Abstract: Objective: To evaluate laparoscopy as a diagnostic and therapeutic method in selected cases in abdominal trauma, and its value in avoiding unnecessary laparotomies at Al-Jumhoori Teaching Hospital in Mosul, Iraq. Patients and methods: From October 2009 to October 2011, sixty hemodynamically stable patients who were admitted with abdominal trauma (48 blunt, and 12 penetrating injuries), were submitted to diagnostic laparoscopy (DL) in the operating theatre of the Emergency Department of Al-Jumhoori Teaching Hospital in Mosul. Data collected and analyzed. Results: Negative and non therapeutic laparotomies were avoided in 38 patients (63.3%), and laparoscopic intervention was done in 4 patients (17.4%). The mean hospital stay of the (DL) negative patients was 2.1 days, and for the (DL) positive patients with laparoscopic intervention was 2.4 days, while of the patients with therapeutic laparotomy was 5.7 days. All the patients were discharged with no reported complication and no deaths were reported. Conclusion: Laparoscopy can be performed safely and effectively in hemodynamically stable patients with abdominal trauma. The most important advantages are reduction of the negative and non therapeutic laparotomy rate and shortening of hospitalization. Keywords: Blunt abdominal trauma, penetrating abdominal trauma, diagnostic laparoscopy.

Abstract: ABSTRACT Aim of the study: The purposes of our study are to evaluate the role of laparoscopy in localizing impalpable testes and the management strategy for both unilateral and bilateral impalpable testes. Patients and methods: Throughout the period between January 2005 to December 2008, 36 patients with impalpable testes were admitted to pediatric surgery centre at Al-Khanssa Teaching Hospital in Mosul, Laparoscopy done for them to assess and manage 42 impalpable testes. In all patients 10 mm canula port was inserted in surpaumbilical position using an open technique, a single 5 mm port was occasionally required in contralateral iliac fosse to manipulate bowel and testes. A further port was used for laparoscopic clipping and division of the testicular vessels. These performed as the first part of the one or two stages Fowler- Stephen orchiopexy (high division of testicular vessels), and all patients has been followed for period of about two years. Results: Twenty seven testes found to be positive, ten of them near the internal inguinal ring and nine in the iliac fossae, while two testes where found intra canalicular. Fifteen testes were absent with closed ring, 12 of them showed vas and vessels enter the internal ring (vanished testes), while three with no vas and vessels entering the ring (agenesis). Assisted laparoscopic orchiopexy using sub dartous pouch was successfully done in 16 testes. Single stage Fowler-Stephen technique was adopted in four testes. Two stages for another two testes, in one patient, fixation done near upper scrotum which was then re fixed by second operation few months later. Conclusion: Laparoscopy is a safe and reliable technique in diagnosing the presence or absence of impalpable testes, provides a valuable information about the associated anomalies and condition of the internal ring, it can direct the surgeon to chose the proper technique for orchiopexy, with no mortality and very low morbidity.

Abstract: ABSTRACT Objective: To describe the epidemiology of ocular trauma in children 15-years and younger living at Mosul city and its periphery who underwent evaluation for a two year period from November 2007 to November 2009 in the emergency department in Al-Jumhory Teaching Hospital. Methods: A retrospective study; review of the medical records of children aged 15 years and less. Records of (393) children with 415 incidents of eye injury were included in the study, of whom (22) were initially treated for bilateral ocular trauma. Results: Most patients (64.9%) were boys. The highest proportion of injuries (44.4%) occurred at home, followed by street and roads (28.6%). Blunt (35.1%) and sharp (22.6%) objects represents most frequent cases of trauma. Closed globe injuries were far more frequent than open-globe injuries for boys (82.4% vs 17.6%). Of those with the closed-globe injuries, 253 injuries (80.0%) registered an initial visual acuity of greater than 6/18, whereas 31 open–globe injury (52.5%) registered an initial visual acuity of less than 6/60. Most closed-globe injuries (223, 92.1%) did not cause final visual impairment in the affected eye, whereas 26 open-globe injuries (53.3%) caused severe visual impairment or blindness. Conclusions: A good proportion of the accidents represent in this study could have been avoided. A data demonstrate a clear need for primary prevention and control measures.

