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

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

Hayfa A. Hussein

Annals of the College of Medicine, Mosul, 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.

Antiphospholipid Antibodies in Patients with Type 2 Diabetes Mellitus

Nada Abdullah Hasso; Ahmed Moayed Hussain; Ali Salah Fatheel

Annals of the College of Medicine, Mosul, Volume 41, Issue 2, Pages 106-111
DOI: 10.33899/mmed.2020.164151

Patients with diabetes mellitus type 2 have a greater risk of accelerated atherosclerosis. Antiphospholipid antibodies(aPL)are associated with greater risk for thrombosis. To demonstrate the possible role of anticardiolipin(aCL) and anti-β2 glycoprotein(β2 GP1) antibodies in such patients, we investigate the presence of these antibodies in a group of type 2 diabetic patients.
Objectives: 1. To investigate the presence of anticardiolipin IgM and IgG antibodies and anti-β2 GP1 IgG antibodies in diabetic patients and compare them with a control group.
2. To analyze their potential implication in the occurrence of vasculopathy in such patients.
Patients and Methods: Fifty patients with type 2 diabetes mellitus and 33 healthy subjects were included in the study. Each blood sample was tested for IgM, IgG aCL antibodies and for anti-β2 GP1 IgG antibodies.
Results:  Seven patients were positive for aCL IgM, 6 were positive for aCL IgG and 4 patients were positive for anti-β2 GP1 IgG antibodies. There was no differences in the means of IgM, IgG aCL and anti-β2 GP1 IgG antibodies titers in patients with complicated and uncomplicated diabetes mellitus.
Conclusion:
 The aCL and β2 GP1 antibodies positive titer means among type2 diabetics were significantly higher than non-diabetic subjects.
 Positive but low titers of aCL and β2 GPI antibodies could suggest that these autoantibodies may play a minor role in the pathogenesis of atherosclerosis.
Low titers of aCL and β2 GPI antibodies were seen in complicated and non-complicated diabetic populations that probably lessen the importance of these autoantibodies as effective contributors in the pathogenesis of diabetic vasculopathy.               

Biomarkers of Oxidative Stress in Polycystic Ovary Disorder

Fatimah Haitham Fathi

Annals of the College of Medicine, Mosul, Volume 41, Issue 2, Pages 112-116
DOI: 10.33899/mmed.2020.164152

Background: oxidative stress(OS) happens when harmful reactive oxygen species (ROS) exceed antioxidants leading to damage of lipid, protein and DNA. OS was documented to participate in pathogenesis and complication of polycystic ovary syndrome(PCOS). PCOS is a common endocrine disorder, with incidence 4-12% between female at fertility period that leads to anovulation and infertility. This syndrome is accompanied with over production of androgen and dysfunction of ovaries which are associated by classical signs and/or symptoms and biochemical characteristics comprising hirsutism, acne, ultrasonic feature of polycystic ovaries, irregular menstrual period, adiposity, dyslipidemia, decrease insulin sensitivity and prediabetes.
Aim of the Study: to evaluate biomarkers levels of oxidative stress in women with PCOS and in healthy control women. This evaluation is necessary to show the effect of oxidative stress on sex hormonal profile of women with PCOS.
Participants and Methods: thirty women (16-38 year) with PCOS and thirty matched age women were enrolled to evaluate oxidative status by measuring serum levels of malondialdehyde(MDA) concentration and total antioxidant capacity(TAC) in all participants.
Results: Women with Polycystic ovary exhibited significantly increased means of MDA levels and significantly decreased mean of TAC levels when compared to healthy participants.
Conclusion: it concluded from this study there is a disturbance of oxidant and antioxidant profile in PCO women supposes a status of oxidative stress, guided by high level of oxidative stress biomarker of lipid peroxidation (MDA) and decreased antioxidant defense mechanism which indicated by TAC. Moreover, the oxidative stress biomarkers can be employed as indicator in early diagnosis of PCOS and utilization of them in monitoring and preventing further complication of it.

