Print ISSN: 0027-1446

Online ISSN: 2309-6217

Main Subjects : Internal Medicine

The Quality of Life in Patients with Chronic Urticaria

sayf Zuhair yousif; Pers Yousif Yaaqub

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

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

Utility of different modalities in treatment of keloid scar

Hala N. Al Salman

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

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

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

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

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

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

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

Rand Abdulateef Abdullah

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

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

The Association Of Body Mass Index And Prostatic Cancer Histopathological Grade

Marwa Muzahim; Adil Siwan AL- aqabi

Annals of the College of Medicine, Mosul, 2021, Volume 43, Issue 2, Pages 139-143
DOI: 10.33899/mmed.2021.130724.1099

Background: Obesity, a global public health concern, has been repeatedly linked to the development of different cancers in epidemiologic and basic  research studies, Prostate cancer  is the most frequently encountered solid tissue cancer in men. Gleason score  of  the prostate cancer is one of  the most important parameter, which provides the most important data about biological behavior of the cancer and affect on  the selection of the treatment and its outcomes. Therefore, accuracy of  Gleason score, based on  histopathological analysis of the biopsy material, has a critical importance
Patients and Methods:  A cross-sectional study with retrospective  analytical elements, among prostate cancer patients who were  diagnosed based on histopathology of  prostate gland ,then classified accorrding to  G.S (gleasson score) and body mass index.
Aim of this study: To evaluate the association between high  body mass index  and Gleason grade  of  prostate cancer.
Results: The results of this study  showed that patients with high body mass index Significantly associated with high grade of prostate cancer, as ( 46.4%  and 62.2% of overweight and obese patients respectively had high Gleason score  above 7 while  12.5% of overweight and 8.1% of obese patients had low Gleason score  and the p Value was (0.002).
Conclusion: This study found that high body mass index associated with increase high grade of  prostate cancer

Outcome of treatment among chronic lymphocytic leukemia and its correlation to Rai staging system in Kurdistan region of Iraq

Zhala Ahmad; Kawa Hasan; Hisham Al-Rawi; Ahmed K. Yassin; Bryar Rashid; Tavan Mahmood; Zeki Mohamed; Nawsherwan Mohammed; Sana Jalal; Basil Abdulla; Dana Abdullah; Shokhan Mustafa; Shlan Mohammed; Lara Abdulrahman; Mrawa Karam; Ghanem Obaid; Rozhat Yousif; Ranan Polus; Rawand Shamoon

Annals of the College of Medicine, Mosul, 2021, Volume 43, Issue 2, Pages 100-108
DOI: 10.33899/mmed.2021.130017.1090

Background: Chronic lymphocytic leukemia is common adulthood leukemia with low incidence in Kurdistan region of Iraq. Staging of chronic lymphocytic leukemia is essential in treatment planning and the pattern of response is variable.
Aim of study: To evaluate the Rai staging distribution of patients with chronic lymphocytic leukemia in Kurdistan region/Iraq and its correlation with the treatment outcome.
Patients & Methods: A retrospective cross sectional review study conducted in three Hemato/oncology centers in Kurdistan for duration of eleven years through the period from 1st of January, 2010 to 31st of December, 2020 on convenient sample of 170chronic lymphocytic leukemia patients. Diagnosis of chronic lymphocytic leukemia was done according to the International Workshop on Chronic Lymphocytic Leukemia. The Rai staging was done by the clinical hematologist in Hemato/oncology center  according to clinical evaluation and laboratory investigations. The pattern of the treatment response was determined according to the International Workshop on Chronic Lymphocytic Leukemia (iwCLL)
Results: The Rai staging of our patients was 0 in 15.3% of them, stage I in 12.4%, stage II 30%, stage III 13.5% and stage IV 28.8%.  The treatment response of studied sample was complete response (43.5%), partial response (17.6%), stable (14.1%), no response (21.8%) and progressive (2.9%).A highly significant association was observed between no response to treatment and advanced Rai staging and also a highly significant association was observed between death outcome of patients and advanced Rai staging.
Conclusions: The treatment response of patients with chronic lymphocytic leukemia is directly related to Rai staging as patients with advanced Rai staging had lower treatment response rate.

