Print ISSN: 0027-1446

Online ISSN: 2309-6217

Volume 36, Issue 1

Volume 36, Issue 1, Summer and Autumn 2010, Page 1-156

Demographic and causal pattern of acute uppergastrointestinal bleeding in Mosul

Khaldoon Th. Al-Abachi

Annals of the College of Medicine, Mosul, Volume 36, Issue 1, Pages 1-7
DOI: 10.33899/mmed.2010.8934

ABSTRACTObjectives: To assess the age and sex distribution of 200 patients presented with acute upper gastrointestinal bleeding (AUGIB) in Al-Salam General Hospital in Mosul, and to identify the causes of bleeding through endoscopic examination. Patients and methods: This is a case series study of 200 patients with (AUGIB) at the endoscopy unit in Al-Salam general hospital in Mosul, during the period from April 1999 to January 2009. The endoscopic findings, causes of bleeding and the patients' age and gender were recorded, analysed and the results were compared with other similar studies.Results: The mean age of the patients was 43.68 ± 19.11 years; those aged 60 years and above constituted 25.5% (51/200). Male:female ratio was ~ 2:1 (135 male, 65 female). Gastroduodenitis with erosions and duodenal ulcer (DU) were the main causes of (AUGIB) constituting 42.5% and 30.5% respectively. Actively bleeding (DU) constituted 36.1% (22/61) while actively bleeding erosions constituted 16.5% (14/85) which is a significant difference (p=0.008). Non-steroidal anti-inflammatory drugs (NSAIDs) were associated with bleeding in 9% of the cases (18/200). Conclusions: In this sample from Mosul city, (AUGIB) afflicted a relatively younger age group compared with western studies, while male: female ratio was nearly similar (2:1). Gastroduodenitis with erosions dominated the causes of bleeding and (DU) came next in frequency, while (DU) is the main cause in most western studies. The results of this study coincide more with the results from some developing countries. Keywords: Acute upper gastrointestinal bleeding, gastroduodenitis, non-steroidal anti-inflammatory drugs.

Prevalence of upper gastro intestinal endoscopy findings in endoscopy referred patients at Mosul city, a ten years retrospective study

Makkie A.K. AL-Youzbaki

Annals of the College of Medicine, Mosul, Volume 36, Issue 1, Pages 8-11
DOI: 10.33899/mmed.2010.8916

Objectives: To analyze the findings of upper GI endoscopic examination carried out in order to assess the prevalence of upper GI disorders in the examined patients.Design and setting: A retrospective clinical case series study done over a 10 years period from the 1st of October 1998 to the 1st of October 2008, at the Endoscopy Unit of Al Salam Teaching General Hospital during which a total of three thousand seven hundreds and nineteen upper GI endoscopic examinations were performed and analyzed.Results: The mean age of our patients was 39.8 years and male to female ratio was 1.29:1 (males 56% and females 44%). Out of the total number of patients (3719), a sum of 1322 (35.5%) patients were typed as normal on endoscopic assessment while 2397 (64.5%) patient were found to retain abnormal findings with the duodenal lesions being the commonest 64%, followed by esophageal one 19%, then gastric lesions 17%. Duodenal ulcer was the most frequently recovered pathology [689 (29%) patients] followed by duodenitis [483 (20%) patients], then by gastroesophageal reflux disease [363 (15%) patients] that is followed by gastritis [312 (13%) patients].Conclusions: Upper GI lesions are frequent in Mosul population. The upper GI endoscopy is a valuable mean in the assessment of upper GI symptomatology. Keywords: GI, gastrointestinal.

