Print ISSN: 0027-1446

Online ISSN: 2309-6217

Volume 31, Issue 1

Volume 31, Issue 1, Winter and Spring 2005, Page 1-51


Plasma level of atrial natriuretic peptide during normal pregnancy and preeclampsia

Abdul-Aziz A. Aziz

Annals of the College of Medicine, Mosul, Volume 31, Issue 1, Pages 1-5
DOI: 10.33899/mmed.2005.8867

objective: To assess plasma atrial natriuretic peptide (ANP) level in pregnant andpreeclamptic women, and to evaluate the role of this hormone in the defense mechanismagainst body fluids and electrolytes disorders encountered under such physiologicaland pathophysiological conditions.Design: A case- series study.Setting: Al - Batool Teaching Hospital for Gynecology and Obstetrics, Mosul, during the period from December 2003 to September 2004.Participants: Twenty five women with normal pregnancy (group I ), 25 pregnant women withpreeclampsia (group ll ) and 25 healthy non pregnant women (control group) were included in this study.Methods: Plasma ANP, serum creatinine, urea, sodium and potassium were measured in allgroups. unpaired -t-test was used to examine the difference in the mean of the studiedparameters between different groups. Pearson correlation was used to assess the relationbetween different parameters within each group.Results: The mean of plasma ANP level was significantly higher in group I (p<0.05) and groupll (p<0.0001) than that in the control group. Furthermore, the plasma ANP level wassignificantly higher in group ll (p<0,0001) than that in group l. The mean of serum creatinineand serum urea were significantly higher in group ll than that in group l (p<0.005 and p<0.0001) and control group (p<0.0001 and p<0.0001).Conclusion: The results of this study indicate that plasma ANP level significantly increasesduring pregnancy especially among those who develop preeclampsia. Since ANP plays animportant role in the maintenance of body fluids and electrolytes homeostasis and bloodpressure regulation, estimation of plasma ANP level may be of value in better understandingand management of pathophysiological conditions that challenge the body homeostaticmechanisms during pregnancy.Key words: Atrial natriuretic peptide, preeclampsia.

Canal wall down mastoidectomy and causes of failure review of 25 patients

Nafi M. Shehab

Annals of the College of Medicine, Mosul, Volume 31, Issue 1, Pages 6-9
DOI: 10.33899/mmed.2005.8871

objective: To study the causes of failure (canal wall down) mastoidectomy procedure.Design: A prospective case series study.Setting: ENT department, Al-Jamhory teaching Hospital during the period of May 1996 to May 2000.Participation: Twenty five patients underwent canal wall down operation over a period of four years. They were reviewed for the final result after the operation.Results: Fifteen patients were noticed to have complete dryness and healing. Eighty percent of the patients get dry ear within the first three months after the operation. failure to get healed cavity was seen in patients with large cavities, high facial ridge and inadequate meatoplasty.conclusion: Recognition -of the possible causes of failure to get dry ear, the surgeon's experience and the regular follow up of the patient, may help in achieving better results.

Bronchiectasis in northern lraq clinical and bacteriological characteristics during acute exacerbation

Rami M. A. Al-Hayali

Annals of the College of Medicine, Mosul, Volume 31, Issue 1, Pages 10-16
DOI: 10.33899/mmed.2005.29435

Context: Bronchiectasis is a relatively common disease in developing countries, The pathogens responsible for its acute exacerbations vary from one area to another.
Objectives: To study the characteristics of patients with bronchiectasis in Northern lraq, and to identify the types of pathogens responsible for the acute exacerbations.
Design: Case series study.
Setting: Respiratory Care Unit and general medical wards in lbn-Sina Teaching Hospital in
Mosul, during the years 2002-2004.
Patients and Methods: Fifty patients with bronchiectasis (16 males and 34 females) presenting during an acute exacerbation underwent clinical and radiological evaluation with sputum Gram (Gm)stain and culture.
Results: The cause of the disease was readily identifiable in 367o of patients. Tuberculosis was the predominant aetiology. Streptococcus pneumoniae and klebsiella pneumoniae were the commonest pathogens. Gm negative bacilli were responsible for 36% of cases overall, and were especially important in those with long standing disease (≥15 years) Pseudomonas
aeruginosa was related to more extensive disease. Most of the isolates were sensitive to
ciprofloxacin and cefotaxime.
conclusion: Gm negative bacilli should be considered in antibiotic selection during acute
exacerbation of bronchiectasis, especially in long standing and extensive disease.
Keywords: bronchiectasis, Gram negative bacilli

Malignant tumours of nasal cavity and paranasal sinuses in north of lraq a fifteen years retrospective study

Q Radwan; Daoud S. Allos

Annals of the College of Medicine, Mosul, Volume 31, Issue 1, Pages 17-21
DOI: 10.33899/mmed.2005.29450

Objectives: To identify the different pathological types of malignant tumors of nasal cavity' and paranasal sinuses, their different clinical aspects, treatment received and prognosis in north of Iraq.
Design : Retrospective study.
Settings: Files of patients treated in the hospital of oncology and nuclear medicine in Mosul
over 15 years period (1980-1994).
Main outcome measures: Types, incidence, age and sex distribution, anatomical sites, clinical presentation, staging, method of treatment and prognosis.
Results: They constituted 0.51% of all malignancies and 2.13 % of head and neck cancers.
Sinus tumours affected both sexes equally as well as both sides. Nasal cavity tumours were
more common in male (male/female=1.4/1) and in the right side (right/left=1.33/1).The
commonest age at presentation was the fifth decade.
The most common presenting symptom was facial and nasal pain with average delay in
diagnosis of about 8.5 months. Tumours of epithelial origin formed the majority of
cases (85.68%).
All maxillary and ethmoidal cases were advanced at time of diagnosis (T3 or T4), while 60%
of nasal cavity tumours were T1 and T2. 21.87% of patients had palpable cervical lymph nodes at presentation.
The majority of patients received radiotherapy alone, few cases had surgery alone or both, but prognosis was generally unsatisfactory
conclusion: Malignant tumours of nose and sinuses are rare in north of lraq, are usually
advanced at presention , and carry poor prognosis.

keywords: Malignant Tumours , Nasal Cavity , Paranasal Sinuses

Middle ear effusion: tympanometry versus operative findings

Ali A. Muttalib

Annals of the College of Medicine, Mosul, Volume 31, Issue 1, Pages 22-26
DOI: 10.33899/mmed.2005.8870

Objective: To evaluate the role of tympanometry in predicting middle ear effusion by comparing results with the operative findings.Design: A descriptive study concerned with 105 ears (57 patients) diagnosed as middle eareffusion by tympanometry; type B, flat curve; that underwent myringotomy operation (with or without ventilation tube insertion).setting: Department of ENT-Al-salam Teaching Hospital/Mosul for the period (April 2003 to September 2004). Tympanometry was performed in the Outpatient Clinic of Al-JamhooriTeaching Hospital.Subjects: The study included 36 males and 21 females with a ratio of 1.7:1. The average agewas 6 years with a range of 3-12 years.Methods: The parameters analyzed included age, sex and tympanometric results. Matchingbetween the suspected ears for middle ear effusion; type B, flat curve; and the operativefindings (fluid found in the middle ear at the time of myringotomy) was recorded.Results: The diagnostic accuracy and examination success rate of tympanometry; type B, flatcurve; in predicting middle ear effusion was 71.4%. Moreover, the sensitivity, specificity, positive and negative predictive values were 97.2% , 57.3%,55.3% and 97.5% respectively. Thus, the positive likelihood ratio was 2.3.Conclusion: The accuracy rate of tympanometry in predicting middle ear effusion showed a fair validity for its exclusion. The use of pneumatic otoscopy and tympanometry together improves the accuracy of diagnosis.Key words: Tympanometry, middle ear effusion, myringotomy.

