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@gmail.com annalsmosul@uomosul.edu.iq

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

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

Print ISSN: 0027-1446

Online ISSN: 2309-6217

The Significance of CD3 Marker in the Diagnosis of Celiac Disease

Saja Hashim Hammo; Professor Wahda Mohammad Taib Al-Nuaimy; Mohammed A. Hayawi

Annals of the College of Medicine, Mosul, 2020, Volume 42, Issue 2, Pages 99-108
DOI: 10.33899/mmed.2020.128710.1055

ABSTRACT
Background: Celiac disease is a common, permanent and reversible health problem of small intestine occurring all over the world in genetically predisposed individuals and in combination with other environmental factors. It causes chronic inflammation of small intestine which is of autoimmune origin. The histopathological features of Celiac disease in duodenal biopsy was stated according to the modified Marsh classification.
The immunohistochemical application of CD3 marker in duodenal biopsy could facilitate the count and the distribution of intraepithelial lymphocytes along the villi, which is regarded as a key for the correct diagnosis in early stages ( Marsh 1).
Objectives: This study was conveyed to correlate the significance of CD3 immunohistochemical expression of intraepithelial lymphocytic population to histopathological changes in Celiac disease, to identify the distribution of CD3 marker along the villi (crescendo or decrescendo) and (diffuse or patchy ) and to delineate the age and sex of Celiac disease in our locality.
Materials and methods: The research was both prospective and retrospective case series study, carried out on 100 cases of endoscopically obtained duodenal biopsies. Data obtained from archives of the pathology department, at AL-Jamhory, AL-Khansaa and AL-Salam Teaching Hospitals/ Mosul city, and collected in a period spanning from January 2019 to May 2020. The information included age, sex and duodenal biopsy location. then assessed histologically and immunohistochemically.
Results: In a total of 100 duodenal samples, patients age was ranged 1 to 69 years ( mean age of 20.74 years), with a female to male ratio ( 2.2:1).
By applying modified Marsh classification: Marsh 0 was detected in 8 % of the cases, Marsh 1 in 30 % , Marsh 2 in 10% , Marsh 3 a in 20%, Marsh 3 b in 17%, Marsh 3 c in 15% and Marsh 4 in 0%. Immunohistochemical expression of CD3 in the sampled cases i.e. CD3 + ≥30 /100 epithelial cells was detected in 79 %. There was a statistically significant difference between CD3+ and modified Marsh classification by Hematoxylin & Eosin (P Value<0.001) for detection of intraepithelial lymphocytosis.
Conclusion: There is a significant relationship between the count of CD3+ T-lymphocytes per 100 epithelial cells and the histopathological changes in the duodenal biopsy according to modified Marsh classification. the immunohistochemical expression of CD3 in intraepithelial T-lymphocyte could lead to a definite assessment in 13 % of the sampled cases with Marsh type 1. All the positive cases are of crescendo pattern of distribution of CD3+ T-lymphocytes as the distribution is more important than the actual count and they distributed diffusely except that associated with Helicobacter pylori infection observed with patchy distribution. The IHC expression of CD3+ marker provides a hint about the distribution of CD3+ marker within the lymphocyte whether global surface or clonal surface and intracytoplasmic to diagnose Refractory Celiac disease. Females were more affected than males and there is a significant relationship between the gender and the histopathological changes. It can be diagnosed at any age and there is no significant relationship between the age distribution and the histopathological changes.

Diagnostic Yield of PAX5 in Lymphoma

Hiba Rafea; Abdul Kareem Yonis Al-Tae; Nazar Mohamed Jawhar

Annals of the College of Medicine, Mosul, 2020, Volume 42, Issue 2, Pages 109-118
DOI: 10.33899/mmed.2020.128737.1058

Background: Lymphoma is a heterogeneous group of neoplasm affecting any stage of lymphocyte development. Nowadays, WHO (2017) adapted their classification depending on their morphological, immunohistochemical appearance, and their clinical and molecular characteristics.

Objective: To determine the expression of PAX5 in Hodgkin and Non Hodgkin lymphoma and their association with clinical parameters (age &site).

Patients & Methods: During a period of 1 year starting from June 2019 to June 2020, 60 lymphoma patients" were included in this"prospective-retrospective"case series study from"medical records and histopathological results in governmental and private labs. Immunohistochemistry examination using PAX5 was performed, and data of the positive PAX5 expression were analyzed.