Waist circumference: a better predictor forlung ventilation than body mass index

Hazim M. Al-Habib; Rajaa A. Yonis; Amjad F. Ahmad

Annals of the College of Medicine, Mosul, Volume 36, Issue 1, Pages 12-17
DOI: 10.33899/mmed.2010.8931

ABSTRACTObjective: To evaluate the relationship between waist circumference, as a measure of central fat distribution, and lung ventilation function in both sexes among different weight categories in comparison with body mass index (BMI). Subjects and Methods: One hundred healthy adults from both sexes were volunteered in this observational-cross-sectional study (53 males aged 19-69 years and 47 females aged 19-51 years). Subjects were recruited from Mosul Medical College students, teaching as well as administration staff. After collecting personal and health information necessary for the study, all subjects underwent anthropometric measurements (height, weight, and waist circumference) before spirometry test using computerized spirometer. The study was conducted in the Department of Medical Physiology-Mosul Medical College.Results: All spirometric data were within 80-120% of the normal predicted values, thus excluding the possibility of any asymptomatic airway disease. A consistent negative correlation between, both waist circumference and BMI, with FVC and FEV1 were clearly observed in both sexes. Unlike BMI, waist circumference revealed stronger and significant negative correlation with lung function especially in male subjects. The significant negative correlation between waist circumference and FVC and FEV1 was more evident in overweight and obese subjects. Conclusion: Waist circumference, as a measure of body fat distribution, seems more reliable predictor of poor lung function, secondary to overweight and obesity, than BMI. This might be attributed to the fact that BMI relies only on body weight and height without consideration to the distribution of body fat, muscle and bone mass which might possess a more significant role. Keywords: Waist circumference, body fat distribution, lung function tests.

The effect of physical training program onbody composition and body mass index; Hussam Qahtan admin.nur; Bashar Jasim AL-juwari

Annals of the College of Medicine, Mosul, Volume 36, Issue 1, Pages 18-25
DOI: 10.33899/mmed.2010.8920

ABSTRACTObjectives: To evaluate the effect of physical training program on body composition and body mass index, and to evaluate the body mass index as predictor of body fat in young adults.Material and methods: Prospective was done at the College of Physical Education – University of Mosul, first year students (100) male and (22) female were participated in this study. A physical training program of 2 hours (aerobic exercise) daily for 4 days per week for 4 months. Medical height and weight scales (Detector) and bio-electrical impedance analysis measurements device(Quantum П) were used for measurements.Results: Physical training program has significant effect on body weight, BMI and free fat mass, but has no significant effect on fat mass. Conclusions: Physical training program increase BMI and free fat mass but has no significant effect on fat mass. BMI is a specific test for overweight and obesity but it is not a sensitive test.Keywords: BMI, physical training program, body composition.

Fever of unknown origin: A prospective study in Northern Iraq

Dhia J. Al-Layla; Humam Ghanim; Rafe; H. Al-Kazzaz; Rami M. A. Al-Hayali

Annals of the College of Medicine, Mosul, Volume 36, Issue 1, Pages 26-35
DOI: 10.33899/mmed.2010.8927

ABSTRACTObjectives: A wide variety of diseases are likely causes of fever of unknown origin (FUO). No fixed guidelines exist to direct the workup in these cases. We followed a diagnostic protocol to study the causes of FUO in Iraq, and to evaluate the contribution of clinical assessment and various investigations in making the final diagnosis. Methods: From March 2002 to September 2009, fifty five consecutive patients with FUO were admitted in a tertiary referral centre in Mosul, Iraq. The patients underwent a series of clinical and diagnostic evaluation in a prospective study, in an attempt to diagnose the underlying cause of fever. The benefit of history taking and clinical examination as directors of the diagnostic workup and the yield of various laboratory and imaging techniques were assessed.Results: Infections were the commonest causes of FUO (32.7%), followed by non-infectious inflammatory diseases (NIID) (25.4%), malignancies (16.4%) and miscellaneous causes (5.4%). No diagnosis was made in 20% of cases. Of infections, tuberculosis was the most important single cause of fever, while various vasculitides and non-Hodgkin's lymphoma were the commonest NIID and malignant disease, respectively. Symptoms of the patients were of little benefit in directing subsequent investigations, but the physical signs were more useful; finding enlarged lymph nodes was significantly associated with malignant diseases (p=0.009). Anaemia, high ESR and elevated liver enzymes were common and bear no significant association with any disease category. Chest radiograph and abdominal ultrasound were helpful initial imaging studies. CT scan of the chest was shown a useful diagnostic procedure.Conclusion: Together with infections, NIID are important causes of FUO in Iraq. Careful physical examination and a systematic approach on investigations are usually rewarding in reaching the diagnosis.

