . The prevention of childhood obesity is considered as the enduring, cost-effective solution to the problem of obesity, effective methods for it still indescribable. In summary, this study will overview the implications, and treatment options available for childhood obesity.

Utility of different modalities in treatment of keloid scar

Hala N. Al Salman

Annals of the College of Medicine, Mosul, 2022, Volume 44, Issue 1, Pages 54-60
DOI: 10.33899/mmed.2022.132869.1134

Background : Keloids constitute an abnormal benign fibro-proliferative wound healing response to any type of skin injury. it has high influence on Patient’s psychology and cosmetic view. It has high prevalence in African-American subjects. Until now there is no definitive treatment.
The aim of study : to assess the response in three different groups using three different modalities (intralesional steroid, cryotherapy, and both).
Patient and method : This was a randomized controlled clinical method with equivalent intervention assignment study, which was done on 16 patients (105 lesions), who attended Ibn Sina Teaching hospital, Mosul, Iraq, from January 2019 to January 2021.
Results : there were significant responses to the three modalities (p-value less than 0.05). and the response assessed for each patient according to Vancouver Score Scale (VSS), Patient and Observer Scar Assessment Scale (POSAS), and 2 diameters assess.
Conclusion: The results of this study showed that the combination of cryotherapy with intralesional steroids is more effective than steroid or cryotherapy alone in treating keloids.

Neonatal gastro-intestinal tract perforation in Mosul city

Bassam Khalid Alhajjar; Ibrahim Shukur Alhadidi; Ahmad Mahmud Al-Sharabi

Annals of the College of Medicine, Mosul, 2022, Volume 44, Issue 1, Pages 61-69
DOI: 10.33899/mmed.2021.131611.1115

Background: Gastro-intestinal perforation (GIP) of neonates considered as one of the foremost emergency problems faced by pediatric surgeons around the world. It represents important challenges with a high mortality of 15-70% has been reported. Despite enhancements in anesthesia, as well as, intensive care, mortality has remained high, especially in premature babies.
Patients and Methods: A retrospective series study including 50 patients diagnosed as GIT perforation were admitted to the neonatal pediatric surgery center in Al-Khansaa teaching hospital, allocated over the period extending from April 2017 to June 2019. Records were reviewed for the age, sex, gestational age, weight, duration of symptoms, associated anomalies, causes of GIT perforation, procedure done, mortality, amorbidity, and hospital stay period. Leak from intestinal anastomosis secondary to resection as surgical interference were  excluded from the study.
Results: The presentation age varied between 12 hours to 27 days with a median age of 3.5 days. The weight mean is 2.93 kg. The mean gestation age was 34 weeks, ranging from 30-42 weeks. The majority had the symptoms before 30 hours. Most of the sample is within the 1st week representing 86.0%. The males are representing 76.0% while the females are 24.0% with a ratio about of (3:1). About 56.0% of the perforations occur in the small bowel and only 4.0% in appendix. The large bowel represents 28.0% and the stomach 12.0%. The positive findings of abdominal X-Ray are found in 80.0% of patients. 40.0% of patients are died. The frequent site is the ileum, found in 8 patients (40.0%) of all deaths. Next are the Jejunum and colon, representing 20.0% for each. The stomach pathology found in 10.0%, as well as, the cecum 10.0%.
Conclusion: The commonest site of perforation is small bowel. History, clinical picture and erect abdominal X-ray are very important for the diagnosis. The risk factors raise the mortality rate include malnutrition, the appearance of complications, lack of certain drugs, delayed diagnosis, prematurity, and associated anomalies. The outcome is improved with early identification, diagnosis, and treatment.
AIM OF THE STUDY : To study the causes and outcome of neonatal GIT perforations in Mosul city and its drainage areas in the north of Iraq.