Results: A total of 60 patients were recruited in this study with the majority (58%) were Non Hodgkin lymphoma, dominated by diffuse large B- cell lymphoma subtype (42.8%) and (42%) were Hodgkin lymphoma where nodular sclerosis subtype formed (52%) and mainly of the nodal site in both of them. The age range of Non Hodgkin lymphoma 7-76 years (median 50 years) and 5-67 years (median 21 years) for Hodgkin lymphoma and male predominance in both of them and there is no significant association between the site and lymphoma (p value=0.0647) while a significant association with age (p value =0.037). Moreover, the immunohistochemical examination demonstrates that positive PAX5 was expressed in 77% of Non Hodgkin lymphoma and 100% of Hodgkin lymphoma. The P-value between them was 0.016, which was statistically significant ,no matter of using PAX5 or CD30 in"the diagnosis of Hodgkin lymphoma,in other hand"there is a significant difference between PAX5 and CD3 expression (P value=0.004), while it is not statistically significant when comparing PAX5 and CD20 (P-value =0.317) in the diagnosis of Non Hodgkin lymphoma .

Conclusion: This study demonstrates that PAX5 is one of the most sensitive and reliable immunohistochemical marker in diagnosing Hodgkin lymphoma and B-cell Non Hodgkin lymphoma.

Evaluation of the Patients with spinal metastasis of unknown primary tumor origin.

Alya A.Zobair

Annals of the College of Medicine, Mosul, 2020, Volume 42, Issue 2, Pages 119-125
DOI: 10.33899/mmed.2020.129029.1062

Abstract
Background: The spine is not only the most frequent site of skeletal metastasis of a known carcinoma but it is also the most frequent site of bone metastasis of unknown primary tumor origin, however, most of the existing reports that analyzed the clinical features of patients who presented with skeletal metastasis of unknown origin have included cases of bone metastasis at any location. Objective: This study was conducted to analyze the clinical features, survival, and specific diagnostic implications in patients presented with spinal metastasis of unknown primary malignant tumor. Method: In this prospective study, 40 patients presented with spinal metastasis of unknown primary tumor origin to Mosul Oncology Hospital were followed up. Result: The primary malignant tumor was identified in (97.5%) of cases, lung cancer was the most frequently identified primary tumor (35%) followed by carcinoma of the breast (30%) and prostatic cancer (12.5%). We found that Computed tomography scan of the chest, abdomen, and pelvis were the most useful diagnostic modality to identify the primary malignant tumor and there was a significant difference in the overall survival of patients with different primary tumor sites, shorter survival time was observed for aggressive tumor like lung cancer compared to patients having less aggressive primary tumor like breast and prostatic cancer.
Conclusion: Spinal metastasis of unknown primary carries a diagnostic challenge to the clinician, it is possible to detect the primary site in the majority of patients if we follow optimal diagnostic strategies. Detection of primary tumor site could help the clinician to provide the best therapeutic strategies.

Prevalence of Caesarean Sections in Mosul City Hospitals :A Cross – Sectional Study

Noor Nazar Al-Sanjary; Omaima Abdulrazzaq Zubair; Raida Muhammed Al-Wazzan

Annals of the College of Medicine, Mosul, 2020, Volume 42, Issue 2, Pages 126-132
DOI: 10.33899/mmed.2020.128879.1059

Background: Caesarean section rates had been increasing markedly in the world and the procedure as it become more safe than before (although it still a major surgical operation) and the objective of this study is to estimate the prevalence of caesarean section in Mosul city hospitals.
Methods: A cross-sectional study was conducted at eight hospitals in Mosul city from both river sides including five governmental hospitals and three private hospitals, (671) women who delivered by caesarean section in Mosul city hospitals during a period of data collection were included from beginning 15th of November 2019 and ending at 15th of April 2020.
Results: Women delivered by caesarean section aged between 20-35 years in (70.6%), (74.8%) of low educational level and (91.8%) were unemployed. The rate of caesarean section during the period of data collection in Mosul city hospitals was (28.8%) while the rate of caesarean section during the period of data collection showed that the highest rate of caesarean section were in private hospital and especially at Al-Zahrawi and Al-Rabee Private Hospitals (100%) while Al-Batool Hospital include (37.6%) from governmental hospitals in spite that the highest numbers of deliveries and caesarean section was in Al-Khansa Teaching Hospital.
Conclusions: Caesarean section rate was higher than WHO recommendation among Mosul hospitals. Further improvement and attention to primary health care should be applied.