Abstract: ABSTRACT Objective: To compare the effect of two ophthalmic viscosurgical devices OVDs (DisCoVisc, Alcon, Fort Worth, Taxes), and (Appavisc, Appassamy ocular devices PVT. LTD.), that currently used in Phaecoemulsification cataract surgery and assess the outcome of these substances on the intraocular pressure (IOP), corneal thickness, endothelial cell counts, corneal clarity and initial visual acuity. Patients and methods: This is a prospective, randomized case series study to compare between two kinds of OVDs used currently in Phaecoemulsification cataract surgery on 40 patients with age range from 55-65 years in the period from June 2009-June 2010, at Al-Jumhory Teaching Hospital, Mosul. Standard procedure was implemented with intraocular lens implantation (IOL). Patients were followed up for three months with particular attention to the first six hours to one day to assess the outcome of surgery in terms of intraocular pressure (IOP), corneal thickness, endothelial cell counts, corneal clarity and visual acuity. Results: The study enrolled 46 patients, and 40 patients completed the study. There was improvement of visual acuity in all patients. No significant difference in the IOP between the two groups in the first 6 hours to 1 day post operatively (17.90±2.53) (18.60±2.21), (P=0.26) and (17.90±2.36) (18.55±2.06), (P=0.941) for Appavisc and DisCoVisc related groups respectively. Also there was no difference with regard to both corneal thickness per-operatively and on day one post-operatively and endothelial cell counts (576.5±44.04) (576.0±50.2) (P=0.974), (665.5±141.9) (670.6±117.1) (P=0.902) and (2311.73±288) (2359.78±383.2) (P=0.657), (2021.2±201) (2035.05 ± 377) (P=0.886) for Appavisc and DisCoVisc related groups respectively. In Appavisc related group; four patients had posterior capsular rupture (PCR) and two patients develop grade III corneal edema. In DisCoVisc related group; two patients had PCR and no significant corneal edema. A formal dry vitrectomy done for those developing PCR with successful IOL implantation, and for those developing corneal edema; a frequent instillation of topical corticosteroid was prescribed with improvement of their vision after two weeks post operatively. Initial visual acuity was better for DisCoVisc related group (0.74±0.21) than for Appavisc related group (0.52±0.29), (P=0.01). Conclusion: Both viscoelastics used had no significant effect on the IOP in the first six hours and first post-operative day, as well as pachymetry and endothelial cell counts both preoperatively and on day one post-operatively, however DisCoVisc was superior to Appavisc regarding corneal clarity and hence visual acuity.

Abstract: ABSTRACT Background: Psoriasis affects 0.5-0.7% of Iraqi people making it one of the significant dermatological problems. Despite the extent of this problem, little information regarding its epidemiology is available in this country. Objectives: To define the socio-demographic and clinical characteristics of psoriatic patients attended dermatology clinics in the four major governmental hospitals in Mosul city. Patients and methods: Study setting: Dermatology clinics in the 4 major governmental hospitals (Al- Jamhouri, Ibn Sina, Al-Salam, and Al- Mosul) in Mosul. Study design: Cross-sectional study. Study period: 1st October 2101 to 25th of February 2011. Participants: Patients with psoriasis of both sexes, and all ages, who attended the dermatological clinics. Each patient was subjected to detailed history and clinical examination. Data collection form included various demographic and clinical characteristics. Results: The sample of the study included 154 patients with psoriasis, comprising 50.6% males ranging in age from 3-62 years. The mean age±SD at presentation was 30.2±15.1 years; the mean age±SD at onset was 22.8±12.0 years. The mean duration of the illness was 7.4 years. A unimodal distribution curve of age at onset was noticed with a peak at the third decade. Early onset of psoriasis before 30 years was significantly associated with family history. Severity of psoriasis was mild in 74 (48.1%) of cases and it was more severe in elderly with longstanding disease. Itching and disfigurement were the main complaints especially the young and female patients. Plaque type (64.9%) was the most common variant, arms (52.6%) were the most commonly affected body site, and the scalp (27.9%) was the most common initial site affected by psoriasis. Nail involvement was seen in 30 (19.5%) patients especially fingernails. Conclusions and recommendation: The study revealed that psoriasis is a heterogeneous disease affecting all ages, genders and socio-economic strata. Further researches to study the relationship and the impact of these characteristics on the life of sufferers is recommended.