Precipitating risk factors for diabetic ketoacidosis in children with type 1 diabetes mellitus

Salem Rahma

Annals of the College of Medicine, Mosul, Volume 31, Issue 1, Pages 27-31
DOI: 10.33899/mmed.2005.8863

ABSTRACTObjective: To determine the precipitating risk factors for diabetic ketoacidosis (DKA) from medical and social points of view as well as risk of prolonged hospital stay.Methods: Forty-eight patients were admitted to Basrah Maternity and Child Hospital for DKA. Over a 2 years period; September 2001 through to September 2003. Patient's age, sex and family socioeconomic status were identified. Duration of hospital stay was examined, prolonged duration of stay was defined as ،ف 7days.Results: Forty eight patients with DKA, their ages ranged between 1 and 15 years, with a male to a female ratio 1.3:1.More than half of the children (58.4%) were males and (60.5%) were from low social status. Poor compliance to continue the treatment and infections were the most common precipitating factors, being responsible for 54.2% and 25% of cases of DKA respectivelyChildren with prolonged hospital stay were significantly found to be of younger age and of low socioeconomic status.Conclusions: DKA is still a commonly seen complication; it can be the presenting feature ofdiabetes. Poor compliance and inadequate treatment are the leading precipitating factors in our patients.

Atrial natriuretic peptide in chronic renal failure on maintenance hemodialysis : effect of heart failure

Abdul-Aziz A. Aziz

Annals of the College of Medicine, Mosul, Volume 31, Issue 1, Pages 32-36
DOI: 10.33899/mmed.2005.8872

objective: To examine the plasma level of atrial natriuretic peptide(ANP) in patients withchronic renal failure (CRF) undergoing maintenance hemodialysis ( HD) and to evaluate theeffect of superimposed cardiac functional impairment on the plasma level of this hormone.Design: A case- series studySetting: Artificial Kidney and Dialysis Unit of lbn-Sena Teaching Hospital, Mosul; during theperiod from June 2003 to August 2004.Participants: Forty patients with CRF undergoing maintenance HD, were divided into 2 groups depending on presence or absence of heart 6itu[. Group l, includes 20 patients with CRF who did not have heart failure and group Il, includes 20 patients with CRF who had heart failure, The study also includes 20 healthy volunteers as a control group.Methods: Plasma ANP, serum creatinine, urea and body weights were measured in CRFpatients before and after HD. The same parameters were also measured in the control group.The paired-t-test was used to examine the difference in the mean of the studied parameters in patients with CRF before and after HD. The unpaired -t- test was used to assess the difference in the mean of the above-mentioned parameters between patients and control group. Pearson correlation coefficient was used to study the relation of the means of differences between pre and post dialysis values of the studied parameters within each patient group.Results: The mean of plasma ANP level was significantly higher in group I (p<0.0001) andgroup ll (p<0.0001) than that in the control group before and after HD. Furthermore, the plasma ANP in group ll was significantly higher (p<0.0001) than that in group I. There was a significant decrease in the plasma ANP in group I (pconclusion: Periodic measurement of plasma ANP level in patients with CRF may be of greatvalue in evaluating the actual fluid status in patients having CRI and in determination offrequency and duration of dialysis sessions. lt also may be of value in predicting cardiacdysfunction in patients with CRF.Key words: Atrial natriuetic peptide, chronic renal failure, haemodialysis.

The prevalence of trichomonas vaginalis in association with other micro-organisms among women with vaginal discharge in Mosul

Ghada A. Al-Daheen; Nawfal Y. Al-Dabbagh; Haytham M. Al-Habib

Annals of the College of Medicine, Mosul, Volume 31, Issue 1, Pages 37-44
DOI: 10.33899/mmed.2005.29455