Effect of hydrochlorothiazide with amiloride on serum lipidprofile and malondialdehyde in hypertensive women

Faris A. Ahmed

Annals of the College of Medicine, Mosul, Volume 36, Issue 1, Pages 36-40
DOI: 10.33899/mmed.2010.8917

ABSTRACTObjectives: To study the effect of hydrochlorothiazde with amiloride on serum lipid profile and malondialdehyde (MDA) in hypertensive women.Methods: A case-control study was carried out in the Outpatient Department in Ibn-Sina General Hospital, Mosul, during the period from November 2005 to May 2006. Thirty hypertensive women treated with 50 mg hydrochlorothiazide and 5 mg amiloride per day in a single dose. The duration of treatment was between 1-5 years. Thirty mild hypertensive women (newly diagnosed, before treatment) were also included as a control group. Blood samples were taken from both the treated patients and controls and analysed for serum lipid profile and MDA. Non-paired 't-test was used to compare between parameters.Results: Hydrochlorothiazide with amiloride did not change serum lipid profile significantly in the hypertensive women compared with the control group, although serum lipid profile was in the upper normal value. The combination therapy decreased serum MDA significantly (P<0.05).Conclusion: Chronic use of combination therapy of hydrochlorothiazide with amiloride had no significant effect on serum lipid profile, but this combination reduced lipid peroxidation in hypertensive women. Lipid peroxidation is a consequence and not a cause of hypertension.Keywords: Lipid profile, lipid peroxidation, malondialdehyde, hypertensive women.

Measurement of lipid profile parameters in hypertensivepatients using atenolol or captopril

Mohammed Khalid Al. Hamo; Rawaa Khazal Jaber; Ahmed Yahya Dallal Bashi

Annals of the College of Medicine, Mosul, Volume 36, Issue 1, Pages 41-48
DOI: 10.33899/mmed.2010.8924

Objectives: To study the effects of atenolol and captopril on lipid profile parameters including total cholesterol (TC), triglycerides (TG), High density lipoprotein cholesterol (HDL-c), Low density lipoprotein cholesterol (LDL-c) and atherogenic index (AI) in serum. Moreover to compare the effects of these drugs on the above parameters with each other.Patients and Methods: One hundred hypertensive patients were involved in this study which were divided into two groups each of 50 patients. Patients in the first group were on atenolol and the patients in the second group were on captopril. All of the cases of hypertension were of the primary type (essential) as the patients were diagnosed by specialist physicians. The patients included were not chronically using any other drugs, nor having family history of hyperlipidemia, and not suffering from any other chronic disease. The ages of the patients in the first group ranged from 35-74 years with a mean of 55±5.02 years, while the ages of the second group ranged from 36-80 years with a mean of 57±6.0 years. Another group of 50 normal individuals participated in this study as a control group, with ages ranged from 35-72 years with a mean of 53±4.4 years. Results: The results of this study showed that serum TG and AI were significantly higher in atenolol using group in comparison with the control group, while serum HDL-c concentration was significantly lower. Whereas, the remaining lipid profile parameters studied were not significantly different from the control group. Serum LDL-c concentration was significantly low in captopril using group compared with the control group whereas the remaining lipid parameters studied were not significantly changed in this group. Further analysis of the results of the present study indicated significant decreases of serum TG and AI in captopril using group in comparison with Atenolol using group. Whereas, serum HDL-c concentration was significantly higher in captopril using group. Conclusion: The overall analysis of the lipid profile parameters studied might suggest that atenolol has certain undesirable effects on these parameters while captopril has less undesirable effects. This might indicate that captopril seems to be more suitable antihypertensive agent than atenolol for patients with lipid profile abnormalities.Keywords: Serum, lipid profile, triglyceride, total cholesterol, HDL-c, LDL-c, atherogenic index, hypertension.