Knowledge, Attitude and Perception of Married Women Toward Family Planning in Shekhan City

Jinan Nori Hasan

Annals of the College of Medicine, Mosul, 2022, Volume 44, Issue 1, Pages 70-75
DOI: 10.33899/mmed.2021.131885.1119

The current study represents a cross sectional study and included 350 married women with ages range between 15 to 45 years from Shekhan city to study their information, attitude and practice concerning contraceptive methods and family planning (FP). The current work revealed presence of high percentage of parity of participant married women (5 and more) which record 107(30.6%), and nearly 63 (18%) of participants were pregnant at study time. Majority of participants think that FP is useful and 162(46.3%) of the enrolled females employed one of FP methods at study time. The most common cause of non-using FP methods is one or both parents want more children. The most common methods used are male condom, IUCDs and contraceptive pills .
The level of awareness was not optimal in regards to FP and contraceptive methods. Modified educational and counselling interferences among child bearing age females messages concerning FP were focused on males mainly so more short courses and seminars in various populations are recommended .

Online Team-Based Learning for Teaching Antenatal Care during COVID- 19 Pandemic

Omaima Abdulrazzaq zubair; Humam Ghanim I. Zubeer; Samar A. Ahmed; Mohamad H Shehata; Mohamad A Hassanein

Annals of the College of Medicine, Mosul, 2022, Volume 44, Issue 1, Pages 76-82
DOI: 10.33899/mmed.2021.131802.1117

Background : Covid 19 era bring learning to be more distant via internet. Many students' engagement methods applied in this context. The present study aims to enhance students' engagement in the learning process through application of online Team Based Learning in teaching antenatal care in fourth year medical students during COVID 19 period .
Methods : A pilot intervention study was used to test the online team based learning application for teaching antenatal care partition of Community medicine curriculum during COVID-19 period. Then, the   study was implemented on two sessions through two academic years for the large group fourth-year medical students of College of Medicine, University of Mosul, Iraq. Google classroom, Google form, Telegram and Zoom platform was the online platform that used for application of the study .
Results : A total of 389 students were voluntarily participated in the study from two different academic years. There was significant improvement in the students’ performance obtained from team readiness assurance test in compares to individual readiness assurance test at each session's application.  Students give high satisfaction for TBL as a better way of teaching comparing to traditional teaching methods .
Conclusion : Pear's study has positive impact on students' understanding and when used online make the teaching easier and enjoyable .

Impact of Conflict on Physical Activity among Teenagers in Mosul City

Mayyadah Y. Mahmmod; Jawad K. Al-Diwan

Annals of the College of Medicine, Mosul, 2022, Volume 44, Issue 1, Pages 83-87
DOI: 10.33899/mmed.2022.131880.1120

Background : Physical inactivity regarded as one of the leading risk factors for global mortality through its effect on multiple chronic non-communicable diseases (NCD), which in turn responsible for disability adjusted life years lost DALY and premature death in addition to mental disorder and a substantial economic burden worldwide.
Aim of study : To estimate the prevalence of physical activity/ inactivity among teenagers in Mosul city/ Iraq in post conflict period (2017-2019).
Patients & Methods : Cross sectional study was conducted upon 600 teenagers aged (12-17) years of both sexes attending secondary schools of Mosul city. Data collected between October and December 2019, using special form of questionnaire (Physical Activity Questionnaire for Adolescent PAQ-A), the data was obtained directly by interview with the students themselves to confirm a detailed questionnaire form. Using (SPSS 25) statistical package for social science program to calculate the prevalence of physical inactivity among teenagers [The student was physically inactive when he spends less than 60 minute daily of moderate to vigorous physical activity and physically active when he spends 6o minute or more daily of moderate to vigorous physical activity]. The data was presented as frequencies and percentages. A statistical test; chi-square test was used to test for the presence or absence of significant association between dependent and independent variables. A p-value less than 0.05 were considered significant.
Results : A total of 600 teenagers had been included in the study, 472 (78%) were physically inactive.
Conclusion : The current study showed the prevalence of physical inactivity is high among teenagers, especially females.
Recommendations : the study recommends the following to minimize the spread of physical inactivity among teenagers in the city:
1. Creation of active environment as provide safe places, public green spaces and ensure time for students to be active at school.
2. Encouraging teenagers, especially females to adopt physical activity routine as a part of their healthy life style.
3. Enhance regular population surveillance system of physical activity across all ages.
 