Abstract: ABSTRACT Background and objectives: Ano-genital warts consist of epidermal and dermal papules or nodules on the perineum, genitalia, crural folds, and anus. Up to the researchers' knowledge, no study concerning the genital warts in Erbil city was published, which was a motivation to study this problem, regarding the epidemiological and clinical patterns of this disease in Erbil city. Patients and methods: This is a cross-sectional study; the data collected conveniently from male patients that have clinical features of genital warts attending two private dermatology clinics in Erbil city from 15th June 2009 through 15th June 2011. Results: In this study, 45 male adults were included; their ages ranged from 20 to 49 years, with mean± SD of 29.8 ± 6.017. The highest rate of genital wart was among age group of 25-29 years (35.6%). Other statistics are; (71.1%) of study sample were married; (40%) were alcoholics; (88.9%) were not using condom in their sexual contact, (66.7%) had more than one sexual partner, (53.3%) of the cases were illiterate or have primary school education and no one of the cases was homosexual. Sixty percent of the lesions were papular in shape, (53.3%) were affecting more than one site of external genitalia, (91%) of the patients had multiple warts, (11.1%) had past history of one of STIs (sexually transmitted infection), (15.6%) of the cases were associated with other sexually transmitted infections and all the cases were contracted through sexual contact. Conclusion: The study concluded that the genital warts are low or infrequent in Erbil city when compared to other areas. The existence of traditional inhibition imposed by the religion and the society on the sexual behavior may be a factor in the low rate of the disease in this community.

Abstract: ABSTRACT Objectives: To determine the prevalence of urinary tract infection (UTI) among pregnant women in Mosul city and to classify the infected women according to their trimesters of pregnancy. The sensitivity of isolated organisms to various antibiotics was also examined. Patients and methods: Sample of 154 pregnant women attending Al-Batool Maternity Hospital in Mosul city from Feb-April 2007 was taken. Information on age, gestational age, gravidity, parity, level of education and residence were collected for each woman. Clean midstream urine samples were examined for UTI microscopically and culture, and sensitivity tests were done for the organisms isolated using a range of antibiotics. Results: Prevalence rate of UTI among the studied subjects was 47.4%. Eschirishia coli was the most frequently isolated organism (73.5%) which was highly sensitive to nitrofurantoin, ciprofloxacin, gentamycin, ceftriaxone and amikacin. Amoxicillin, cotrimoxasole, tetracycline and ciprofloxacin are the effective antibiotics to half of isolated Gram positive bacteria. Of the variables examined, 79.5% of the infected participants were in the age group 20-35 years, 53.0% were in their third trimester, 41.0% had 1-4 children, 30.1% were primigravidae, 63.0% attended the antenatal care unit on need, and 71.2% were urban at 6-12 years schooling. Conclusion: UTI is still a major health problem among pregnant women especially during their third trimester. Escherichia coli is the predominant pathogen causing UTI. All detected bacteria were sensitive to amikacin. Urinalyses with culture and sensitivity tests are mandatory for all pregnant women during the different trimesters. Health education with regular antenatal care share greatly in reducing the incidence of this infection.

Abstract: ABSTRACT Aim: This study was conducted to evaluate the biochemical composition of urinary stones in Dohuk Province. Patients and methods: A prospective study done at Azadi-Teaching Hospital in Duhok city, during a period of two years from Jun. 2009 to Jun. 2001. The total number of patients collected was 150. Both inpatients and outpatients were included. Pediatric age group excluded. The source of collection of samples was: stones passed spontaneously by the patient with conservative treatment, or after surgery or extra corporeal shock wave lithotripsy (ESWL). Results: Total number of patients was 150, 102 patients (68%) were males & 48 patients (32%) were females, male: female ratio = 2.1:1. Out of 150 patients, 52 (35%) had calcium phosphate, 45 (30%) had calcium oxalate, and 30 (20%) with uric acid stones. 20 patients (13%) had mixed stones "calcium phosphate and calcium oxalate" and only 3 patient (2%) had pure oxalate stones. Out of 150 patients, 117 (78%) had calcium stones & 30 patients (20%) had uric acid stones, & 3 patients (2%) had oxalate stone. No other types of stones were detected in this study. Conclusion: The study revealed that most of the stones in our patients were calcium containing stones. The most common stones were calcium phosphate, and the percentage of uric acid stones was high.