Application of FISH Technique in Evaluation of Equivocal Cases of HER2/neu in Breast Carcinoma

Saja Faisal Jaafar; Ekhlas Ahmed Ali; Nazar mohmmed jawher

Annals of the College of Medicine, Mosul, 2020, Volume 42, Issue 2, Pages 133-140
DOI: 10.33899/mmed.2020.128713.1056

Background: Breast cancer in Iraqi females is one of the extreme popular malignant tumors. It represents the third of registered female cancers. Management and outcome of breast cancer are affected by variables such as tumor size and grade, as well as histologic type, HER2/neu status of the tumor and hormone receptor status. HER2/neu (or erbB-2) is a proto-oncogene found on chromosome 17, that is overexpressed and/or amplified in 15% to 25% of invasive breast carcinomas and is connected to worse clinical outcome. Patients with HER2/neu positive breast carcinoma have showed a good response to targeted therapy (Herceptin) that improving the prognosis.
Objectives: To assess the immunohistochemical overexpression of HER2/neu in breast carcinoma, to detect the frequency of amplified HER2/neu by FISH on immunohistochemically equivocal cases, and to correlate HER2 overexpression & or amplification with various clinicopathological parameters.
Patients and Method: A total of hundred breast carcinoma patients at different ages were included in this retrospective and prospective case series study design. Formalin fixed paraffin embedded blocks were collected from different private labs in Mosul, between 1st November 2019 to 1st April 2020. FISH technique was performed on 25 equivocal cases of HER2/neu tested by immunohistochemistry technique using Leica KreatechTM FISH Dual Probe (Red/Green).
Results: Among a total of 100 patients with mean age was (52) years old diagnosed as breast carcinoma via histopathological findings, 58% were tested negative for HER2/neu,17% positives for HER2/neu, and 25% were equivocal by Immunohistochemistry. However, FISH method is conducted for those patients indicated as equivocal at immunohistochemistry and has identified 7(28%) positive cases and 18(72%) negative cases. The association between HER2/neu and the grade of the tumor was statistically considerable (P value=0.03). Furthermore, the analysis indicated that the HER2/neu was not statistically related with histological type of the tumor and age of the patients (P value=0.35, P value= 0.75, respectively). In this study, HER2/neu was statistically inversely associated with both ER and PR receptors (P value=0.03, P value=0.05, respectively).
Conclusion: HER2/neu is overexpressed by immunohistochemistry in 17%. HER2/neu is amplified by FISH (in equivocal cases) in 28%. HER2/neu is statistically significant correlation with tumor grade, and is in inverse statistically significant correlation with estrogen and progesterone receptors while not statistically significant with age and histological types of tumors.

The Frequency of Blood Donors and Polycythemia among General Population in Nineveh Governorate, Iraq.

Rana Nidam Al-Deen Al-Nuri

Annals of the College of Medicine, Mosul, 2020, Volume 42, Issue 2, Pages 141-147
DOI: 10.33899/mmed.2020.128424.1049

abstract:
Objectives: the aim of the study is to determine the percentages of blood donors among general population in Mosul, Nineveh, Iraq, in an attempt to increase their proportion through encouraging healthy voluntary donation. Then to report the issue of polycythemia and discouraging the contributing unhealthy habits like smoking, especially among young people.
Methods: subjects enrolled in this study were the blood donors at Mosul Central Blood Bank in Nineveh, Iraq. Data were reviewed retrospectively, from March, 2019 to March 2020. For whole blood donors in general and for polycythemic ones, who donate blood as a therapeutic measure.
Results: the total number of donors were 36940. Percentage of blood donors among general population was 2.27 %, while 99.43 % were male donors. Prevalence of polycythemic subjects among general population of Mosul city was 0.04 %, among blood donors was 1.65 %. while 88.87 % of polycythemic donors were male, and the distribution of polycythemia was higher in those aged 35 years and less (38.46 %).
Conclusions: the percentages of blood donors in general population was low, which need to increase through encouragement and improve commitment. The prevalence of polycythemic subjects in those aged ≤ 35 years was high which necessity intensification of the awareness among those productive age groups.

The Effect of Maternal Obesity on The Placental Histology

Harith Al-Ali; luma Al-Allaf

Annals of the College of Medicine, Mosul, 2020, Volume 42, Issue 2, Pages 148-156
DOI: 10.33899/mmed.2020.127435.1038