Complications after Covid-19 vaccination

Sameer Ibrahim Hasan; Imad A Thanoon; Abdul-rahman I. A-J Thanoon; Omar SI. Hasan; Rwqaya S. Dawood

Annals of the College of Medicine, Mosul, 2022, Volume 44, Issue 1, Pages 88-94
DOI: 10.33899/mmed.2022.134076.1151

Background : Coronavirus disease (COVID-19) is an infectious disease caused by the SARS-CoV-2 virus.
Most people who fall sick with COVID-19 will experience mild to moderate symptoms and recover without special treatment. However, some will become seriously ill and require medical attention.
Objective : The aims of this study is to explore the different side effects associated with the three most common vaccines against Covid-19 in Nineveh, Iraq. Such study will aid healthcare workers and policy makers in the betterment of medical care for concerned patients, therefore, improving their quality of life.
Patients and methods: The study is a prospective case series study, included 498 participants, 48.1% of them were between the ages 18 to 30 years, 54.0% are married, Only these two characteristics were significantly different among vaccine users (p-value = .041 and .001, respectively).
Results: Frequency of Adverse Reactions Based on the Vaccine
For the first dose, the most common symptoms were body/joint pain, headache, fatigue and fever.
The frequency of these symptoms in addition to respiratory symptoms were significantly more frequent within the AstraZeneca vaccine (all p <.001).
While the Pfizer-BioNTech vaccine had significantly higher frequency of no experienced symptoms (p <.001).
For the second dose, the trends of the adverse effects did not change. However, the symptoms of joint/body pains, headache, fatigue, and fever were significantly more pronounced in the Pfizer-BioNTech vaccine (all p <.001).
Conclusions and recommendations: In conclusion, we noticed that post vaccine side effects are common with all vaccines but are more pronounced in new technology vaccines.
The application of a governmental surveillance system adverse effect severity is highly recommended.

Peroxisome Proliferator- Activated Receptors (PPARs): A Review on Effects on Glucose Metabolism, Energy Homeostasis and Cardiovascular System

Amjad Hazim Al-Naemi

Annals of the College of Medicine, Mosul, 2022, Volume 44, Issue 1, Pages 95-102
DOI: 10.33899/mmed.2022.133951.1148

Background:Molecular biology and human medical genetics have introduced several novel biomarkers giving control over vital body functions, of these are transcriptional factors known as peroxisome proliferator activated- receptors “PPARs”. The aim of this review is to shed light on available online information and published research works about these biomarkers. The current review will try to display those findings mainly related to energy homeostasis, glucose metabolism, insulin sensitivity and some cardiovascular interactions.
Methods:a literature review about peroxisome proliferator activated- receptors and their roles in controlling some vital body functions has been made and recorded. Search covered published investigations and research works over the last three decades as accessible.
Results: peroxisome proliferator activated- receptors have crucial roles in controlling a big deal of vital biological processes in humans.
Conclusions: Peroxisome proliferator-activated receptors are important transcriptional factors with clinical impacts. Literature shows a wide spectrum of effects and interactions through affecting many genes involved in processes of glucose homeostasis, energy balance, and peripheral insulin sensitization in addition to interfering with processes of inflammation, angiogenesis, blood pressure control and atherosclerosis. 

Effects of quetiapine on body mass index and reproductive hormonal levels in male schizophrenic patients

Omar M. Y. Shindalla; Shamil H. Othman; Imad A. Thanoon

Annals of the College of Medicine, Mosul, 2011, Volume 37, Issue 1, Pages 110-113
DOI: 10.33899/mmed.2011.35778

Objective: To asses the effects of quetiapine therapy on body mass index (BMI) and serum level of testosterone, prolactin, follicle stimulating hormone (FSH), luteinizing hormone (LH), and estradiol (E2) in newly diagnosed male schizophrenic patients in comparison to healthy controls.
Patients and methods: Thirty male patients with schizophrenia were included in this study. The diagnosis of schizophrenia was made according to DSM-IV criteria of the American Psychiatric Association (APA). Another thirty apparently healthy male individuals were included in the study as a control group. Blood samples were taken initially from patients and controls and assay of serum testosterone, prolactin, FSH, LH, and E2 were done using enzyme –linked fluorescent immunoassay (ELFA) technique by vidas instrument. Later, after 6 months of quetiapine therapy, other blood samples were taken and assay of the same parameters were done. Calculation of BMI was done for the patients and controls using special equation.
Results: There was an insignificant difference in the mean BMI, serum testosterone, prolactin, FSH, LH, and E2 levels between patients in the pre-therapy stage group and in both the post-therapy stage group and controls.
Conclusion: Chronic quetiapine therapy might be regarded as a safe drug with regard to effects on BMI and serum levels of reproductive hormones in newly diagnosed male schizophrenic patients.

