Volume 40, Issue 2, Summer and Autumn 2018, Page 1-76

Effect of tyrosine kinase inhibitor in patients with chronic myeloid leukemia (cytogenetic, molecular response) in Mosul

Annals of the College of Medicine, Mosul, Volume 40, Issue 2, Pages 1-8

Objective: To evaluate the cytogenetic, molecular response, effect particularly on bone and heart for imatinib and nilotinib respectively in patients with chronic myeloid leukemia (CML).
Methods: The study was conducted on eighty seven patients on imatinib and twenty nine patients on nilotinib as second line treatment who were treated at Ibn-Sena Teaching Hospital /Outpatient Hematology Department were reviewed from April 2002 to April 2014. The Fluorescent in situ hybridization (FISH) analysis was carried on at central authorized laboratory in Baghdad. The reverse transcriptase-polymerase chain reaction (RT-PCR) carried on authorized laboratory initially in Baghdad then in Mosul, (both laboratory using the same standard and sponsored by Novartis). To study the effect of imatinib mesylate on bone mineral density fifty out of 87 patients were enrolled for this purpose. For all the patients ionized calcium, total calcium, serum albumin, serum alkaline phosphatase, serum phosphate, urea, creatinine and serum levels of intact parathyroid hormone measured at baseline, 6 months and 12 months. Dual energy X-ray absorptiometry (DEXA) measurements of the lumbar spine (L2–L4 vertebrae), and femoral neck were performed using a DEXA scanner. For the nilotinib group, all patients had a base-line standard 12-lead electrocardiography (ECG), with a follow-up ECG’s performed every 6 months during the study period to assess any occurrence of QT prolongation, ischemic changes, or arrhythmias Noninvasive cardiac imaging was performed using the resting transthoracic Echocardiography (Echo) with its 2-dimentional and M-mode views.

Assessment of cardiac hemodynamic changes during pregnancy in normal and hypertensive women

Annals of the College of Medicine, Mosul, Volume 40, Issue 2, Pages 9-17

Background: The hypertensive disorders of pregnancy (HDP) are the most common complication of pregnancy and are major cause of maternal and perinatal morbidity and mortality. Hypertension in pregnancy complicates about 10 % of all pregnancies worldwide.
Objective: This study aims to compare the hemodynamics of healthy pregnant women with hemodynamics of pregnant women with gestational hypertension (GH) or preeclampsia (PE).
Methods: A total of (120) women were included in this study; their ages range from (17 to 42) years; classified as follows: (60) normotensive pregnant women and (60) pregnant women with GH or PE. 2nd group is subdivided into: (30) hypertensive pregnant women who take antihypertensive treatment (methyldopa) and (30) those without antihypertensive medications. All women subjected to echocardiographic examination by experience specialist.
Results: Compared with healthy pregnant women, untreated pregnant women with GH or PE were associated with increase mean arterial pressure (MAP) (82.81±9.083 mm Hg vs. 113.66±7.327 mm Hg, p ˂ 0.001), increase total peripheral vascular resistance (TPR) (1379.01±425.65 dyn.sec.cm-5 vs. 1733.99 ± 396.97 dyn.sec.cm-5, p˂0.001), increased cardiac output (CO) (5.01 ± 1.100 L / min vs. 5.55 ±1.42 L/min, p = 0.04), increased ejection fraction (EF) (64.9 ± 4.9 % vs. 67.4± 6.561%, p=0.04) and fractional shortening (FS) (34.76±3.492% vs. 37.34±4.21%, p = 0.003), increased left ventricular mass (LVM) (136.41±29.22 gm vs. 174.16±41.04 gm, p˂0.001) and decreased ratio of peak velocity of early transmitral flow to late transmitral flow (E/A ratio) (1.39±0.166 vs. 1.30±0.19, p=0.02).
The hypertensive pregnant patients treated with methyldopa; compared to non-treated group; showed a significant decreased in MAP (99.91±13.874 mm Hg vs. 113.66±7.325 mm Hg, p˂ 0.001, decreased TPR (1534.58 ± 349.47 dyn.sec.cm-5 vs. 1733.99 ± 396.97 dyn.sec.cm-5, p= 0.04), decreased EF (63.7±4.621% vs. 67.4±6.561%, p=0.014), decreased LVM (153.087±33.778 gm vs. 174.16±41.04 gm, p=0.03) and significant increase in E/A ratio (1.444±0.262 vs. 1.306±0.190, p=0.02).
Conclusion: Pregnant women with PE or GH have evidence of hemodynamic changes that justify routine echocardiographic assessment even in the absence of cardiac symptoms.