Accuracy of clinical scores in differentiatingstroke subtypes in Mosul

Mahmood Mal-Allah; Khalid Gh. Hameed Al-Abachi; Hakki Mohammed Majdal

Annals of the College of Medicine, Mosul, Volume 36, Issue 1, Pages 49-55
DOI: 10.33899/mmed.2010.8918

ABSTRACTObjectives: To study the validity of clinical scores in differentiating intracerebral hemorrhage and ischemic stroke and to see which of them is more applicable in our hospitals.Methods: A prospective study of 100 consecutive patients with acute neurological deficit admitted as inpatient to the neurological unit in Ibn-Sina Teaching Hospital in the city of Mosul, evaluated with computed tomography and Allen and Siriraj scores to determine the pathological type of stroke during the period from September 15th 2008 and January 28th 2009.Results: The prevalence of hemorrhage (diagnosed with computed tomography) was 19%. Allen scores were "uncertain" in 13 cases and Siriraj scores in 17 cases; Sensitivity, specificity, positive and negative predictive values, for haemorrhage were 0.53, 0.96, 0.77 and 0.90, for Allen scores and 0.79, 0.97, 0.88, and 0.95 for Siriraj scores; such values for infarction were 0.91, 0.89, 0.97, and 0.71 for Allen scores and 0.80, 0.95, 0.98 and 0.53 for Siriraj scores.Conclusion: When CT-Scan is not immediately available and the clinician wishes to start antithrombotic treatment, the Siriraj score (and possibly the Allen score) can be useful to identify patients at low risk of intracerebral hemorrhage and The Siriraj score is simple, cheap, reliable and practical method which can be used immediately after the stroke.Keywords: Ischemic stroke IS, intracerebral hemorrhage ICH, computerized tomography (CT-Scan), Allen Hospital score (AS), Siriraj stroke Score (SS).

The effects of pulse pressure on left atrium andleft ventricle geometry in hypertensive patients

Arwa M. Fuzi Alsaraf

Annals of the College of Medicine, Mosul, Volume 36, Issue 1, Pages 56-62
DOI: 10.33899/mmed.2010.8921

ABSTRACTObjectives: An increased pulse pressure (PP) suggests aortic stiffening. New evidence suggests that (PP) is more sensitive measure of cardiac risk than other indexes of blood pressure. We aim to study the effect of pulse pressure in hypertensive patients on left atrial and left ventricle diameters (LAD, LVD), left ventricle geometry [wall thickness (WT), left ventricle mass (LVM), regional wall thickness (RWT)] and the effects of age and sex on the PP. Methods: Echocardiography study of LAD, LVD, left ventricle end diastolic diameter (LVEDD), aortic root diameter (ARD), ratios and left ventricle geometry was performed on 92 patients (61 female & 31 male). A correlation analysis between these variables and pulse pressure was done. Patients were grouped into high PP >60 mmHg and normal PP <59 mmHg and chi-square test was applied.Results: We found strong positive correlation between age and PP (p value =0.00), positive correlation of PP with WT, LVM and SBP (p value < 0.05) and positive correlation of LVM to LAD, LVD, RWT, LAD/ARD, LAD/LVEDD and the age (p value <0.05). Conclusion: The PP which increased by age is the most important BP measurement (compared to SBP and DBP) that directly affects LV geometry mainly WT & LVM.Keywords: Pulse pressure, left atrium, left ventricle, geometry, LV mass, wall thickness, regional wall thickness.

Bone marrow trephine in some hematologicaland non-hematological disorders

Nazar M. Jawhar; Mohammed S. Saeed

Annals of the College of Medicine, Mosul, Volume 36, Issue 1, Pages 63-71
DOI: 10.33899/mmed.2010.8932