The Frequency of Allergic Bronchopulmonary Aspergillosis in Patients with Asthma

Mahdi Saleh Mahdi; Samet Alyas Qasim; Ali Abdulmuttalib

Annals of the College of Medicine, Mosul, Volume 41, Issue 2, Pages 117-124
DOI: 10.33899/mmed.2020.164153

Background: Allergic bronchopulmonary aspergillosis ABPA is an unusual but not rare illness that affects young atopic adults with allergic asthma. There are clinical and laboratory tests for the diagnosis of ABPA, these tests include history of asthma, peripheral blood eosinophilia, immediate cutaneous reactivity to Aspergillus fumigatus, serum precipitating antibodies to A. fumigatus or elevated total serum IgE and radiological infiltration.
Objectives: This is a case control study designed to evaluate the frequency ofallergic bronchopulmonary aspergillosis ABPAin patients with asthma.
Methods: This is a case control study carried on 150 asthmatic patients consulting the allergic disease center of Aljumhori Teaching Hospital in Mosul for the period from November 2003 to July 2004 to identify patients with allergic bronchopulmonary aspergillosis ABPA. Their ages ranged from 6-65 years, 52% of them were females and 48% were males. The results were compared with a 60 apparently healthy individuals selected randomly as a control group.
To prove that patients’ symptoms were allergic bronchopulmonary aspergillosis ABPA, the following tests were performed for all patients, peripheral eosinophilia which was found in 40.6% of asthmatic patients, skin test for Aspergillus which was positive in 51.3%, ELISA test for total IgE which was positive in 28% and chest-X ray abnormalities were found in 17.3% of patients mainly as pulmonary infiltration.
Results:The major criteria for allergic bronchopulmonary aspergillosis ABPA were found in 19(12.6%) patients out of 150.  Moreover, it was significantly higher in most age groups mainly in those patients between 6-15 years and 16-25 years of age. Peripheral eosinophilia, Skin test, ELISA and CXR did not appear to be related to the sex of patients or duration of asthma, but they were significantly higher than the control group (P<0.05) in those with atopic asthma associated with other allergic diseases as eczema, urticaria, rhinitis and conjunctivitis.
Conclusion:The current study revealed that 12.6% of asthmatic patients fulfill the criteria of allergic bronchopulmonary aspergillosis ABPA and there was a significant relationship between asthma and Aspergillus fumigatus as a risk factor.

Fluctuation of Serum Leptin Through Menstrual Cycle in Young Fertile Women in Mosul City

Rajaa A. yonis; Fadhila S. Al-Doski

Annals of the College of Medicine, Mosul, Volume 41, Issue 2, Pages 125-131
DOI: 10.33899/mmed.2020.164154

Background:  Leptin  is a hormone secreted by adipocytes , it is aprotein  encoded by the ob gene.  Mutations in the ob gene in animals  cause obesity , leptin affects  nutritional homeostasis  and  reproductive function.
Objectives : a  followup  study  was done  to  investigate serum leptin  levels in 30  fertile healthy normal weight  women with regular menstrual  cycle aged (8-45) years   in folicular and luteal phase of menstrual cycle.
Methods: Fasting  blood samples were obtained from normal weight fertile women(BMI 19.5-24.9 Kg/m2) to measurement   serum  concentrations  of  leptin, which  measured  by  using( ELISA)  in follicular phase (2nd day of menstriual cycle )  then ask the women to come back  and  give another blood sample in 21st- 23nd day of the cycle to measure serum progesterone and leptin in luteal phase of the menstrual cycle.
Results: The mean  age ± SD  of the normal fertile women  was (29.1± 8.4) years, the mean weight  value ±SD  was (53±5)kg  and  the mean height   value±SD was(158 ± 6.2) cm and the mean BMI±SD  was (21.2± 1.3).
    Leptin was higher in luteal phase than follicular phase in normal weight  fertile women ,this was statistically significant (p≤ 0.000), the mean   ± SD of progesterone hormone  was (7.8 ± 3.2 ) in day 21-23 of the cycle this was the indicator  for ovulation and starting of luteal phase.
Conclusion: A great variation in serum leptin levels throughout the menstrual cycles with lower  levels in the follicular rather than luteal phase in normal weight fertile women is found.