Abstract: 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.

Abstract: ABSTRACT Objective: To detect cases of pervasive developmental disorders among a sample of primary school students in Mosul city. Design and method: A descriptive study including 137 students boys and girls of the second class in Al-Thawra, Al-Ghazali and Abi-Tamam primary schools. A questionnaire paper was used which was filled by the teachers after discussing all the matters with them by the investigator. Rechecking was done and evaluation of the three categories involved in the paper (social interaction difficulties, language defects and conduct disorders). The students were divided into three groups according to the scores on the items of the scales. Group three with high marks in some questions (3, 4) were studied further including any risk factors for their defects, their midyear exam results and their marks in Arabic language. Statistical analysis was done to evaluate the collected data. Results: No case of autism or related disorder was detected. Other problems were detected which were more among males. The commonest problems were being aloof with their own world and excessive fear of noises. Two boys in Al-Thawra school had some conduct disorders and another two had delay in language and speech. Those with language defects had low marks in Arabic language of midyear examination. Conclusion: Problems in social interactions, speech and behavior were important to look for among students which may affect their progress at school.

Abstract: ABSTRACT Objectives: To assess, the oxidant / antioxidant status and thyroid function tests in newly diagnosed hypertensive patients and the effect of therapy with captopril or valsartan for 2 months on these parameters in comparison to healthy control subjects. Methods: This study was conducted in Ibn-Sina Teaching Hospital, Consultative Clinic for Internal Medicine in Mosul city, from Jan. to Dec. 2008. Patients with certain criteria were included in this study. Blood samples were taken from the patients and assay of serum level of malondialdehyde (MDA), total antioxidant status (TAS) and thyroid hormones; [total triiodothyronine (T3), total thyroxine (T4) and thyroid stimulating hormone (TSH)] were done. They then started to receive either valsartan in the first group or captopril in the second group for 2 months after which another set of blood samples were taken and assayed for the same parameters mentioned above, were done. Forty apparently healthy subjects were also included in this study. They were recruited as a control group. Results: Before starting therapy newly diagnosed hypertensive patients, had a significantly higher MDA serum levels and a significantly lower TAS, with non-significant differences in the levels of thyroid hormones (TT3, TT4 & TSH) in comparison to healthy controls. After 2 months of treatment with either captopril or valsartan, there was a significant decrease in MDA serum levels and a significant increase in TAS levels with non-significant effects on thyroid hormonal levels in comparison to pre-therapy stage. Conclusion: Captopril and valsartan therapy improves oxidant / antioxidant status and carry no adverse effects on thyroid function in newly diagnosed patients with mild to moderate hypertension.

Abstract: ABSTRACT Objective: To highlight the possible effects of toxoplasmosis on serum activities of liver enzymes. Methods: Sixty serologically toxoplasmosis positive women referred to the Public Health Laboratory Centre in Nineveh Province were enrolled during the period from Oct. 2008 – March 2009. Their ages ranged between 16-35 years and mean±SD (24.9±4.8 years). Cases were compared with 40 age matched apparently healthy high school, medical college students and employees of Mosul College of Medicine control women who were serologically negative for toxoplasmosis; their ages ranged between 17-35 years and mean ± SD (23.9± 5.5years). Serum activities of aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), gamma glutamyl transferase (GGT) and lactate dehydrogenase (LDH) were measured in all cases and controls. Results: Liver enzymes activities were higher in patients compared with those of the controls. Conclusion: A probable involvement of the liver in the disease process was noticed for the toxoplasmosis patients although not sufficient to produce clinical signs and symptoms of liver disease.

