Print ISSN: 0027-1446

Online ISSN: 2309-6217

Main Subjects : Internal Medicine

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.

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.

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.