Frequency of Osteoporosis in Patients with Coronary Heart Disease

Jasim Mohammed Taib Al-Hayali; Abd Al-Razak Salim Mahdy

Annals of the College of Medicine, Mosul, Volume 41, Issue 2, Pages 132-138
DOI: 10.33899/mmed.2020.164155

Objectives: To explore and discuss the  possible  relationship  between coronary  artery disease and osteoporosis  in men and in postmenopausal women  in  comparison with healthy control.
Patients and methods: Fifty patients  with ischemic heart diseases, with positive catheterization  results whose ages range between 45 - 65 years old were enrolled  in  the study and referred as Group A.  Fifty  aapparently healthy  subjects, matched for  e with  the patients group ,  were kept as control  group and referred as Group B. We divided the patients understudy into two groups based on the mineral density they have; these groups are  osteoporosis  groupand normal bone mass group .
Results: The frequency  of bone density by using Dexa (T-score)  in studied  subjects  in Group A were normal (T-score=  5.5  to -0.9) in 34 (68%) subjects,  osteopenia  (T• score= -1  to -2.4) in  11  (22%) subjects, and osteoporosis  (T-score  = -2.5)  in 5 (10%) subjects.  For Group B,  32 (64%) hainormal   Dexa results, 17 (34%) were osteopenic,  and 1   (2%) had osteoporosis.
The study has found that the relationship between the two groups was not statistically significant when tested by the chi square test.
Conclusion: There was no relationship  between osteoporosis  and cardiovascular diseases. Gender had no effects on osteoporosis.

Helicobacter pylori in Gastric biopsy: A Histochemical and Immunohistochemical Assessment

Zainab Waleed Aziz; Shuaib Hashim Saleem; Hatim Abdulmajeed Al-Nuaimy

Annals of the College of Medicine, Mosul, Volume 41, Issue 2, Pages 139-147
DOI: 10.33899/mmed.2020.164156

Background: Helicobacter species pylori represent one of the medically prominent and most common infections in the world. Contamination with this microbe has set as a causal factor in the development of gastritis, peptic ulcer, and gastric neoplasia. Consequently, prompt diagnosis is essential.
Objectives: This study was conveyed to detect H.pylori in gastric biopsies specimens by using routine Hematoxylin, Modified Giemsa dye as well as immunohistochemical stain, besides to assess the specificity and sensitivity of Helicobacter microbe detection in each method.
Patients and methods:The research was both prospective and retrospective, carried out on 100 cases of endoscopically obtained gastric biopsies. Data obtained from archives of the pathology department, at      AL-Jamhuri Teaching Hospital, Mosul city, and collected in a period spanning from April 2013 to March 2014. The information included; Age, sex, gastric biopsy location, inflammation status, the presence of dysplasia or carcinoma. Helicobacter pylori infection was assessed histochemically and immunohistochemically.
Results: In a total of 100  gastric samples, patients’ age range was 11 to 82 years (mean age of 46.5 years), with a male to female ratio of 1.38:1. Helicobacter pylori bacilli were positive with H&E/MGS in 71 (71%) of cases, increased to 75 (75%) case with IHC. Chronic gastritis noticed in 85 biopsy specimens, 74% were positive for H.pylori. There was a statistically significant difference between IHC and H&E/MGS (p=0.04) for detection of H.pylori. The sensibility and specificity of the H&E/MGS were measured compared with the recommended standard sensitive and specific IHC test; they were 95% and 100% respectively.
Conclusion: The routine ancillary stains request for the detection of H.pylori remains a laboratory and an institution right. This study revealed that, in our laboratory, the regular application of ancillary dyes is not obliged for the description of H.pylori because it was readily recognizable in the bulk of sections with haematoxylin staining. However, we recommend the use of IHC  in specific circumstances.