The effect of interferon-beta on oxidative stress in patients with multiple sclerosis

Annals of the College of Medicine, Mosul, Volume 40, Issue 2, Pages 18-23

Objective: To assess the effect of interferon–beta on oxidative stress and total antioxidant status in patients with multiple sclerosis (MS).
Design: Case-control study.
Setting: College of Medicine and Ibn-Sina Teaching Hospital, Mosul.
Methodology: The study included 40 female patients with MS. They divided into 2 groups of 20 patients each. Group one included newly diagnosed MS patients and group 2 with relapsing–remitting multiple sclerosis (RRMS) in remission phase, who were on interferon therapy. Another twenty apparently healthy females, age matched with the patients, were considered as a control. Malondyaldehyde (MDA) and total antioxidant status (TAS) were measured in all groups.
Results: MDA values of both patients groups (1.48±0.59 µmol/l and 1.00±0.49 µmol/l, respectively), were significantly higher than those of the control group (0.60±0.18 µmol/l) (p<0.001). MDA values were significantly higher in newly diagnosed group than of RRMS 0.001). The TAS values of both patients groups (0.91±0.26 mmol/l and 1.43±0.20 mmol/l, respectively) were significantly lower than those of the control group (2.14±0.21 mmol/l), (p<0.001). TAS values of the newly diagnosed patients were significantly lower than those of the patients group with RRMS on interferon thera patients group (p<0.001).
Conclusion: MS patients have higher levels of MDA and lower levels of TAS than the control group. The newly diagnosed patients have significantly higher levels of MDA and lower TAS than RRMS patients on interferon-beta therapy. This result may give a new insight about interferon being effective in management of MS by acting as antioxidant.


Frequency of congenital heart disease among patients with Down’s syndrome in Mosul

Annals of the College of Medicine, Mosul, Volume 40, Issue 2, Pages 24-28

Background: Down’s syndrome (DS) or trisomy 21 is a chromosomal disorder frequently associated with a varied combination of morphological and structural birth defects. Individuals with Down syndrome are more prone to congenital heart defects such as atrioventricular septal defects (ASD), ventricular septal defects (VSD), isolated secundum atrial septal defects. Congenital and acquired gastrointestinal anomalies and hypothyroidism are common in patient with DS.
Aims: To measure the frequency of congenital heart disease (CHD) among study population, to categorize CHD according to their anatomical location and to demonstrate socio-demographic characteristics of Down syndrome patients.
Methods: Case series study design was conducted in Mosul over one year period starting from the 1st of Dec. 2011 to the 30th of Nov. 2012. Parents have been intervened by one of the investigators, and a specially designed questionnaire form were completed to each patient.
Echocardiography have been conducted to all patients included in the study by a qualified pediatric cardiologist in Echo Unit- Khansaa Teaching Hospital, the echo result was recorded in the questionnaire form. Analysis of the data was conducted by using SPSS, and excels computer systems; simple rates and ratios were calculated in order to describe the study findings.
Results: The present study includes a total of 69 patients diagnosed with Down’s syndrome. Two thirds of study population was below six months of age. Male gender constitutes 69.6% of study population with male to female ratio 1:0.44. 39.2% of mothers are in age group ≥40 years. Fifty patients (72.5%) with DS diagnosed to have CHD by echocardiography. ASD was the most common defect and was diagnosed among 30% of patients, followed by complete AV canal and VSD which constitutes 20% each. 14.5% of patients with DS have extra cardiac anomalies and GIT anomalies were the most frequent one.
Conclusion: The incidence of congenital heart disease in patients with Down’s syndrome was high in this study (72.5%). ASD was the most frequent form observed.

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

Annals of the College of Medicine, Mosul, Volume 40, Issue 2, Pages 29-33

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

The effect of Omega-3 fatty acid on Adiponectin and potential implication for obesity management

Annals of the College of Medicine, Mosul, Volume 40, Issue 2, Pages 34-40

Objective: To evaluate the effect of 2 months use of omega-3 fatty acids on adiponectin and other parameters contribute to weight control in healthy obese volunteers like body mass index (BMI), waist and hip circumferences and to compare the concentrations of adiponectin between interventional groups and control groups.
Design: Open–labeled randomized trial.
Method: This study included seventy- eight volunteers, aged 20-55 years with different gender and BMI. The patients were divided into 2 groups, namely the omega-3 alone group which consisted of 25 obese subjects and the second one consisted of 26 obese subjects which represented the omega-3 and diet group. The subjects groups were followed for 2 months during which the above parameters were measured before starting therapy and at the end of the follow-up period using commercially available kits. The patient groups were compared with a control group consisted of 67 apparently healthy subjects. The determination of adiponectin concentration in human serum was done using ELISA technique
Results: Significant differences were found regarding adiponecin (p=0.001) in the interventional groups in comparison with control group. The studied parameters were compared in the omega-3 groups and showed non-significant differences between the two studied groups concerning serum adiponectin (p=0.065). By comparing the studied parameters in the omega-3 alone group after 2 months of treatment, a significant differences were found in serum adiponectin (p=0.012). The use of omega-3 with diet for 2 months of treatment resulted in a significant increase in serum adiponectin (p=0.000). The percentage improvement in the studied parameters in the first group after 2 months of treatment showed highly significant increase in serum adiponectin (114.53%) with p-value (0.000). While in the second group, highly significant increase in serum adiponectin (214.10%) with p-value (0.000) were obtained.
Conclusion: The level of Adiponectin was significantly increased in interventional groups compared to control. The level of Adiponectin was very significantly increased in omega-3 with diet group compared with omega-3 alone group which reflected on the improvement in anthropometric parameters such as weight and BMI.

Trends of Maternal Mortality in Nineveh (2004-2013), A Time Series Analysis

Annals of the College of Medicine, Mosul, Volume 40, Issue 2, Pages 41-47

Context: Maternal Mortality is a worldwide issue that serves as a visible health indicator of a nation’s health care system. As part of the 5th Millennium Development Goal, the UN established the target of reducing maternal mortality by three-quarters between 1990 and 2015 for all national and regional populations.
Aim: Determine the trend of maternal mortality in Nineveh for 10 year period (2004-2013).
Subjects and methods
Study design: Descriptive biometric study design.
Study settings: Nineveh Governorate/North of Iraq.
Study sample: Maternal deaths, women at childbearing age, and live births from 2004 to 2013.
Data collection tool: Death certificates, vital registration system.
Outcome measures: Maternal mortality rate, ratio, and life time risk of maternal death, stages of maternal mortality, in addition to their mortality causes and trends by using various rates, ratios, proportions, and Chi-squared test for trend.
Results: Maternal mortality ratio changed significantly (p=0.002) during the study period being worst in 2007 (45.01/100,000 live birth). On average, about 1:666 women at childbearing age died either due to direct causes predominated by hemorrhage or indirect ones mainly CVDs.
Conclusions and Recommendations: Maternal mortality still a major problem that should be addressed carefully through facilitating women's accessibility to maternity services to save their lives.

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

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.

Laparoscopic cholecystectomy in obese patients

Annals of the College of Medicine, Mosul, Volume 40, Issue 2, Pages 54-58

Background: Obesity has been considered as a relative contraindication to laparoscopic cholecystectomy.
Aim: Evaluating the safety of laparoscopic cholecystectomy in obese patients.
Patients and methods: The study was performed in Al-Jomhoory Teaching Hospital, Mosul City. From July 2004 to January 2015. This is a prospective study included 1145 patients who underwent laparoscopic cholecystectomy. All patients from Mosul province, were divided according to the body mass index into two groups. Group I included 141 patients (12.3%) who were obese (BMI more than 30), and group II, included 1004 non-obese (87.7%) (BMI less than 30). Peroperative and Postoperative complications, conversion rate, and hospital stay were compared between these two groups.
Results: There was no difference between obese and non-obese groups in preoperative complications, except Subcutaneous insufflations which occurred in 5 cases (3.5 %) and bleeding from the portal site in 3 cases (2.1%) in obese patients. Regarding to the pre and post operative complications there were no significant difference between the two groups with p value (p ≤ 0.05).
Conclusion: Laparoscopic cholecystectomy is a safe and effective treatment for obese patients with cholecystitis. There is no difference in preoperative and postoperative technical procedures between obese and non-obese patients.

The role of ultrasound in detection of ovarian cysts confirmed by histopathology

Annals of the College of Medicine, Mosul, Volume 40, Issue 2, Pages 59-62

Objective: The aim is to diagnose the ovarian cyst by ultrasound modality and confirmed this by histopathologic results.
Methods: Aprospective study on one hundred and fifty female patients in the period of one year (2009) in gyne-and obstetrical out patent clink.
Results: The patients examined and (150), ninty of these patient (60%) have ovarian cysts. (48) patient 53%. Their cyst resolved completely while (42) patient 47% are not respond to medical treatment and need surgical interference and these cyst are exposed to the histopathological assessment.
Conclusion: Sonography of the pelvic organs to detect ovarian cyst is a good imaging modality, quick and safe procedure, need no much preparation and easily predict the nature and type of the cyst and very easy methods to follow these patients.

Trends of multiple sclerosis in Nineveh province

Annals of the College of Medicine, Mosul, Volume 40, Issue 2, Pages 63-68

Background: Multiple sclerosis is the major cause of non-traumatic disability in young adults worldwide with considerable social impact and economic consequences. It is a multifactorial disease with different epidemiological patterns and clinical presentations in various populations.
Aim: This study was conducted to calculate the disease prevalence in Nineveh Governorate, explaining the demographic features, characterizing the clinical and epidemiological features of multiple sclerosis, and finding possible variations in some features of the disease compared to other regions.
Materials and methods: A total of 136 patients from both sexes with confirmed MS who are living in Nineveh Governorate and attending MS Clinic at Ibn-Sina Teaching Hospital, were enrolled in this study during a period of 7 months from October 2011 to April 2012. Data were collected from filing system of MS Clinic and from direct interview with the patients (78 patients).
Results: The prevalence of MS calculated to be 4.72/100,000. MS affects females more than males in Nineveh (88 females- 64.7%; 48 males- 35.3%) with a female to male ratio (1.83:1), and a mean age of onset (30.9) years and mean age of presentation (39.5) years with an average delay of (8.5) years in diagnosis of the disease. The disease mostly affects the age range (20-50) years age. Family history was found in (8.8%) of patients. Most of MS patients in Nineveh were well educated and some of them with higher educational degrees, and majority of patients (68%) were living in Mosul city. The most frequent initial symptom of disease was weakness in one or more limbs (36.8%), followed by ataxia (14%), and visual disturbance (13.2%). A relapsing remitting pattern was the most frequent category of the disease (78.7%).
Conclusions: The study showed that MS is rare in Nineveh Governorate which is considered to be a low risk area for MS, and the characteristics of the disease are nearly comparable to findings of other studies in Iraq and Middle eastern region.

A review of bone marrow examinations in Ibn Sena Teaching Hospital in Mosul

Annals of the College of Medicine, Mosul, Volume 40, Issue 2, Pages 69-73

Objective: To assess the indications and different pathologies of bone marrow aspirates and to evaluate and analyze a considerable percentage of dry blood taps and normal bone marrow aspirates.
Methods: A retrospective study. All request procedures and reports of bone marrow examinations between January 2001 and December 2008 were reviewed.
Results: There were (2008) bone marrow aspirations performed during the period, 1258 (63%) of the marrow aspirations were non-malignant and 750 (37%) of the samples were found to be malignant. In 216 cases (11%) marrow aspirates were found to be non-conclusive. There were 154 (8%) full blood tap a recent full blood picture performed at the time of the bone marrow examination. The commonest indication was for investigation of thrombocytopenia and the most frequent diagnosis encountered was acute leukemia.
Conclusion: The bone marrow aspiration and trephine biopsy (scientific speaking) are complementary and give a higher diagnostic yield when both are available for a patient. This study also reveals that the failure rate of obtaining either of the samples is not significant and this issue needs to be addressed appropriately.