Background: Obesity become one of the most universal medical problem that affect women at reproductive periods. . It has complicated drawbacks in mother and child appeared immediately or after long time.
Aims: so the aim of this study to evaluate the placental histological changes of obese mothers in comparison to women with normal body mass index.
Methods: This work is prospective case- control study which were examined placentas that were obtained from 40 singleton pregnant women who delivered at Al-Khanssa Maternity Teaching Hospital, Mosul, Northern of Iraq starting from December 2019 to February 2020. The women were classified into two groups: Group 1 which includes 20 women with BMI ranged between 18-24.9 kg/m2, and Group 2 which includes 20 women with BMI ≥ 30. Two placental biopsies were obtained from maternal side and fetal side of each case and submitted for histological examination via light examination.
Results: The histopathological examination of placental sections obtained from obese mothers showed several placental changes compared to those of control group. The most frequent feature among these sections is the presence of syncytial knotting in 13(65%) out of 20 placentas.In addition, features of hypovascular villi, villous fibrinoid necrosis are noticed in 10 (50%) of these sections, while thickening of trophoblastic basement membrane was occur in 9 (45%) of these sections. On the other hand, the histopathological examination of placental sections obtained from obese mothers revealed presence of perivillous fibrin deposition which was appeared in 10 (50%) of these sections .Features of stromal fibrosis were noticed in (40%) of sections. Other placental changes are seen in placental sections obtained from obese mothers including presence of nucleated red blood cells (NRBC) in fetal capillaries, chorangiosis, villous edema, paucity of vasculosyncytial membrane VSM, inflammation, apoptosis and decidual fibrinoid necrosis.
Conclusion: this work revealed a marked increase in the frequencies of different placental changes in obese mothers in comparison with controls. Further studies are recommended to clarify the exact mechanisms that stand behind these histological changes.

Hematological parameters of β-thalassemia Trait in Premarital Screening in Nineveh Province

bassma adnan; Professor Muna Abdulbasit Kashmoola Abdulbasit Kashmoola

Annals of the College of Medicine, Mosul, 2020, Volume 42, Issue 2, Pages 157-161
DOI: 10.33899/mmed.2020.128666.1052

ABSTRACT
Background: β-Thalassaemia syndromes are inherited group of abnormalities of hemoglobin synthesis. These abnormalities characterized by a defect in β-globin genes which may result either in the reduction or absence of one or more of the β-globin chains of hemoglobin. This genetic defect can be homozygous or heterozygous.
Aim of this study was to detect the hematological parameters of β-thalassaemia trait in premarital screening individuals in Nineveh province.
Subjects and Methods: This is a cross sectional study that was performed in Nineveh province in three main centers for premarital screening program. In the period between the 15 November 2019 and the 15 May 2020 a total of 1127 subjects who attend to these centers were screened for carrier conditions of β-thalassemia. Blood samples of the couples were obtained during attendance to the marriage office. Complete blood counts and hemoglobin variant analysis were performed with automated counter and high performance liquid chromatography technique.
Results : Out of 1127, β-thalassaemia trait was diagnosed in 47 subjects, 31 were male (66 %) and 16 were female (34 %). The mean of their hemoglobins was 14.4 g/dl in males, and 12.5 g/dl in females. The mean of mean cell volume and mean cell hemoglobin were 68.3fl and 22.4pg respectively. The mean for HbA2 concentration was 4.9 % and for HbF was 1.2%.
Conclusion: β-thalassaemia trait is usually presented with low MCV and/or low MCH but the accurate and dependable technique in detecting carriers is the use of High Performance Liquid Chromatography (HPLC).

Evaluation of Interleukin- 6 in Lymphoma

Anfal Saleh Mohammed AL-jubory; Sanaa mohammed taib Al- Hayali

Annals of the College of Medicine, Mosul, 2020, Volume 42, Issue 2, Pages 162-168
DOI: 10.33899/mmed.2020.128731.1057

ABSTRACT
Background: Cytokines play a pivotal role in lymphoma ,cytokines either can be produced or exert effects on neoplastic or reactive cells. The elevated level of cytokines can contribute to the clinical and histopathologic alterations associated with malignant lymphoma.
Objectives: to assess the level of IL-6 in newly diagnosed lymphoma patients in relation to their level in normal control subjects and to evaluate the correlation between IL-6 and hemoglobin (Hb), stage of disease and B-symptoms ,age and sex.
Methods: This is a case control study, a total of 40 patients with lymphoma (HL & NHL) who attended private Clincs and hospitals in Mosul city and 40 age and sex matched control were included. A venous blood sample were taken for Complete blood count, Retic and IL-6 level. Enzyme-linked immunosorbent assay(ELISA)was used to determined IL-6 level.
Results: There were a significant difference between the mean level of IL-6 of lymphoma cases and control (p-value=0.00). In the subset of patients with anemia, IL-6 levels inversely correlated with hemoglobin levels (p-value=0.00). There was significant correlation between IL-6 and patients with more advanced stage Ⅲ- IV disease(p-value=0.04). there was positive correlation between IL-6 levels and B-symptoms)p=0.05(
Conclusion: IL-6 level was elevated in lymphoma and it was significantly higher in lymphoma patients .IL-6 plays important role in the development of anemia in lymphoma.The adverse impact of elevated IL-6 is consistent with demonstration of higher level of IL-6 in patients with advanced stage of disease.

Comparative study between sharp dissection and electro cautery dissection in incisional hernia surgery.