Abstract: ABSTRACT Objectives: The aim of this study, first, to evaluate the frequency of immunohistochemical expression of p53 in different types of ovarian tumors, second, to correlate p53 expression with age of patients, histological type and grade of tumors, and third, to compare the results with those of others. Methods: This study was performed on 60 primary ovarian tumors. Samples were obtained in a prospective and retrospective fashion (cross sectional study). The samples were collected from Al-Jumhuri Teaching Hospital, Al-Salaam General Hospital, Al-Khansaa Teaching Hospital, and some private Laboratories, during a period of eight months, from June 2009 through January 2010. P53 expression was assessed immunohistochemically. Results: The patients' age ranged from 13 to 80 years, with a mean of 43.88 year. Most of them were in the fifth decade (28.3%). Data concerning the age were missing in five patients. P53 immunoreactivity was observed in 48.1% of the malignant tumors. It was positive in 13 of 20 cases of serous adenocarcinoma, in all of the 5 cases of mucinous adenocarcinoma, in 3 of 12 granulosa cell tumors, in 2 of 4 endometrioid carcinomas, in 1 of 3 clear cell carcinoma, in 1 of 2 dysgerminomas, and in the one case of Sertoli-Leydig cell tumor. It was negative in malignant thecoma, malignant teratoma and in all borderline and benign tumors. Statistically p53 expression was not significantly related to the age of the patients, grade, or to the histological type of the tumors. It was mainly found in malignant serous tumors (50%), in the poorly differentiated tumors (47.6%), and in the 6th decade of age (30.8%). Conclusions: P53 was expressed in 48.1% of malignant ovarian tumors, 80.8% were epithelial tumors, 15.4% were sex cord-stromal tumors, and 3.8% were germ cell tumors, and it was negative in benign and borderline tumors.

Abstract: ABSTRACT Objectives: To examine the prevalence of osteoporosis in steroid dependent asthma. To compare it with non-asthmatic patients who use steroid for different diseases and with a third group of patients who were referred for dual-energy X-ray absorptiometry (DXA) for various complaints and they never used steroid. Patients and methods: The study involved 70 asthma patients (12 males and 58 females) on oral corticosteroids and /or inhaled steroid, with their mean age of 48.94 with SD±13.49, 40 non asthmatic patients (3 males and 37 females) on oral steroid with their mean age of 53.93 with SD±13.02 and 47 patients as control one male and 46 females who are neither asthmatic nor using steroids, their mean age of 52.47 with SD±9.76. All patients and controls were studied in the outpatient department in Ibn Sena Teaching Hospital. All patients and controls had their bone mineral density (BMD) measurement done by using dual-energy x-ray absorptiometry (DXA). Results: The effects of weight on the development of osteopenia or osteoporosis indicate no statistically significant effects on the development of osteopenia or osteoporosis. The doses of steroids in osteoporotics showed no statistically significant difference between asthmatics and non-asthmatics. In osteopenia in both groups indicates statistically significant differences between them in favour of asthmatics over non-asthmatics. The duration of treatment with steroids for asthmatics and non-asthmatics indicates that, in osteoporotics asthmatics and non-asthmatics there were statistically significant difference between them, in favour of asthmatics over non-asthmatics, so as in osteopenics. Patients with asthma who take inhaled steroid only, indicates that the higher dose of inhaled steroids lead to osteoporosis with statistically significant difference between those who developed osteopenia or osteoporosis. We compared the DEXA scan score values (T-scores and Z-score values) of asthmatics and nonasthmatics in the entire sample in this study. There were statistically significant differences between asthmatics and non-asthmatics (including the controls) with p-value for the T-scores and Z-score of (0.000, 0.000) respectively. Conclusion: asthma should be regarded as independent risk factor for the development of osteopenia and osteoporosis. Steroid dose should be monitored. Adequate vitamin D supplement as preventive measures is well recognized factor in osteoporosis and osteopenia of all causes.

Abstract: ABSTRACT Background: Genu varus deformity (bowlegs) is deviation of leg distal to knee toward midline, it is very common in early childhood. No data is available in apparently healthy Iraqi children. Objective: To identify the common causes of genu varus, and to evaluate its correction. Patients and methods: it is case series study; two hundred and thirteen children with bilateral genu varus deformities were included from Orthopedic Outpatient Clinic, Aljumhoori Teaching Hospital. The intercondylar distance was measured every 6 months during the period of follow-up which ranged between 2- 6 years. Results: Physiological genu varus was the commonest cause, 153 children (71.8%), their mean intercondylar distance was 3.42 ± 0.93, corrected spontaneously within two years. Nutritional rickets was the second cause in 58 patients (27.2%), their mean intercondylar distance was 4.22 ± 0.92 corrected spontaneously with medical treatment within 4 years. Two patients had vitamin D resistant rickets (hypophosphataemia), their deformities increased with growth. Conclusion: The most common cause of bilateral genu varus was physiological, usually corrected spontaneously within two years. Nutritional rickets was the second cause which leads to more severe genu varus, and delay its correction.