objective: To screen women with vaginal discharge for Trichomonas vaginalis as well as other pathogens and to follow them up.
Setting: outpatient Gynaecologic Clinic, Family Planning Clinic, and Antenatal Clinic at Al- Batool Teaching Hospital for Gynaecology and Obstetrics.
Participants: a 440 women with vaginal discharge (July 1997 to June 1999).
Intervention: Full medical, gynaecological, sexual and social history was recorded. Clinical examination was carried out. Laboratory investigations including vaginal, cervical and urethral swabs for direct examination, gram-stained smear, as well as culture on appropriate media.
Results: The total number of Trichomonas vaginalis infection was 68 (15.5%). The isolated microorganisms in association with Trichomonas vaginalis were candida albicans in 19 women (27.9%), Staphylococcus epidermidis in 10 women ( 14.7%
), and Lactobacilli in six women constituting (8.8 %) . Both Diphtheroids and Neisseria ganorrheae showed lower incidences, as only eight women were positive (5.9 %) for each. Escherichia. Coli was present in one patient (1.5%).24 patients were positive for Trichomonas vaginalis only (35.3 %).
The remaining 372 women who were negative Trichomohas vaginalis showed a high rate of infection with Candida species (21.5%),followed by Staphylococcus epictermidis(18.3%) and lactobacilli (15.3%).other isolates included Streptococcus species (8.6%)., E.coli (5.9%), Klebsiella ( 3.8%) ,Enterococcus fecalis (3.0%), Gardnerella vaginalis (2.6%), Neissenria gonorrheae (2.4%), Proteus (2.2), Diphtheroid (1.9%), staphylococcrus aureus(1.3%) and Pseudomonas aeruginosa (0.8%). Moreover, 46 (10.5%) of women showed no growth. 50.0% of infection with Trichomonas vaginalis was at age 26-35 years Considering marital status, the highest rate (76.4 %) of infection was among married women followed by divorced (14.7 %), widows (5.8 %) and singles ( 2.9%). Pregnant women positive for Trichomonas vaginalis represented (45 .6 %) of cases. 61.7% of infection was among illiterate women.
Metronidazole (flagyl) was given to all in a dose of 250mg orally thrice daily for seven days.
Metronidazole was prescribed at the same time to husbands of infected women. other specific medications (antifungal, antimicrobial agents) were given when indicated either alone or in combination with metronidazole.
Two weeks later only 112 women came for reassessment clinically and by repeating direct smear and culture, that showed fifteen positive cases. Five of them still having Trichomonas vaginalis, eight were having Candida albicans, and two showed normal smears. Further courses of treatment were given as indicated.
conclusion: Vaginal discharge is common among women in reproductive life.
Culture is indicated for precise diagnosis
Key words: Trichomonas vaginalis. Vaginal discharge, Metronidazole.

Malignant peripheral neuroepithelioma "peripheral neuroblastoma" a case report

Amer A. Yousif; Bedoor AK. Al-Irhayim

Annals of the College of Medicine, Mosul, Volume 31, Issue 1, Pages 45-47
DOI: 10.33899/mmed.2005.8866

ABSTRACTPeripheral neuroepitheliomais a rare malignant tumour of primitive peripheral non autonomic nervous system. The tumour can occur at any age involving soft tissue mainly of lower extremities, Other sites of occurrence are the shoulder-thoracic region and the head and neck.It is a very aggressive tumour with early metastasis mainly to the lung.Herewith we report a case of 16 years old female who was presented with soft mass of labia majora of 3 years duration which has been rapidly enlarging in the last 6 months. The mass was excised and followed by administration of chemotherapy and radiotherapy. The patient developed secondaries in the lung 3 months after excision, with pleural effusion, but no local recurrence. However, eight months after the diagnosis and in January 2005, the patient died from the tumour.Keywords: Peripheral Neuroepithelioma Primitive Neuro Ectodermal Tumour "PNET" Soft tissue.

Spontaneous ovarian hyper stimulation syndrome following hydatidiform mole(A case report)

Ghada Abdul - Ghani Al - Daheen

Annals of the College of Medicine, Mosul, Volume 31, Issue 1, Pages 48-51
DOI: 10.33899/mmed.2005.8868

OHSS is an uncommon, but Potentially life threatening complication of ovarianstimulation by ovulation induction agents. This condition was first describedas being iatrogenic following the use of gonadotropins in ovulation induction.White the incidence of iatrogenic OHSS varies between 0.5 - 10 %, it is very rare tooccur spontaneously.