Keywords: Schizophrenia, quetiapine, BMI, testosterone, prolactin, FSH, LH, E2.

Risk factors for development of transient tachypnea of newborns

Annals of the College of Medicine, Mosul, 2018, Volume 40, Issue 1, Pages 15-19
DOI: 10.33899/mmed.2018.159185

ABSTRACT
Background: Transient tachypnea of the newborn (TTN) is a frequently encountered form of neonatal respiratory distress. The underlying mechanism involves residual lung fluid that is delayed in clearance. TTN primarily occurs soon after birth and can last from 24 to 72 hours. Risk factors for TTN include elective cesarean section, male sex, late prematurity, low birth weight, macrosomia, polycythemia, maternal asthma and maternal diabetes. Treatment is often supportive with observation and potential oxygen supplementation.
Objective: To identify the risk factors associated with development of transient tachypnea of newborns who were delivered either normally or through cesarean section, at 36 weeks or beyound and to compare the results with those of others.
Patients and methods: This is a case -control study of 200 newborns suffering from respiratory distress during a period from the 1st of September 2011 to the 1st of September 2013 in the neonatal intensive care unit at AL-Kansaa Teaching hospital in Mosul. The perinatal history of newborns was analyzed. TTN was diagnosed on clinical basis and by exclusion of other diseases affecting the respiratory system including sepsis. The study included 200 healthy newborns as control.
Results: Multivariate analysis identified that the development of TTN was significantly associated with elective cesarean section 56% (p-value=0.001), male sex 66.5% (p- value=0.001), late prematurity 21% (p-value=0.009), maternal diabetes 8% (P-value=0.014), maternal asthma 10.5% (p-value=0.01), birth asphyxia (low APGAR score) 9.5% (p-value=0.005), low birth weight 16.5% (p-value=0.003), prolonged labor or using (forceps or vacuum) 22% (p-value=0.037) and in vitro fertilization 2.5% (p-value =0.024).
Conclusion: Transient tachypnea of newborns is strongly related to elective cesarean section, male sex, late prematurity, maternal diabetes, maternal asthma, birth asphyxia, low birth weight (1500-2500g), prolonged labor or using forceps or vacuum and in vitro fertilization..

The relation of body mass index and smoking with liver function

Annals of the College of Medicine, Mosul, 2018, Volume 40, Issue 2, Pages 48-53
DOI: 10.33899/mmed.2018.160010

Objective: To assess the effect of BMI and smoking on liver function.
Materials and methods: Case- series study was conducted to assess the relation between liver function tests(aspartate amino transferace (AST), alnine amino transferace (ALT), Alkaline phosphatase, lactate dehydrogenase (LDH), protein albumin and billirubin), and BMI and smoking in 1020 apparently healthy persons using commercially available kit.
Results: Significant direct relationship between liver enzymes activities, serum total protein and globulin and BMI were observed. Albumin, bilirubin and A/G ratio values were decreased by increasing BMI. Significant relation was observed between the mean activity of (AST) and cigarette smoking. Significant inverse relationship was observed between mean values of total protein, albumin, globulin and bilirubin with cigarette smoking
Conclusion: serum enzymes activities of (AST, ALT, ALP and LDH), total protein and globulin had direct positive relationship with BMI, while albumin, A/G ratio and total bilirubin had inverse relationship. Smoking has a significant effect of on AST, total protein, albumin, globulin and total bilirubin, while doesn't affect ALT, ALP, and LDH.
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The effect of concentrated bone broth as a dietary supplementation on bone healing in rabbits

Mahmood A. Aljumaily

Annals of the College of Medicine, Mosul, 2011, Volume 37, Issue 1, Pages 42-47
DOI: 10.33899/mmed.2011.34633