Objective: To evaluate the frequency, age distribution and document the histological pattern of various hematological disorders reported in bone marrow biopsy.Methods: A retro and prospective study carried out from 2000 to 2007 at pathology laboratory of Irbil Razkary Hospital. A total number of 117 cases were investigated. The biopsy was taken from posterior superior iliac spine by the clinician. A length of 0.5 to 2 cm of marrow element was obtained, put overnight in 10% formalin for fixation, followed by decalcification in 5% nitric acid. Then processed in usual manner. Sections were examined by 2 pathologists independently.Results: the mean age of patients was 46.16 years ranging from 2 years to 76 years. The male to female ratio was 1.49:1. The commonest presenting clinical features of patients underwent bone marrow biopsy were pallor (91.4%), followed by body weakness (59.0%). The most frequent histological diagnoses in order of frequency were unremarkable bone marrow (28.20%), lymphoma (11.1%), acute leukemia, chronic myeloproliferative disorders (9.40%), chronic leukemia, (5.12%), multiple myeloma (3.42%), metastatic tumor (2.56%), myelodysplastic syndrome and megaloblastic anemia equally reported (1.71%), pure red cell aplasia and granulomatous inflammation were present in (0.85%). Acute leukemia was encountered mostly in 1st and 2nd decades of life. Lymphoma, chronic leukemia, chronic myeloproliferative disorders occur in 4th and 5th decades. Myelodysplastic syndrome presented in older age group 5th and 6th decades. Multiple myeloma and metastases were seen in 6th and 7th decades of life. Other disorders were randomly distributed. Conclusion: Bone marrow trephine biopsy is an invasive procedure with few known complications, but is a valuable diagnostic tool in the diagnosis, staging, management and follow up of various conditions both neoplastic and non-neoplastic. High percentage of cases in our study showed normal marrow finding, this may reflect overindication of marrow biopsy, such finding urge for more clinicopathological coordination and data analysis.

Serum ferritin level in transfusion dependent â-thalassaemia patients in Mosul

Omar A. Sadoon; Faris Y. Bashir

Annals of the College of Medicine, Mosul, Volume 36, Issue 1, Pages 72-78
DOI: 10.33899/mmed.2010.8922

Objectives: To establish a correlation between serum ferritin and different clinical, biochemical and haematological parameters and to determine the efficacy of chelation therapy using desferrioxamine measured by serum ferritin. Patients and Methods: A case-series of one hundred patients with transfusion dependent â-thalassaemia were included in the study during a period of one year (Nov. 2007-Nov.2008). The study included clinical evaluation, routine haematological tests and serum ferritin level. Results: Mean value of serum ferritin in our patients was 1886.74 ng/ml. It was found that serum ferritin was higher in older patients, those who received higher number of blood transfusions to date and those of higher annual blood consumption. â-thalassaemic patients with serum ferritin level equal or higher than 2500 ng/ml were older, of shorter stature, had higher percentage of splenectomy, higher number of blood transfusions to date and higher annual blood consumption than patients with serum ferritin level less than 2500 ng/ml. It was found that patients with good compliance to chelation therapy with desferrioxamine had lower mean serum ferritin than patients with poor compliance. Thirty seven percent of our patients had growth retardation regarding weight for age and 57% were low in height for their age.Conclusions: Serum ferritin was higher in older patients, those with higher annual blood consumption and those with poor compliance to desferrioxamine therapy when compared to patients with good compliance. Patients with serum ferritin equal to or more than 2500 ng/ml were older and of shorter stature for their age than patients with serum ferritin less than 2500 ng/ml.

Value of IgA human recombinant tissue transglutaminase antibody test in diagnosis of symptomatic celiac disease in children

Khaldoon Th. Al-Abachi; Nashwan M. Al-Hafidh

Annals of the College of Medicine, Mosul, Volume 36, Issue 1, Pages 79-85
DOI: 10.33899/mmed.2010.8928

Objective: To identify the value of serological examination in diagnosis of celiac disease in children.
Patients and methods: A prospective case series study was conducted at private clinics in Mosul city during the period from 30th of October 2007 to 30th of October 2009. A total of 40 patients (29 males, 11 females) aged more than 6 months on gluten containing diet presented with symptoms suggestive of celiac disease were screened by serological testing using second generation ELISAs IgA human recombinant tissue transglutaminase antibody. Multiple duodenal biopsies were performed for every patient enrolled in this study regardless of the results of serology. Statistical methods were used to indicate sensitivity, specificity, negative and positive predictive values of serological test in comparison to biopsy results.
Results: A total of 16 (40%) out of 40 symptomatic patients with mean age of 51 months, demonstrated both positive IgA anti-tissue transglutaminase antibody test and biopsy results for celiac disease, the remaining 24 patients (60%) displayed negative results for both serology and biopsy. IgA anti-tissue transglutaminase antibody test had (100%) specificity, sensitivity, positive predictive value, and negative predictive value in relation to biopsy results.
Conclusion: Our results provide additional support to the concept that IgA anti-tissue transglutaminase antibodies can be used as a diagnostic serologic marker for celiac disease.