Antihyperglycemic effect of the alkaloids extracted from Adiantum capillus in diabetic rats

kawa dizaye; Roshna S. Aziz

Annals of the College of Medicine, Mosul, Volume 41, Issue 2, Pages 148-157
DOI: 10.33899/mmed.2020.164157

Background: Biomedical researches have long sought to develop novel therapies that are more effective, less costly and possess fewer side effects, to treat chronic diseases including diabetes mellitus. Adiantum capillus is among the medicinal plants that have been widely used in traditional medicine and are known to have hypoglycemic effects. This study was designed to find the chemical constituent of Adiantum capillus that exerts the hypoglycemic effect.
Materials and Methods: Fifty-four rats were split into nine groups. Twelve normal rats were included in the first group; six acted as negative controls and six were administered Adiantum capillus water extract. The second group was comprised of 42 streptozotocin-induced diabetic rats sectioned into seven subgroups of six rats. The first subgroup functioned as a positive control. The second subgroup was administered 100 mg/kg/day of Adiantum capillus aqueous extract for 21 days, while the third and the fourth subgroup received 50 mg/kg/day of metformin and acarbose respectively. The remaining three groups were administered alkaloids (4 mg/kg/day), flavonoids (24 mg/kg/day) and phenolic compounds (30 mg/kg/day) extracted from Adiantum capillus for 21 days. Fasting blood glucose levels, insulin levels, insulin resistance, serum amylase levels, C-peptide levels, liver function and renal function were monitored.
Results: The use of an Adiantum capillus aqueous extract in diabetic rats for 21 days effectively controlled blood glucose levels, elevated amylase level and improved renal and liver function. A significant decrease in blood glucose, AST, ALT, ALP and blood urea levels accompanied by significant increase in the serum amylase of diabetic rats was produced by the alkaloids extracted from Adiantum capillus. However, flavonoids and phenolic compounds did not cause any significant change in blood glucose levels.
Conclusion:It can be concluded that the alkaloids extracted from Adiantum capillus are the chemical constituent that contributes to the antihyperglycemic effect of the plant.

Intra-Gastric Balloon, an Aid for Weight Reduction in Obese Patient

nashwan mahgoob

Annals of the College of Medicine, Mosul, Volume 41, Issue 2, Pages 158-162
DOI: 10.33899/mmed.2020.164158

Background: we share our experience with an intra-gastric balloon to evaluate the safety, tolerability, and efficacy for patients with class one and two obesity. Methods: From January 2015 to January 2017, intra-gastric balloons were inserted in the stomachs of 85 patients at the endoscopy unit in CMC Hospital Erbil/Kurdistan/ Iraq. All the patients had a body mass index between 30 to 39 kg/m2 and were within the age range of 17-50 with a mean age of 29 years, there were 55 female 30 male patients, the patients underwent consent, pre balloon insertion investigation tests and anesthesia evaluation. The balloon was inserted via an upper endoscopy device after diagnostic study and then it was filled with 550-600 (mills) of stained saline. All patients' were given an analgesic and antiemetic for a week and anti-secretory proton pump inhibitors for 6 months. Diet and the importance of the exercise were part of the program phase and protocol during the period of the study. The balloon was removed after 6 months. The patients were followed during the 6 months of insertion and 6 months after the removal. The weight reduction and complications were documented and reported.                
Results: Satisfactory weight loss was obtained in 85% of patients after six months and 75% after 12 from insertion respectively.  One patient underwent early removal of the balloon after 7 days of insertion; another patient had balloon leak and shrinkage which necessitated replacement by another one.  Early postoperative pain and vomiting were universal but subsided in 90% during the first 10 days.                                                                                                     
Conclusion: in well-selected patients the intra-gastric balloon is an effective tool that can be used to achieve weight loss with minimum complications.                 