Background: A variety of substances, biological and physical interventions have been used to enhance bone fractures healing. There is growing evidences for the importance of nutrition in maintenance of bone health and support of fracture healing.
Objective: The aim of this study was to evaluate the effect of the daily oral dose of concentrated bone broth as dietary supplementation on bone healing in experimental animals (rabbits).
Material and methods: Twelve young male rabbits divided into two groups after induction of open ulnar osteotomy, the experimental group receive daily dose of concentrated bone broth as a dietary supplementation. The control group received ordinary diet. In the end of second weeks three animals from both group were killed, at the end of fifth week, the other animals were sacrificed and the specimens taken for radiological and computerized tomography (CT) scan densimetry and histomorphometric evaluation carried out for the callus at site of osteotomy.
Results: The ulnar bone osteotomies in both groups were united at the end of the fifth week macroscopically and radiologically. The callus density was measured in site of osteotomy by CT scan densimetry, at the end of 2nd week the difference between the experimental and control group was not significant, (P value > 0.05), and at the end of 5th week the difference between the experimental and control group was highly significant, (P value < 0.001). The histomorphometric evaluation of healing in site of osteotomy carried out, and at the end of 2nd week the difference between the experimental and control group was not significant, (P value > 0.05), and at the end of 5th week the difference between the experimental and control group was significant, (P value < 0.05).
Conclusion: The present study demonstrate that a daily oral administration of concentrated bone broth as dietary supplementation in rabbits enhance bone healing by increase callus density in CT, and improve histomorphometric evaluation of healing.

Keywords: Bone broth, fracture, healing, and dietary supplementation.

The Effect of Using Combined Oral Ethinyl Estradiol and Levonorgestrel in the Resolution of Menstrual Pattern Disorder and Functional Ovarian Cyst

Najlaa Saadi Ismael; Sana Jafar Mohamed; Maha Atout; Qutaiba Ahmed Al Khames Aga; Sura Yasir Taha Alkhammas

Annals of the College of Medicine, Mosul, 2019, Volume 41, Issue 2, Pages 190-196
DOI: 10.33899/mmed.2020.164163

Objectives: To evaluate the usefulness of combined oral contraceptives (ethinyl estradiol and levonorgestrel) in resolving menstrual pattern disorder in reproductive-age women with a functional ovarian cyst in Iraq.
Method:A longitudinal (before and after) ,  interventional study  was used. Data were collected at a single obstetrics and gynaecology outpatient clinic in Mosul City, Iraq. Participants: A sample of 96 women aged between 15 and 45 years participated in the study. Participants diagnosed with ovarian cysts were treated using an oral administration of contraceptive pills (combination of ethinyl estradiol, 0.03 mg, and levonorgestrel, 0.15 mg) on a daily basis for a treatment duration of 2 months. The Outcome Measures are Menstrual pattern disorders (dysmenorrhea, irregular menstrual cycle, and amenorrhea) and cyst dimensions were recorded.
Results: After one therapy cycle, a statistically significant disappearance of menstrual pattern disorder was observed (p=0.000). Cyst resolution was observed in 89.58% of the patients (n=86), while mean ovarian cyst size fell from 4.452 ± 1.0603 cm at the start of therapy to 0 .451 ± 1.5613 cm(p = 0.000). 5 of the 10 persistent cysts disappeared after the second cycle (2 months after the start of therapy) and complete cyst resolution was 94.8% (n = 91) after two cycles. This indicated a further significant reduction of mean ovarian cyst size to 0.335 ± 1.4684 cm. However, no significant difference was observed between mean cyst size in the first and second months of treatment (p=0.329).
Conclusion: Combined oral contraceptives (ethinyl estradiol and levonorgestrel pills) are effective in relieving dysmenorrhea, irregular menstrual cycle, and amenorrhea. They also hasten the disappearance of functional ovarian cysts, and are associated with high rates of success in patients with functional ovarian cysts.

Effects of quetiapine on body mass index and reproductive hormonal levels in male schizophrenic patients

Omar M. Y. Shindalla; Shamil H. Othman; Imad A. Thanoon

Annals of the College of Medicine, Mosul, 2011, Volume 37, Issue 1, Pages 110-113
DOI: 10.33899/mmed.2011.35778

Objective: To asses the effects of quetiapine therapy on body mass index (BMI) and serum level of testosterone, prolactin, follicle stimulating hormone (FSH), luteinizing hormone (LH), and estradiol (E2) in newly diagnosed male schizophrenic patients in comparison to healthy controls.
Patients and methods: Thirty male patients with schizophrenia were included in this study. The diagnosis of schizophrenia was made according to DSM-IV criteria of the American Psychiatric Association (APA). Another thirty apparently healthy male individuals were included in the study as a control group. Blood samples were taken initially from patients and controls and assay of serum testosterone, prolactin, FSH, LH, and E2 were done using enzyme –linked fluorescent immunoassay (ELFA) technique by vidas instrument. Later, after 6 months of quetiapine therapy, other blood samples were taken and assay of the same parameters were done. Calculation of BMI was done for the patients and controls using special equation.
Results: There was an insignificant difference in the mean BMI, serum testosterone, prolactin, FSH, LH, and E2 levels between patients in the pre-therapy stage group and in both the post-therapy stage group and controls.
Conclusion: Chronic quetiapine therapy might be regarded as a safe drug with regard to effects on BMI and serum levels of reproductive hormones in newly diagnosed male schizophrenic patients.

Keywords: Schizophrenia, quetiapine, BMI, testosterone, prolactin, FSH, LH, E2.

Effects of Bee Propolis on Blood Pressure Record and Certain Biochemical Parameter in Healthy Volunteers

Annals of the College of Medicine, Mosul, 2018, Volume 40, Issue 1, Pages 20-26
DOI: 10.33899/mmed.2018.159191

ABSTRACT
Objectives: To evaluate the effect of encapsulated bee propolis supplementation 500 mg twice daily for 2 months on blood pressure record, fasting serum glucose, lipid profile and serum uric acid in otherwise healthy volunteers in comparison to controls.
Design: The study was conducted from October 2017 to April 2018, subjects included in the study was healthy non-obese from different areas in Mosul city, so as the control.
Subjects and methods: Forty apparently healthy subjects (Sixteen male and twenty–four female) were included in this study. Blood pressure (BP) were recorded, body weight and body mass index (BMI) were calculated, then a blood sample was taken with assay of fasting serum glucose (FSG), lipid profile {Total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL –C), while serum low density lipoprotein (LDL –C), very low density lipoprotein (VLDL-C) and atherogenic index (AI)} were calculated by using certain equations and serum uric acid (SUA), was measured for both the intervention and the control groups.
After 2 months of supplementation with encapsulated bee propolis 500 mg twice daily, the BP, body weight, BMI, LDL-C, VLDL-C and AI were calculated and FSG, TC, TG, HDL and SUA were measured for the intervention group. All data were presented as means± standard deviation (SD) of mean. Independed t –test of two mean was used. Dependent t – test of two mean was applied for the differences in the intervention group (before and after). Chi square test of independence was used for categorial variables. P–value≤0.05 was considered statistically significant.
Results: Initially, at the start of the study, there was insignificant difference between the interventions and the control groups with regard age, sex, weight, BMI, systolic and diastolic BP, serum TC, HDL- C, LDL –C, AI and SUA, with a significant differences in FSG, TG, and VLDL. By comparison before and after supplementation in the intervention groups, there was a significant decrease in the systolic and diastolic BP record, FSG, TC, TG, LDL –C, AI, SUA, with a significant increase in body weight and HDL –C.
Conclusion: Bee propolis supplementation at a dose of 500 mg twice daily for 2 months carries a beneficial effects on BP record, FSG, lipid profile, and SUA, which should be taken in preventive medicine, since hyperglycemia, hyperlipidemia and hyperureciemia, contributed to the development of atherosclerosis, cardiovascular and cerebrovascular diseases.

Assessing the effects of low dose aspirin on uricacid and renal function in healthy adults

Yaser Adeep; Jonaya Sarsam

Annals of the College of Medicine, Mosul, 2009, Volume 35, Issue 2, Pages 154-159
DOI: 10.33899/mmed.2009.8848

ABSTRACTObjective: To evaluate the effects of low daily aspirin doses on uric acid (UA) level and renal functions in healthy adults.Methods: Healthy adults were randomized to receive 100 mg (n= 33), or 300 mg (n = 31) aspirin daily for one month. Laboratory tests included measurement of blood urea nitrogen (BUN), serum creatinine, and uric acid (UA) levels. Urine creatinine, urea and uric acid excretion were measured in a 24 h collection of urine, 24 hours urine uric acid, creatinine clearance (Ccr), were measured at baseline and then after 4 weeks of therapy.Results: After 4 weeks of therapy, 100 and 300 mg/d dosage, aspirin caused a 7% and 12% decrease in the rate of UA excretion respectively (P< 0.05). Patients at the dosage 300 mg/d but not the 100mg/day had an increase in serum levels of uric acid (UA), creatinine and urea with a significant decrease in 24 hour creatinine clearance and urinary urea excretion (P<0.05) when compared with the baseline.Conclusion: Because of the effects of 300 mg dose aspirin, in the lowering of kidney function and the potential of aspirin to cause dose-dependent impairment of renal function, patients taking low-dose aspirin therapy should be monitored for the development of impaired renal function.Keywords: Low dose aspirin, renal function, healthy adult.

Effect of Ginkgo biloba on lipid profile in hypertensive patients on Valsartan monotherapy

Annals of the College of Medicine, Mosul, 2018, Volume 40, Issue 2, Pages 29-33
DOI: 10.33899/mmed.2018.160002

Aim: The study was conducted to evaluate the effects of Ginkgo biloba as an add on therapy to Valsartan monotherapy in hypertensive patients on lipid profile.
Patients and methods: The study was done in private clinics in Mosul City, during a period of sixth months from 15 October 2017 to 15 April 2018. The total number of patients enrolled in the study was 50 hypertensive patients using Valsartan monotherapy of both sexes. The patients were administered Ginkgo biloba 80 mg twice daily and followed for 2 months duration. Their lipid profile was determined at baseline level and after 2 months from administration of Ginkgo biloba.
Results: Treatment with Ginkgo biloba showed a significant reduction in serum total cholesterol and triglycerides, while LDL, VLDL, HDL, and AI showed no significant changes.
Conclusion: This study revealed that Ginkgo biloba could be regarded as a natural and relatively safe drug in reducing total cholesterol and triglycerides in hypertensive patients.
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Urinary tract infections among pregnant women in Mosul city

Dhukaa; A. Al-Jawadi

Annals of the College of Medicine, Mosul, 2012, Volume 38, Issue 2, Pages 35-39
DOI: 10.33899/mmed.2012.64499

ABSTRACT
Objectives: To determine the prevalence of urinary tract infection (UTI) among pregnant women in Mosul city and to classify the infected women according to their trimesters of pregnancy. The sensitivity of isolated organisms to various antibiotics was also examined.
Patients and methods: Sample of 154 pregnant women attending Al-Batool Maternity Hospital in Mosul city from Feb-April 2007 was taken. Information on age, gestational age, gravidity, parity, level of education and residence were collected for each woman. Clean midstream urine samples were examined for UTI microscopically and culture, and sensitivity tests were done for the organisms isolated using a range of antibiotics.
Results: Prevalence rate of UTI among the studied subjects was 47.4%. Eschirishia coli was the most frequently isolated organism (73.5%) which was highly sensitive to nitrofurantoin, ciprofloxacin, gentamycin, ceftriaxone and amikacin. Amoxicillin, cotrimoxasole, tetracycline and ciprofloxacin are the effective antibiotics to half of isolated Gram positive bacteria. Of the variables examined, 79.5% of the infected participants were in the age group 20-35 years, 53.0% were in their third trimester, 41.0% had 1-4 children, 30.1% were primigravidae, 63.0% attended the antenatal care unit on need, and 71.2% were urban at 6-12 years schooling.
Conclusion: UTI is still a major health problem among pregnant women especially during their third trimester. Escherichia coli is the predominant pathogen causing UTI. All detected bacteria were sensitive to amikacin. Urinalyses with culture and sensitivity tests are mandatory for all pregnant women during the different trimesters. Health education with regular antenatal care share greatly in reducing the incidence of this infection.

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