Non CNS pediatric malignancies in Mosul

Sahar K. Omar; Likaa Fasih Al-Kzayer; Khalil I. Mahmood

Annals of the College of Medicine, Mosul, Volume 36, Issue 1, Pages 86-91
DOI: 10.33899/mmed.2010.8923

ABSTRACTObjectives: To find out the types of pediatric malignancies in patients from Mosul, their age and sex distribution as well as the death rate among these diseases with special emphasis on acute lymphoblastic leukaemia.Patients and methods: A survey which was conducted in Mosul pediatric wards of oncology in Alsalam, Ibn Sina general hospitals and Ibn Alatheer hospital for pediatric diseases on 228 children of both sexes, their ages were less than 12 years from year 2001-2007. The clinical data were taken from their case sheets regarding age, sex, clinical presentation at time of admission and the lab tests including tissue biopsy as well as bone marrow examination.Results: The commonest 3 types of these malignancies were acute lymphoblastic leukaemia (ALL) (43.4%), lymphoma (19.5%) and neuroblastoma (7.9%). The mean age of presentation was 65 months; the majority of cases were between 13 months - 6 years. Males predominate in a ratio of 1.28/1. Regarding ALL the main clinical features at presentation were fever, pallor, bone pain and bleeding. All cases were treated as inpatients. Death rate was high (35.08 %), the commonest causes were sepsis, bleeding and progressive disease.Conclusion: There were different types of malignancies in children in Mosul, the commonest were ALL, Lymphoma and neuroblastoma, with high death rate.Keywords: Pediatric, malignancies.

Soft tissue tumors - Histopathological study of 93 cases

Intisar S. Hasan; Abdulkarem Y. Suliman; Bashar A. Hassawi

Annals of the College of Medicine, Mosul, Volume 36, Issue 1, Pages 92-98
DOI: 10.33899/mmed.2010.29083

Objective: Histopathological and immunohistochemical examination of soft tissue tumors to assess the value of these techniques in verifying the primary diagnosis and their classification.
Methods: A prospective study of 93 consecutive soft tissue biopsies that reached the department of histopathology, central labs, Dohuk, and application of immunohistochemical markers on 27 biopsies.
Results: Out of 93 soft tissue tumors, 70 (75.2%) were benign with mean age 27.6 y. and 23 cases (24.8 %) were malignant with mean age 39.1 y.. Immunohistochemistery was performed in 27 cases; 21 (77.7%) cases of malignant tumors and 6 (22.3%) benign cases. The most common benign tumors were Lipoma, Haemangioma, Neurofibroma, while malignant muscle tumors (leiomyosarcoma and Rhabdomyosarcoma) and malignant round cell tumors (Ewing’s sarcoma/ PNET) were the major groups .
Conclusion: High quality H and E stained section, remain the best method for establishing the primary diagnosis of soft tissue tumors, but immunohistochemical examination proved extremely helpful in sub classifying them, where 7 out of 9 cases of gastrointestinal tumors (GISTs) showed strong immunoreactivity with (c – kit proteins) CD117, CD34, while other (non GISTs) tumors were negative.

The role of aerobic and anaerobic bacteria innon gonococcal urethritis (NGU) in men

Haitham B. Fathi; Haitham M. Al-Habib

Annals of the College of Medicine, Mosul, Volume 36, Issue 1, Pages 99-105
DOI: 10.33899/mmed.2010.8929

ABSTRACTObjectives: To identify causative microorganisms of nongonococcal (NGU) urethritis in men.Methods: A descriptive comparative study included 240 male patients with urethritis and 40 age-matched males free from urethritis was carried out. The urethral swabs were inoculated on different culture media and incubated both aerobically and anaerobically.Results: A 153 patients were considered as NGU cases. From them, 18 genera of aerobic and anaerobic microorganisms were isolated. