Print ISSN: 0027-1446

Online ISSN: 2309-6217

Volume 33, Issue 1

Volume 33, Issue 1, Summer and Autumn 2007, Page 1-69

Surgical treatment of the displaced diaphyseal fractures of forearm in children

Ali.K. Mohi-Aldeen; Mahmood. A. Al-Jumaily; Nabeel M. Al-Sabbagh

Annals of the College of Medicine, Mosul, Volume 33, Issue 1, Pages 1-8
DOI: 10.33899/mmed.2007.8838

Objective: To present the patients and the results of surgical treatment in displaced diaphyseal fracture of radius and ulna in children and to compare the result of the group treated with plate and screws with group treated by intramedullary Kirschner wire fixation. Methods: A prospective and comparative study of operative treatment; conducted at the Department of orthopedic in ALjamhory teaching hospital, Mosul between September 2001 and May 2003. Out of 153 children with traumatic displaced diaphyseal fracture of radius and ulna, operative treatment was indicated in 50 children, who were divided in two groups. The first group (26 patients) was treated with fixation by intramedullary Kirschner wires (K-wires), the wire introduced from distal end of radius and from olecranon or distal end for ulna. The second group (24 patients) was treated with fixation by 1/3-tubular plate (type AO) and screws. The functional outcome results at last follow up were assessed clinically.Results: There were 37 males and 13 females. The mean follow-up was 27 months. The mean age of patients was (10.42) years ranged. The right side was affected in 36% and left side in 64%. The operative time and duration of hospitalization were significantly shorter in the group treated by intramedullary Kirschner wires (K-wires). Most of the patients in both groups passed without serious complications. About 88% of patients in both groups had good or excellent results in last functional assessment.Conclusion: Both intramedullary K-wires fixation and plate and screws fixation are useful techniques in the treatment of displaced diaphyseal fractures of radius and ulna. Intramedullary K-wires fixation are safe, easy, cheaper, shorter in duration, skin incisions are smaller, less soft tissue dissection, the stripping of the periosteum is minimal, and with less complications. The ease of K-wires removal in the outpatient clinic and no need for second operation as in plate removal is another advantage.

Fine needle aspiration biopsy "FNAB" for peripheral lung lesions: diagnostic value, complications and role of US guidance.

Talal AL-Saegh; Hazim K. AL-Allaf; Aasem M. AL-Chalabi

Annals of the College of Medicine, Mosul, Volume 33, Issue 1, Pages 9-14
DOI: 10.33899/mmed.2007.8833

Objective: To assess the role of ultrasound in guiding fine needle aspiration lung biopsy in peripheral lung lesions.Methods: Using real-time ultrasonography, Seimense Sonoline equipment with 3.5 and 5.0 MHz transducer, the patients were examined to localize the lesions and prepare for performing biopsy.Main result: One hundred fifty patients having peripheral lung lesions, 119 (79.3%) males and 31 (20.7%) females with mean age of (56) years were exposed to lung biopsy. One hundred forty (140) patients showed malignant lesions. Six patients had tuberculosis, two patients had interstitial pneumonitis and other two were normal.Conclusion: Ultrasound guided transthoracic biopsy appears very safe and effective method for the diagnosis of peripheral lung lesions when bronchoscopy failed to reach the lesion, and to avoid the need of thoracotomy to achieve that.

Pattern of cerebral palsy in Mosul

Nada A.A. Al-Ali

Annals of the College of Medicine, Mosul, Volume 33, Issue 1, Pages 15-19
DOI: 10.33899/mmed.2007.8839

Objective: To examine the possible etiological factors, the clinical types, and the consequences of cerebral palsy in Mosul.Methods: This prospective descriptive (case series study) took place in children’s teaching hospitals Mosul. All children diagnosed as cerebral palsy between March 2000 and March 2005 were recruited for this study. Children without a clear diagnosis and those below the age of 12 months were excluded. Thus 306 Patients were recruited prospectively from those attending the inpatients and outpatients clinics of children’s teaching hospitals in Mosul. The caretakers of children were asked to fill in questionnaire. The patients were examined and classified. They were also assessed by an ophthalmologist and an audiologist; computerized tomography of the brain and EEG were performed when appropriate. Results: There were 306 patients; 184 were females and l22were males. The female to male ratio was 1.5:1 .Birth asphyxia accounted for 118 (38.6%) of cases. Low birth weight accounted for 70 (22.9%) of cases. The etiology was undetermined in 66 (21.4%). Neonatal jaundice: 32 (10.5%), meningoencephalitis:16(5.2%), and brain malformations in 4 (1.3%), spastic cerebral palsy was found in 244(79.7%) of the clinical typing, psychomotor delay was present in 96 (31.4%) and epilepsy was reported in 114 (37.3%). Ocular problems were reported in 152 (49.7%); speech problems were reported in 108 (35.3%); and hearing problems were reported in 8(2.0%).Conclusion: The etiological factors of cerebral palsy are sometimes preventable in our region. Improvement in antenatal, natal, and perinatal care is essential in the reduction of the incidence of cerebral palsy.

Arthroscopy in the treatment of knee septic arthritis

Ahmad I. Al- Jibbory; Mahmood A. Aljumaily

Annals of the College of Medicine, Mosul, Volume 33, Issue 1, Pages 20-25
DOI: 10.33899/mmed.2007.8837

Objective: to evaluate the use of arthroscopic irrigation in the treatment of septic arthritis of the knee joint.
Methods: This case series study. Was conducted in Al-Jamhori Teaching Hospital in Mosul, from August 2003 to December 2005, on twenty patients with septic arthritis of knee joint who presented with pain, fever, swelling and limitation of movements of their affected knee joint. The mean age of the patients was 31.5 years, and the female to male ratio was 1:1.5. Arthroscopic irrigation was arranged within 24 hours of admission, suction drain used, with the use of intravenous antibiotic for 7 days then change to oral antibiotic for 5-6 weeks. laboratory investigation and X-ray were done, aspiration of synovial fluid was send for analysis, direct gram stain, culture and sensitivity.
Results: Synovial biopsy confirmed the diagnosis and showed typical changes of septic arthritis. We achieved 60% excellent, 30% good and 10% acceptable results of the knee joint depending on clinical evaluation and laboratory investigation. Most of patients were delayed in presentation. Staphylococcus aureus was the commonest causative organism.
Conclusion: Arthroscopic irrigation of knee joint has encouraging results in the treatment of septic knee with low incidence of complications.

Detection of chlamydia and other bacteria in cervicitis.

Zainalabideen A. Abdulla; Asmaa Z. Sheetawy

Annals of the College of Medicine, Mosul, Volume 33, Issue 1, Pages 26-34
DOI: 10.33899/mmed.2007.8842

Objectives 1.To detect the presence of chlamydia in the cervix of symptomatic and asymptomatic cases of cervicitis 2. To conduct a full bacteriological identification of the microorganisms isolated from the cervix and vagina of the studied women 3. To study the association between chlamydial infection and negative bacterial cultures. 4.To evaluate the findings of wet preparation of vaginal swabs in chlamydia positive and negative cases. 5. To estimate the serum concentration of C-reactive protein (CRP) in chlamydia positive and negative cases. Materials and methods: This study was conducted during the period from December 2003 up to June 2004. It included a total of 200 women; 120 women were suffering from symptomatic cervicitis and 80 were asymptomatic for any gynaecological problems. Two endocervical and one high vaginal swabs were collected from each patient. One of the two endocervical swabs was used for the detection of chlamydia by immunochromatographic card test and the second one was used for bacterial culture. The high vaginal swab was used for wet preparation, and bacterial culture. The sera of these patients were tested for serum CRP level. Results: Chlamydia infection was detected in 34 (17%) of the total 200 cases studied. Among the symptomatic group, 19(15.9%) were found to be chlamydia positive, while among the asymptomatic group, 15 (18.7%) were chlamydia positive. The association of chlamydia with negative bacterial culture was found to be significant in symptomatic group of patients (p< 0.001), but not in the asymptomatic group (p>0.100). The wet preparation findings in chlamydia positive cases revealed that the increased numbers of PMN (>10/hpf) were statistically not significant in symptomatic group (p>0.194), but significant in the asymptomatic group (p<0.036). The association of chlamydia positivity with increased serum CRP level (> 6 mg/L ) was also found to be significant in both symptomatic and asymptomatic groups of cases (p <0.001). Also, The presence of clue cells and Trichomonas vaginalis infection increases the possibility of chlamydia infection.Conclusions: The immunochromatographic card test for chlamydia antigens represents a rapid, informative and not an expensive method for the detection of chlamydia infection. The negative bacterial cultures increase the possibility of chlamydia infection in symptomatic cases, but not in the asymptomatic ones. The CRP level increases significantly in infections caused by chlamydia, but not by other bacteria.

Oxidative stress in epileptic patients on different antiepileptic monotherapy

Imad A.J. Thanoon

Annals of the College of Medicine, Mosul, Volume 33, Issue 1, Pages 35-41
DOI: 10.33899/mmed.2007.8835

Objective: To assess, the oxidative stress (by assessing lipid peroxidation) and total antioxidant status, in epileptic patients on different antiepileptic monotherapy (carbamazepine (CBZ), valproic acid (VPA) or Phenobarbital (PhB)),in comparison with the control.Methods: This case-control study was conducted in the department of pharmacology- College of Medicine –University of Mosul from the 1st of June 2005 to the 15th of June 2006. A total of seventy four epileptic patients, on different antiepileptic monotherapy were included 38 on carbamazepine, 23 on valproic acid and 13 on phenobarbital, with 40 apparently healthy subjects as a control group for patients on carbamazepine or valproic acid and with 15 healthy children as a control group for patients on phenobarbital. For each patient and control subject, serum malondialdehyde (MDA) which reflects the lipid peroxidation, and total antioxidant status (TAS) were measured. Results: There was a significant increase in serum MAD level and a significant decrease in serum TAS level in epileptic patients on different antiepileptic monotherapy (CBZ, VPA and PhB). With the exception of patients on PhB, there was a poor correlation between MDA, TAS, the age of patients, the duration of illness and the duration of therapy.Conclusion: Epileptic patients on CBZ, VPA and PhB monotherapy had elevated lipid peroxidation as reflected by a significant increase in serum MDA and a decrease in serum TAS level, which might reflect a great impact on oxidative /antioxidant status.

Popular health beliefs: Old wives tales about pregnancy and its outcome in Mosul city.

Asma A. AL-Jawadi; Nuha Hachim; Dhafer B. AL-Youzbaki

Annals of the College of Medicine, Mosul, Volume 33, Issue 1, Pages 42-50
DOI: 10.33899/mmed.2007.8836

Background: Searching of popular health beliefs carries many benefits to the whole health process and any physician wants to function effectively in his community must be aware, socially, about these important popular beliefs about health and illness that may manipulate any treatment or preventive health plan. This work was conducted to evaluate the most important popular health beliefs related to pregnancy and its outcome. Methods: A cross sectional design was used in this work. From the sociological point of view, it is a qualitative research, using a consecutive sample of women attendants at a primary health care centers for the period from. 1st. October 2006 to 1st. February 2007.Assessment of the popular health beliefs about pregnancy regarding nutrition, hygiene, physical activity, dressing, utilization of medical services during pregnancy, deliveries, breast feeding, and sexual activities throughout the pregnancy was carried out by the use of especially designed questionnaire. All the information were gathered from women more than 40 years old, who have children and living in Mosul city since 30 years. Results: Most of the participants in this study agreed about the importance of organ and red meats, milk, vegetables and fruits during pregnancy (99%, 97%, 95%, and 94% respectively). A lower proportion agreed about the usefulness of vitamins (63%), iron tablets (61%) and white meats (61%). Sufficient numbers (71%) regarded bathing as a healthy practice during pregnancy as well as tooth brushing (68%) and hand washing (92%). Only 36% went with walking for the pregnant women, 96% were against aerobics and also against running. More than two thirds (77%) supported vaccination, all refused exposure to X-ray and 90% also refused non-prescribed medication. The majority (91%) agreed about the importance of hospital deliveries and three quarters (75%) disagreed about untrained dia as a birth attendant. Fortunately, 83% were agreed about giving the colostrums to the new born directly after delivery. A dangerous proportion (18%) of mothers was assured about the benefits of application ash of dung or dung on the umbilical stump. Breast feeding got support from 84% while, 60% agreed about 3 weeks and more as a rest period after delivery. Conclusion: Many popular health beliefs regarding pregnancy in Mosul city go in agreement with the scientific health facts and theories that should be reinforced and supported. Moreover, the very hazardous popular health belief that ash of dung or dung may be applied to the umbilical stumps of the newly born babies, still needs an intensive intervention health educational program.

Validity of ultrasound examination in the diagnosis of acute appendicitis compared with surgical results

Hazim K. AL-Allaf

Annals of the College of Medicine, Mosul, Volume 33, Issue 1, Pages 51-58
DOI: 10.33899/mmed.2007.8840

Objective: To assess the validity of ultrasound examination in the diagnosis of acute appendicitis.Methods: This case series study included 750 patients. From January 2003 to March 2007, patients with suspected acute appendicitis were sent to the radiological section in the AL-Jamhory teaching hospital and my private clinic for sonography.A distended appendix with a lumen more than 6mm, aperistaltic appendix with appendicolith in its lumen are all signs and criteria for the diagnosis of acute appendicitis.Result: Of the 750 patients suspected to have acute appendicitis who were examined by sonography, 527 were males and 223 females. 468 patients had true acute appendicitis, and 220 patients were negative for this disease.Thirty patients showed false positive diagnosis, while 32 patients proved to have false negative results. The overall sensitivity of ultrasound examination to diagnose acute appendicitis was 94%, specificity 88%, accuracy 92%, positive predictive value 93% and negative predictive value was 88%.Conclusion: sonography must be used as first modality to assess suspected acute appendicitis. It is easy, non invasive, simple and rapid.

Evaluation of acute flaccid paralysis surveillance system in Kerkuk governorate

Zaid M. Yassen

Annals of the College of Medicine, Mosul, Volume 33, Issue 1, Pages 59-65
DOI: 10.33899/mmed.2007.8841

Context: High quality acute flaccid paralysis surveillance system is a aquite important strategy for polio eradication. Surveillance data are the cornerstone to document a national polio free status. The aim of the present study is to evaluate the acute flaccid paralysis surveillance system in Kerkuk Governorate. Methods: Program evaluation of the Directorate of health, primary health care districts (sectors), hospitals, and primary health care centers in Kerkuk Governorate. All the responsible personnel for the acute flaccid paralysis surveillance system were interviewed and included in addition to the relevant records. Ordinary percentages were used in the description of acute flaccid paralysis cases. While rates were used in the evaluation of the performance indicators. Results: The study revealed a sensitive acute flaccid paralysis surveillance system (Non polio acute flaccid paralysis rate 3.98 and 3.1 in 2005 and 2006 respectively) with clear field guidelines. All the performance indicators were high indicating a high quality surveillance system in Kerkuk Governorate.Conclusions: Solid surveillance structure, regular contract and excellent case management were observed, in addition to regular passive and active surveillance.

Effect of combined oral contraceptive pills on some haemostatic parameters

Muna A. Kashmoola; Ahmed J. AL-Husaynee

Annals of the College of Medicine, Mosul, Volume 33, Issue 1, Pages 66-69
DOI: 10.33899/mmed.2007.8834

Objective: To assess our local status of markers of coagulation in response to combined oral contraceptive (COC) pill.Methods: A prospective clinico- haematological study was carried out in private lab. Forty non smoker women on (COC) pill ( Levonorgestrel 0.25 mg and ethinyl estradiol 0.05mg) for 3 months and more; their ages ranging between thirty and thirty five with a control group of 40 women were studied during a period of 6 months starting from August 2006. Most important haemostaic parameters including platelet count (PC) Prothrombin time (PT) and activated partial thromboplastin time (APTT), Fibrinogen and D-dimer were done for them.Results: There was a significant increase in the mean values of (PC), fibrinogen with (P <0.05, <0.05) respectively, while the PT and APTT were significantly reduced with (P <0.05, <0.05) respectively. D-dimer was significantly positive in users than non users (P<0.001).Conclusion: there was some degree of pro-coagulant activity in women on COC and such females need monitoring of haemostatic parameters.