Omar Saad Mahmood; khalaf rasheed jadoa

Annals of the College of Medicine, Mosul, 2020, Volume 42, Issue 2, Pages 169-176
DOI: 10.33899/mmed.2020.128390.1048

Background: Incisional hernia is a common problem in our surgical practice and it poses a challenge due to its high incidence of complications like seroma and surgical site infection (SSI).
The objective of this study is to assess the contribution of diathermy to postoperative seroma formation and wound complications in incisional hernia surgery and also to assess other predictors for wound complications including comorbidities, personal and hernia characteristics.
Patients and Methods: This is a prospective case series study comparing two types of flap dissection in cases of open incisional hernia mesh repair. Sixty patients randomized in to two groups of abdominal flap dissection, one group with electro cautery dissection and other group with sharp dissection by scissors and knife. Surgical procedure was the same between the two groups. Primary outcome measures were postoperative seroma, SSI and wound dehiscence.
Results: There was no significant difference in seroma formation (p=0.738), SSI rate (p=0.641) and wound dehiscence rate (p=0.150) between the electro cautery group and the sharp dissection group. The use of cautery leads to reduction in the intraoperative blood loss (p<0.0001) and operative time (p<0.0001). The relation between body mass index (BMI), diabetes mellitus (DM), hernia length, width and postoperative seroma was highly significant (p=0.002, 0.034, 0.002, Conclusions: The use of cautery instead of scissors during flap dissection does not result in increased postoperative wound complications in incisional hernia patients. The use of cautery lead to reduction in the operative time and intraoperative blood loss. The relation between DM, BMI, hernia defect size and increased rate of wound complications was significant.

Obesity, adipose tissue types and adipocytokines

Nuha Shareef; Maryam Hani Abduljalal

Annals of the College of Medicine, Mosul, 2020, Volume 42, Issue 2, Pages 177-183
DOI: 10.33899/mmed.2020.128256.1045

The prevalence of obesity has increased worldwide in the last 50 years, reaching pandemic levels. The etiology of obesity is multifactorial, involving a complex of interaction among genetics, hormones and the environment. The adipose tissue plays a central role in regulating whole body energy. In one hand, the adipose tissue stores energy in the form of lipid and controls the lipid mobilization and distribution in the body, and on the other hand, adipose tissue acts as an endocrine organ and produces numerous bioactive factors such as adipocytokines. Moreover, brown and beige adipose tissue burn lipid by dissipating energy in the form of heat to maintain euthermia and have been considered as a new way to counteract obesity. In this review, we will summarize the recent findings of the types of adipose tissue and their role in controlling metabolism, focusing on its endocrine function. This review describes the molecular actions and clinical significance of the some important adipocytokines.

complications related to posterior hypospadias repair

Professor Abdulrahman sulaiman; Thayer Mohammed Ameen Aboush; ahmad mothafar hamodat

Annals of the College of Medicine, Mosul, 2020, Volume 42, Issue 2, Pages 184-189
DOI: 10.33899/mmed.2021.128957.1060

Background: Proximal hypospadias repair carries high complications rates. single
stage is the standard practice for management but sometimes it is not easy to perform
single stage for posterior hypospadias and here appears the need for staged surgery
in this study we assess the out coms and complications of the most commonly used
techniques in Mosul pediatric surgery center at alkhansaa teaching hospital
Objective: To assess the results of management of posterior hypospadias by
Tubularized incised plate as single stage and staged repair and to knew the most
important complications associated with these two procedures.
Methods: this is prospective study for forty patients who were admitted to Mosul
pediatric surgery center at alkhansaa teaching hospital from October 2011 till
October 2013, their age ranged from 9 month to 15 years, five of them were operated
before with complete failure, 31 patient operated by single stage Tubularized Incised
Plate technique and the other 9 by two stage technique and they were followed for
6-18 months.
Results: The total complications rate was (52%) as follow: (7) cases (17.5%)
develop meatal stenosis, (4) patients (10%) develop retrusive meatus, No one
develops stricture, (10) cases (25%) develop fistula and none of them develop
diverticulum,
the total complication rate for Single stage TIP technique was (48.3%) the total
complication rate of complications for staged surgery was (66.6%).
Conclusion: proximal hypospadias repair is very challenging with high
complication rate which need a good experience to deal with it. Single stage or
multistage procedure can be utilized to repair this type of hypospadias. Most of the
published papers has low number of cases in comparison to the anterior type which
represent 70_80% of all cases and for that reason may be the great difference in
between different centers in the incidence of complications rate.