Local Effect of Intramuscular Injection of Meloxicam and Diclofenac: An Experimental, Comparative and Histological Study

Ahmed Hisham Qassim; Omar Riadh Hamdi; Ashraf Abdulraheem Ayoob; Mohammed Taib Taher

Annals of the College of Medicine, Mosul, Volume 41, Issue 2, Pages 163-169
DOI: 10.33899/mmed.2020.164159

Objectives: To compare the local effect of therapeutic doses of meloxicam and diclofenac on the muscle of rats at different periods by intramuscular injection.
Materials and methods: Thirty six adult albino rats were divided equally into 6 groups. The 1st and 2nd groups were injected intramuscularly with normal saline for 2 and 4 weeks respectively, the 3rd and 4th groups were injected intramuscularly with meloxicam for 2 and 4 weeks respectively, the last 2 groups were injected intramuscularly with diclofenac sodium also for 2 and 4 weeks respectively. The drugs were injected into the quadriceps femoris muscle of the right femur once each day till the end of the period stated. The specimens were histologically processed, stained with hematoxylin and eosin and examined with light microscope.
Results: No changes were seen in quadriceps femoris muscles of groups 1, 2, 3 and 4, whereas group 5 showed congested blood vessels within normal muscle tissue. In Group 6 mononuclear inflammatory cells infiltration, vascular congestion, fibrosis, degenerative changes and muscle tissue necrosis were seen.
Conclusion: Meloxicam is safer than diclofenac sodium on muscular tissue after a long-term daily intramuscular injection.

Virulence Factors of Yeasts Isolated From Oral Lesions

Nia am N. Jammil; Manahil M. Yehia

Annals of the College of Medicine, Mosul, Volume 41, Issue 2, Pages 170-177
DOI: 10.33899/mmed.2020.164160

Objectives: To detect the virulence factors of yeasts which are proteinase and phospholipase                 which have important role in the pathogenesis of oral lesions.                                                                                               Patients and methods: This study included 120 children manifested with oral lesions admitted to the Consultating Clinic and Medical Wards of   Ibn – Sina and Ibn Al – Ather Teaching Hospitals in addition to Neonatal Care Unit of Al – Battol Teaching Hospital. Samples collected during the period from December 2012 – May 2013. Control group was 60 apparently healthy children from whom oral swabs 'were obtained.  Identification' of' the isolated yeasts were conceded by "direct examination, culture, biochemical tests and API – 20 C system, then detection of' protienase and phospholipase of yeasts isolated from oral lesions".                                                       
Results: Candida albicans isolates have a high expression rate for the production of proteinase (95.3%) and phospholipase(97.1%) in comparison to the other candida and yeast species with a significant difference     (p = 0.001). 
Conclusion: The isolates produce two important virulence factors namely proteinase and phospholipase significantly more in Candida albicans than other yeasts.               

Foreign Body Inhalation: A shift in Clinical Pattern

Rabea S. A. Al Sofi; Ziad T. Mahmood; Omer M. T. Hammodat

Annals of the College of Medicine, Mosul, Volume 41, Issue 2, Pages 178-183
DOI: 10.33899/mmed.2020.164161

Background: Foreign body inhalation is a common presentation in thoracic surgery and it is well known to present mainly in toddlers, commonly due to sun flower seeds or water melon seeds.
Objectives: To determine the changes in clinical pattern of foreign body inhalation regarding the age, sex, and type of foreign body.
Methods: This is a case series study of patients with foreign body inhalation admitted to Al-Jumhori teaching hospital in Mosul. The parameters used in this study are sex, age group and type of foreign body.
Results: The main age group affected was adolescents, and the commonest foreign body inhaled was the veil pin.
Conclusion: The bad habit of holding pins in mouth while doing other things with your hand has led to this change in clinical pattern of foreign body inhalation.

The role of vitamin C and E in improving hearing loss in patients with type 2 diabetes

Marwan M. Merkhan; Kassim S. Abdullah

Annals of the College of Medicine, Mosul, Volume 41, Issue 2, Pages 184-189
DOI: 10.33899/mmed.2020.164162