Dermatoscopic evaluation of alopecia areata

Qasim S. Al Chalabi; Anfal Al harbawi; Hala N. Al Salman

Annals of the College of Medicine, Mosul, 2021, Volume 43, Issue 2, Pages 144-151
DOI: 10.33899/mmed.2021.131614.1116

Objective: to assess the dermoscopic characteristics of alopecia areata and their correlations with clinical variants, nail changes, and severity of the disease.
Patients and methods: This is a case-series study, which was carried out on 209 patients with alopecia areata in the Department of Dermatology from January 2020 to January 2021 at Ibn-Sina Teaching Hospital, Mosul, Iraq. After the patient's acceptance to participate in this study, a detailed history was taken. A clinical and dermatological examination was done included hair pulling test, and disease severity was graded according to the severity of alopecia tool (SALT) scoring. Each patch of alopecia areata was examined and assessed using a SKIARY Smartphone Dermatoscope©, photos ‎were taken and evaluated by three dermatologist experts in dermatoscopy separately ‎and their notes were recorded, evaluated, and tabulated‎. Spearman`s rank-order correlation test was used for data analysis.
Results: Two hundred and nine patients with alopecia areata had participated in this research. The male to female ratio was 1.5:1.  The mean age of presentation was of 21 ± 10.64 years. 45% of the patients had Grade S2 severity. Yellow dots were the most common dermatoscopic finding followed by black dots, while perifollicular scales were the least common. Yellow dots, broken hairs, exclamation mark hairs, and nails changes were correlated with the severe form of the disease (P <0.05).
Conclusion: Alopecia areata has many dermatoscopic manifestations which are helpful in the clinical diagnosis and prognosis of the disease. Yellow dots, black dots, exclamation marks hair, broken hairs, and nail changes are related to the severe form of the disease.

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

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.

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

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.

Under-Graduate Oncology Education in Iraq: Roadmap for Improvement

Layth Yahya Ibrahim Mula-Hussain; Bassam Al-Zuhairy; Saif Al-Izzi; Alyaa Mula-Hussain; Muzahim Al-Khyatt

Annals of the College of Medicine, Mosul, 2020, Volume 42, Issue 1, Pages 90-98
DOI: 10.33899/mmed.2020.127346.1033

Oncology is a branch of medicine that specializes in the diagnosis and treatment of cancer and is divided into surgical oncology, radiation oncology, and medical oncology. Cancer is one of the leading causes of morbidity and mortality worldwide and there is a distinct shortage of adequately qualified oncologists in Iraq. Oncology education should be introduced at the beginning of medical school (college) as every doctor may face cancer patients in their training and practice after graduation. However, there is a gap in this area, as this branch is relatively new compared to other clinical branches. Holistic cancer care and a patient-centered approach should be the goal of modern oncology. Comprehensive under-graduate oncology education should be a critical component in medical education. This work is aiming to present a roadmap for an ideal oncology curriculum, which can be integrated and implemented into the Iraqi medical schools’ curricula.

The Role of exercise ECG Test in determining the severity of CAD and the Jeopardy of Myocardium

khalid hameed

Annals of the College of Medicine, Mosul, 2020, Volume 42, Issue 1, Pages 68-75
DOI: 10.33899/mmed.2020.126925.1024


Objective: To assess the value of exercise ECG test in evaluating the severity of coronary artery disease and jeopardy of myocardium.
Methods: A prospective study of 75 consecutive patients were all had history of angina, and they underwent both treadmill test (TMT) and coronary angiography in Mosul Center for Cardiology and Cardiac Surgery in the priod from April 2013 to August 2014 .Those with significant angiographic coronary artery stenosis (61 patients) were divided into four groups according to the size of myocardium supplied by and the resulting jeopardized myocardium. This division depends on identity of involved vessel, number of vessels and the site of the lesion on the involved vessel. Also, the result of TMT with ST depression was classed into class A (ST segment depression involving ≥ 5 leads) and class B (ST depression involving < 5 leads). Correlation between the angiographic groups and the results of TMT regarding the number of leads showing ST changes was done.
Results: The study involved 53 (70.5%) male and 22 (29.5%) female patients. The sensitivity and specificity of TMT were 77% and 71.5%, respectively. There were significant difference between class A and class B in patients with group I angiographic changes (which is the most severe angiographic coronary artery lesions and the largest jeopardized myocardium) and in patients w ith group IV (which is the least severe of coronary lesions with the smallest jeopardized myocardium). These differences became more significant after excluding patients with myocardial infarction (MI) and/or patients who develop severe typical angina (STA) at low workload which preclude continuation of test before appearance of the ECG changes of ischemia. Also w hen comparing group I, II or III separately or collectively with group IV we noticed significant differences regarding both class A or class B, especially after excluding patients with MI and/or patients with STA at low workload.
Conclusion: Our data suggest that exercise ECG test can b e useful in determining the severityof coronary artery disease and size of jeopardized myocardium rather than the location of lesion or number of vessels involved.

Clinical Evaluation of the Sensitivity and Induced Pain Pattern on Passive Straight Leg Raisng Test in Patients with Lumbosacral Root Pain

Ali Abdul-Rahman Younis; Ali F.Y. Al-Barodchi; Wameedh R.S. Al-Omari

Annals of the College of Medicine, Mosul, 2019, Volume 41, Issue 1, Pages 69-74
DOI: 10.33899/mmed.2019.161329

Background: The straight leg raising test (SLR) is widely used to evaluate patients with sciatica. The SLR was evaluated in many previous studies; however, there is no agreement about the characterization of the test.
Objective: To investigate the patterns of pain on passive SLR in patients with sciatica and to evaluate the effects of various maneuvers on this test.
Study design: Case series study.
Setting: Rheumatology division, Ibn Sinna Teaching Hospital, Mosul, IRAQ.
Methodology: Seventy patients with unilateral sciatica for less than 2 years duration, there ages are between 20 to 50 years, were studied. A detailed history was obtained from the patients and they were subjected to full physical examination for their current problem. The SLR was performed, the angle of elevation was recorded and the effect of ankle dorsiflexion and maximal neck flexion was evaluated. After that, the SLR repeated but with lumbar flexion, the angle of the SLR was also recorded. Then crossed SLR was performed.
Results: SLR was positive in 91.4% of cases. Ankle augmentation was positive in 95.3% of cases, while neck flexion increased pain in 28.1% only. Cross SLR test was positive in 17.1% of cases. Increased SLR angle by contralateral hip flexion was seen in 81.3% of cases; mean SLR angle with the contralateral hip extension was 47.8±12.4 degree, while contralateral hip flexion increased the mean SLR angle to 58.9±16.9 degree. The patterns of pain induced by SLR were: low back pain only in 50% of cases, leg pain only in 42.1% of cases, low back and leg pain in 7.9% only.
Conclusion: The patterns of pain that were induced by passive SLR were: low back pain only, leg pain only, low back and leg pain. This could bear relation to the position of the prolapsed disc.
The use of sensitizing maneuvers (ankle dorsiflexion, neck flexion) increases pain in patients with sciatica with positive SLR test, so we recommend the conduction of these maneuvers in patients with positive SLR.  Measurement of SLR was influenced by the position of the contralateral hip (flexed Vs. extended).

Disability Measurement in Patients with Low Back Pain Using Roland-Morris Questionnaire as a Model and Studying Possible Modifications

Ismail D. Saeed; Ali F.Y. Al-Barodchi

Annals of the College of Medicine, Mosul, 2019, Volume 41, Issue 1, Pages 18-27
DOI: 10.33899/mmed.2019.161256

Background: Self-reported questionnaires have become popular measures in assessing disability in patients with low back pain (LBP). Roland-Morris Questionnaire (RMQ) is one of the internationally accepted, self-reporting questionnaire which demonstrates good psychometric properties.
Objectives: The present study intended to evaluate a face to face interview applying Arabic version of the RMQ, and comparing it with a modified version of RMQ (RMQV), and whether the purely subjective RMQ scores correlate with symptoms and signs which have predictive or prognostic values.
Design: case-series study
Methods and materials: Case-series study conducted on seventy-two patients with chronic LBP at Ibn-Sina Teaching Hospital in Mosul city. Physical examination at rheumatology outpatient clinic performed for every patient, and the patients are allowed to answer the questions of RMQ through a direct investigator-patient Arabic conversation. The disability measured by the RMQ subdivided into: mild (0-8), moderate (9-16) and severe (17-24). An individualized literature review performed for clinical features which have predictive or prognostic values in LBP, and including these features in the clinical evaluation of patients in the current study.
Results: The results showed that the Arabic conversational RMQ have acceptable reliability and RMQV have excellent reliability (Cronbach’s alpha values=0.72 and 0.94 respectively). There was a significant direct correlation between these two questionnaires (r=0.861; p-value<0.001). However, we found a significant difference between them (p-value<0.01). The scores of the RMQ and RMQV correlate moderately with a score of the predictive features (r=0.503; p-value < 0.01 and 0.530; p-value Conclusion: The study found that the modified version (RMQV) has higher reliability than the original one. Also, the RMQV showed a better correlation with the narrow-angle straight leg raising test, and its mild and moderate subgroups have significant differences regarding the duration and pain intensity of the current episode of LBP. Other measured properties look similar between the two questionnaires.