Incidentally diagnosed papillary carcinoma in a thyroglossal duct cyst. What is the next step? A case report and review of the literature

Professor Nashwan mahgoob

Annals of the College of Medicine, Mosul, 2020, Volume 42, Issue 2, Pages 184-189
DOI: 10.33899/mmed.2020.127674.1042

Thyroglossal duct cyst is the commonest congenital disorders of the thyroid gland. Rarely, it can be a malignant tumor which is picked up incidentally in postoperative histopathology. Although management is still a controversy, a careful treatment and follow up planning is necessary for the management of such condition. We present a case of a 16-year-old female patient with thyroglossal duct cyst carcinoma.

The white banner test. A simple intra-operative leak test during laparoscopic sleeve gastrectomy.

Professor Nashwan mahgoob

Annals of the College of Medicine, Mosul, 2020, Volume 42, Issue 2, Pages 190-194
DOI: 10.33899/mmed.2020.127882.1043

ABSTRACT:
Objective: To evaluate the efficacy of a simple intra-operative test (white banner test) for the detection of a leak during laparoscopic sleeve gastrectomy.
Design: A prospective case series study.
Setting: Obesity center at Soran private hospital, Erbil, Iraq, during the period from January 2017 to June 2019.
Participants: eighty patients underwent the white banner test during laparoscopic sleeve gastrectomy. The records of intraoperative findings and post-operative follow up were analyzed.
Patients and methods: After completing the sleeve process and hemostasis, a gauze of 4*12 cm was introduced through the 12mm trocar and displayed along the course of remaining sleeved stomach, nasogastric tube inserted to the upper portion of the stomach, compression of the pylorus by grasper against the vertebrae, 100 milliliters of saline stained by methylene blue dye were injected slowly by the anesthetist through the nasogastric tube, waiting for 30 seconds, any discoloration of the gauze was recorded and the site of leak (if any) was identified and managed. If the gauze appeared white, gauze withdrawn and the procedure finished.
Results: In 80 patients, only two patients showed a blue spot at the gauze, which were fixed by suture. In all other patients, the gauzes were completely clean and (white). Postoperatively no early leak was detected.
Conclusion: This is a simple and not time-consuming intraoperative procedure that can be used to detect intra-operative leaks during laparoscopic sleeve gastrectomy.
Keywords: obesity. Sleeve gastrectomy. Leak. Intraoperative test.
Acknowledgment: The author thanks all the staff who works at the obesity center at Soran Private Hospital for their unlimited support for this study.
The study received no outside funding and no relevant financial disclosures.
The researcher declares that there is no conflict of interest regarding the publication of this research

RARE AND DEMANDING: PARATHYROID ADENOMA LOCALIZATION, SURGERY AND OUTCOME.

Saad Muawafaq Attash; Nazar Mohammed Jawhar; Mohammed tahseen yahya; Professor Muzahm K. Al-Khyatt

Annals of the College of Medicine, Mosul, 2020, Volume 42, Issue 2, Pages 199-206
DOI: 10.33899/mmed.2020.128441.1050

ABSTRACT
Objectives: To assess the methods of preoperative parathyroid adenoma localization and to compare it with operative findings.
Patients and methods: Between June 2017 and June 2019, we had operated 8 cases of parathyroid adenomas. Three patients were males and 5 patients were females. Age ranged from 26 year old to 72 year old with average of 42 year old. Seven cases were sporadic while one case was part of MEN2a. All patients had ultrasonography for preoperative localization, all had CT scan and 4 patients had Sestamibi scan. In all patients, intraoperative measurements of parathyroid hormone was done before and 10 minutes after surgical excision.
Results: Ultrasonography was successful in localizing only one case with certainty. CT scan located the adenoma in another 2 patients. In 4 patients who performed Sestamibi scan, the adenomas were located precisely in all of them including one case of ectopic parathyroid adenoma behind the sternum. In one patient, all the modalities failed in localization which was achieved easily intraoperatively. Single adenoma was found in 6 patients and two adenomas in two patients. The adenomas were located in the neck in 7 patients and in the anterior mediastinum in one patient .Surgical removal was done through neck incision in 7 cases while midline sternotomy in one case. All the patients had resolution of symptoms within the follow up period.
Conclusion: Sestamibi scan is the best investigation in preoperative localization of parathyroid adenoma. Ultrasonography and CT scan can aid in the diagnosis with less sensitivity. Intraoperative localization is possible even in cases of negative investigations.

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.

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.
.

Degloving and skin realignments or dorsal dartous flap technique in management of isolated penile torsion in pediatrics

Ahmad M. Hamodat; Bassam Kh. Al-Abbasi

Annals of the College of Medicine, Mosul, 2013, Volume 39, Issue 1, Pages 89-93
DOI: 10.33899/mmed.2013.75990

ABSTRACT
Objective: To evaluate the proper technique used for management of penile torsion in pediatrics in relation to degree of torsion.
Patients and methods: From February 2008 to December 2010, 54 patients were assessed for the degree of penile torsion at pediatric surgery center at Al-Khansaa Teaching Hospital in Mosul. The angle of torsion was assessed using a digital photograph of the penis and classified into three grades, Mild with 15 - 30 degree angle of torsion, moderate with 45-90 degree angle of torsion and sever with 100-170 degree angle of torsion.
Two techniques were used for repairing the torsion, the degloving and skin realignment technique for the mild condition and dorsal dartous flap technique for the moderate and severe types. All operations were done as a day case procedure. No catheter used.
Results: Forty five patients (83%) were discovered accidentally while assessing for circumcision or other problems, 30 patients (55%) were in the first year of life, 50 patients (93%) have a counter clock wise direction of torsion (to the left) while only 4 patients (7%) have a clockwise direction (to the right). Thirty five patients (65%) classified as mild torsion, while 16 patients (29.5%) have moderate degree of torsion and only 3 patients (5.5%) severe degree. Degloving and realignment of skin were used for the mild condition in 35 patients (65%) while dorsal dartous flap technique was confined for moderate (29.5%) and both procedures used for severe type patients (5.5%).
Conclusion: Simple realignment technique during circumcision was enough to manage the mild degree, while in severe degree, dorsal dartous flap rotation seems to be more effective. There were no complications, and good cosmetic results were obtained.

Keywords: Penile torsion, degloving, dorsal dartous flap.

Spontaneous healing of traumatic perforations ofthe tympanic membrane

Salim H. Al-Obiedi

Annals of the College of Medicine, Mosul, 2009, Volume 35, Issue 1, Pages 26-32
DOI: 10.33899/mmed.2009.8889

ABSTRACTObjective: To study the spontaneous healing of various types of traumatic perforations of the tympanic membrane in a prospective study carried out on patients with traumatic perforations of the tympanic membrane, presented to same author.Methods: Eighty patients with 84 traumatic perforations of the tympanic membrane were studied at Tikrit Teaching Hospital, during the period from Jan. to Dec. 2007. Diagnosis made by a history of trauma and otoscopic examination. Antibiotics were given to prevent or treat infections. Advice to keep the ear dry. Follow up the patients for a minimum of six months.Results: The male: female ratio was (2.6:1). Left ear perforation was more than right ear, (5%) were bilateral. The commonest cause was blast injury in 34 patients (43%), then hand slap in 22 patients (27.5%). The age of the patients was from 4-65 years, common age group affected was (21-30 years), they were 39 patients (49%). Spontaneous healing occurred in 69 cases (82%), persistent dry perforation in 8 cases (9.5%), and 7 cases (8.5%) ended with chronic suppurative otitis media. Fifty-six cases (81%) got complete healing within six weeks. All cases due to fractures of temporal bone got spontaneous healing (100%), then perforation by foreign body and instrumentation (89%), ear syringing, and hand slap was equal (88%), then due to ear suction (80%), and the lower incidence in blast injury were (75%). Healing of posterior and anterior perforations about equal (92%), (91%) respectively, then kidney shape perforation (85%), but none of 7 cases of subtotal perforations healed spontaneously.Conclusion: Conservative care for traumatic perforations of the tympanic membrane gives excellent chance for spontaneous healing. The factors affecting spontaneous healing include, large size perforations, ear infections, type of trauma, and Eustachian tube dysfunction.Keywords: Traumatic perforation; tympanic membrane; spontaneous healing.

Evaluation of causes of acute hip pain in children at Erbil teaching hospital

Sherwan J. Shareef; Zohair M. Al-Saffar

Annals of the College of Medicine, Mosul, 2011, Volume 37, Issue 1, Pages 103-109
DOI: 10.33899/mmed.2011.34732

Objectives: Painful hip in children is a common pediatric problem and there are several causes for hip pain. In this study we will show the most common causes of hip pain in children and evaluate the procedures performed at our hospital, with a view of establishing which parameters most relevant to make a clinical decision.
Methods: This is a case review study which was carried out at Erbil Teaching Hospital between December 2006 and October 2007. Sixty two patients who had con¬sultations and/or been admitted at our hospital complaining of hip pain were included in this study. We did investigations for them and we reviewed their clinical, laboratory and imaging documents.
Results: The differential diagnosis was transient synovitis (TS) 54.8%, Legg-Calves-Perthes disease 24.2%, septic arthritis (SA) 8.1%, traumatic synovitis 4.8%, avulsion fractures 3.2 %, brucellosis 1.6%, tuberculosis 1.6%, and non specific synovitis 1.6%. We found that three or more criteria,(the clinical and laboratory parameters), were present in all cases of septic arthritis (100% sensitivity), but also were present in 10% of non septic conditions (90% specificity). Radiographs showed abnormalities in 50% of the cases. Ultrasound showed joint effusion in 43 patients with 100% of sensitivity.
Conclusions: Transient synovitis is the most common cause of irritable hip. Application of our scheme might result in a reduction of the number of patients who need hospital admission and also reduction of invasive procedures and containment of the cost.

Keywords: Diagnosis of painful hip.

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.

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.

Evaluation of Chronic Gastritis in Endoscopic Antral Biopsies Using the Up-dated Sydney System

Hayfa A. Hussein

Annals of the College of Medicine, Mosul, 2019, Volume 41, Issue 2, Pages 95-105
DOI: 10.33899/mmed.2020.164150

Objectives: To evaluate the histological parameters of chronic gastritis in endoscopic antral biopsies, to grade them according to the up-dated Sydney system and to compare the obtained results with those of others.
Methods:From the 1st of July 2018 to the end of December 2018,100 endoscopic antral gastric biopsies were submitted to the Histopathology Unit in Al-Salam Teaching Hospital in Mosul, obtained from patients complaining of different clinical symptoms and referred for upper gastrointestinal endoscopy. Biopsies were assessed for the histological parameters of chronic gastritis and were also graded using the visual analogue scale of the up- dated Sydney system.
Results:The 100 biopsies belonged to 42 males and 58 females ranging from 9-85 years old with a mean of 42.7 years and a peak age incidence in the fourth decade. The commonest symptom was epigastric pain in (46%) of cases. Antral gastritis was the major endoscopic finding in (66%) of cases. All cases revealed mononuclear cell infiltration(100%), followed by neutrophilic activity (84%), glandular atrophy(22%), intestinal metaplasia(14%) and dysplasia(9%).Helicobacter pylori (H. pylori) was detected in(77%) of cases and a significant statistical association was found between
H. pylori and each of: mononuclear cell infiltration(P<0.001), neutrophilic activity (P<0.001) and glandular atrophy (P<0.05). while insignificant statistical association was observed between H. pylori and both intestinal metaplasia and dysplasia (P>0.05).
Conclusion:Histopathological study of endoscopic antral gastric biopsy is of value in detection of H. pylori and various histological changes of chronic gastritis. A statistically significant association was found between H. pylori and each of : mononuclear cell infiltration, neutrophilic activity and glandular atrophy. Dysplasia is an important histological change in chronic gastritis that requires endoscopic follow up to rule out the possibility of gastric cancer, and it is advisable to be incorporated in the visual analogue scale of the up-dated Sydney system.

Nerve conduction and electromyography in rheumatoid arthritis patients: a case - control study

Hakki M. Majdal; Shakir M. Sulaiman; Mohammed E. Sulaiman

Annals of the College of Medicine, Mosul, 2012, Volume 38, Issue 2, Pages 44-51
DOI: 10.33899/mmed.2012.64587

ABSTRACT
Objectives: This study aims to assess peripheral nerve conduction and electromyographic function abnormalities in patients with rheumatoid arthritis.
Subjects and methods: One hundred normal subjects and rheumatoid arthritis patients for each were included in this study, the normal subjects were matched regarding the age and sex with rheumatoid arthritis patients, rheumatoid arthritis patients were diagnosed according to American revised criteria (ARC) 1987; at the Department of Rheumatology in Ibn-Sina Teaching Hospital in Mosul city during the period of 15th of November 2009 - 15th of May 2010. Nerve conduction study for median, ulnar, radial (motor and sensory), posterior tibial and common peroneal nerves were done for all normal subjects and rheumatoid arthritis patients by using system 98-MyoQuik (micromed) EMG. Electromyography for tibialis anterior, gastrocnemius and quadriceps muscles were done for normal subjects and rheumatoid arthritis patients by using Dantec- Neuromatic 2000M-EMG.
Results: In this study, peripheral neuropathy was detected in 54 patients (54%); mononeuritis simplex was the commonest lesion and detected in 36 patients (66.6%) out of the 54 patients. The entrapment neuropathy was found in 25 patients (46.74%), affecting the median (24.07%), posterior tibial (14.81%) and ulnar (7.40%) nerves. Mononeuritis multiplex was detected in 11 patients (20.37%), and symmetrical polyneuropathy found in 7 patients (12.90%).
In the present study, the axonopathy (due to vasculitis mainly), and local demylination (due to entrapment mainly), were the common types of nerve injury seen in rheumatoid arthritis patients. Muscle involvement could be detected by electromyography in rheumatoid arthritis patients in this study.
Conclusion: Neurogenic lesions were present, while no myogenic lesion was detected in patients with rheumatoid arthritis.

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