Objective: to evaluate the effect of antioxidant vitamins on hearing loss in diabetic patients.
Patients and methods: Sixty type 2 diabetic patients with positive pure tone audiogram (PTA) enrolled in the study and divided into two groups: each group consists of thirty patients, group one was put on antioxidant therapy, and group two on placebo therapy, for 2 months duration. Thirty healthy individuals were kept as a control. Fasting blood sugar (FBS), and malondialdehyde (MDA) were measured in all groups. MDA and PTA were repeated after therapy.
Results: The FBS and MDA are higher in diabetic patients, and beneficial effects of the administration of vitamin E and C combination on the oxidative stress and significant improvement, with mean differences of 12.5±7.79 decibel (dB), in the sensorineural hearing loss (SNHL) in diabetic patients were obtained. Conclusion: the present study demonstrated that diabetic patients have exaggerated oxidative stress, and administration of vitamin E and C combination had beneficial effect on the oxidative stress, and on the SNHL in diabetic patients with mean differences of 12.5±7.79 dB (p<0.001).

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, 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.

Histological and Immunohistochemical Analysis of Special Compartments of Palatin Tonsils in Relation to Tonsillar Diseases

Zahraa A. Tabou; Abduljabbar Y. AL-Hubaity; Eklas A. Ali

Annals of the College of Medicine, Mosul, Volume 41, Issue 2, Pages 197-204
DOI: 10.33899/mmed.2020.164164

Background:The tonsils are lymphoepithelial tissue, it contains specialized lymphoid functional compartments which include the lymphoid follicles, parafollicular areas, crypt epithelium and high endothelial venules, which together have an essential role in the immunological process. These compartments may be altered histomorphologically throughout life time underneath common pathological condition.   
Aim:The aim of the current study is to evaluate special microstructural functional compartment changes as high endothelial venules, lymphoid follicles, interfollicular and connective tissue areas according to histopathological ground of the palatine tonsils.
Methods:one hundred palatine tonsillar samples which were attained from patients suffering from chronic tonsillitis, recurrent tonsillitis and obstructive hypertrophic tonsils were admitted at Al-Jumhuri Teaching Hospital and Al-salaam teaching hospital in Mosul city during the period from February 2018 to February 2019. Age of patients ranged from  (2-40) years. Specimens of tissue were directly fixed in 10% formalin then processed. Paraffin sections of 4μm thickness were exposed to routine stain with hematoxylin and eosin, while the studied marker (CD34) was detected by immunohistochemical method using labelled streptavidin-biotin (LSAB/HRP) method.
Results: The high endothelial venules found in the subepithelial compartments as well as with in the reticulated crypt epithelium were characterized by prominent nuclei of the endothelial cells with non-epithelial cells were found on the luminal side. The mean count of high endothelial venules was peak with statistically significant in recurrent tonsillitis and hypertrophic tonsil in both surface epithelium1.67±0.24, 0.78±0.22 and crypt epithelium1.89±0.31, 0.89±0.20 (p=0.046, p= 0.032) respectively. However the percentage of follicle area compartment in the tonsillar hypertrophic cases was greater than in other infectious tonsillar diseases (30.33%) respectively. Contradictory, the interfollicular and connective tissue areas reach their maximum in chronic tonsillitis.
Conclusion:The high endothelial venules are dispersed throughout the surface in addition to crypt epithelial. Follicular area percentage in the hypertrophic tonsils is higher than that in the chronic and recurrent tonsillitis group, representing a hyperplastic state of lymphoid cells in the germinal centers. It can also explain the alteration in immune defense mechanism underlying these pathological conditions.

Intra-gastric balloon, an aid for weight reduction in an obese patient

nashwan mahgoob

Annals of the College of Medicine, Mosul, In Press
DOI: 10.33899/mmed.2019.125957.1006

Background: To evaluate safety, tolerability, and efficacy of MedSil intragastric balloon for patients with class one and two obesity.
Methods: From January 2015 to January 2017, MedSil intragastric balloons were inserted in stomachs of 85 patients. All the patients had a body mass index between 30 to 39 kg/m2 and were within the age range of 17-50. There were 55 female and 30 male, the patients underwent consent, pre balloon insertion investigations and anesthesia evaluation. The balloon was inserted via an upper endoscopy after diagnostic study; it was filled with 550-600 milliliters of methylene blue stained saline. All patients' were received analgesic and antiemetic for a week and proton pump inhibitors for 6 months after the procedure, the patients followed a program protocol included diet and exercise. The balloon was removed after 6 months. The patients were followed during the period of insertion and 6 months after the retrieval of the balloon. The weight reduction and complications were reported.
Results: Satisfactory weight loss was obtained in 85% of patients after 6 months and 75% after 12 months from insertion respectively. One patient underwent early removal of the balloon; other patient had balloon leak which necessitated replacement. Early postoperative pain and vomiting were universal but subsided in 90% during the first 10 days.
Conclusion: The intragastric balloon can be effective to achieve weight loss with low complications in stage one and two obesity.

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, 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, 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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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, 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, 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, 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, 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.

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, 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.

Assessment of quality of life of amputee in war victims

Saad H. Murad; Bashar J. Al-Jawary

Annals of the College of Medicine, Mosul, Volume 34, Issue 1, Pages 42-53
DOI: 10.33899/mmed.2008.32521

Aims: To assess the quality of life (Q.o.L) of amputee patients and the relation with some variables.
Methodology: A descriptive study was carried out at Al-Mosul rehabilitation center during the period from 10th April to 30th June 2004. The sample of the study consisted of 160 amputee patients with lower limb amputation selected randomly. The data was collected by using assessment tool which consists of (66) items distributed to three domains (physical, psychological and social).
Results: The results of the study show that there are many problems in all areas through the amputee patient's life. The psychological problems come in the first rank among problems faced by amputee patients, while the physical and social aspects come later throughout the amputee patient life . Significant differences were found between the quality of life of amputee patient and variables of study (age, social status, level of education, urbanicity, level of amputation, reason of amputation and using assistance device).
Recommendations: The study recommended to establish rehabilitation centers to accommodate war victims; training program should be carried out in special workshop for vocational rehabilitation therapy and educational programs for families of amputee patients for care to provide and improve quality of their life.

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, 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.

Feasibility of percutaneous needle aspiration for the treatment of breast abscesses

Karam K. Younis

Annals of the College of Medicine, Mosul, Volume 39, Issue 1, Pages 65-69
DOI: 10.33899/mmed.2013.75960

ABSTRACT
Objective: To assess the feasibility and effectiveness of percutaneous needle aspiration under local anesthesia for the treatment of acute breast abscesses in the outpatient breast clinic.
Design: A retrospective study of forty three female patients with acute breast abscesses.
Setting: Breast clinic in Al Jamhoory teaching hospital in Mosul between February 2004 to February 2007.
Methods: Forty three patients with acute breast abscesses were studied. Special enquiries were made regarding lactation, symptomatology and sites of abscesses. All patients had preliminary breast ultrasound (U/S) examination. In the breast clinic, percutaneous needle aspiration of pus under local anesthesia was done followed by systemic antibiotic therapy. Repeated aspiration was carried out later when deemed necessary and follow up by (U/S) was conducted.
Results: Forty three patients aged between 16-75 years (mean 37 years) having a provisional diagnosis of acute breast abscesses. All patients presented with a palpable tender mass, of which 4 patients had retro-areolar abscesses. All patients had (U/S) of breast. Five patients were found on breast U/S to have inflammation without evidence of focal pus and they only required antibiotics. Four patients refused aspiration and underwent primary incision and drainage under general anesthesia (GA), while in two patients the abscesses were pointing and opened spontaneously before intervention, and they settled with wound toilet and antibiotics alone.
The remaining thirty two patients had their abscesses aspirated, and the treatment was successful in twenty nine patients (91%) with no complications or recurrence. The treatment failed in three patients who required subsequent incision and drainage.
Conclusions: Percutaneous needle aspiration of acute small unilocular breast abscesses after prior breast (U/S) followed by systemic broad spectrum antibiotics is successful, when the abscesses are completely drained. The use of this modality of the treatment has still not found wide application in our locality. This study is an attempt to recommend its use wherever facilities exist for its feasibility, low cost, no interruption with lactation and better cosmesis, though incision and drainage still may be necessary for definitive treatment for large or multilocular abscesses.

Keywords: Breast, abscess, aspiration.

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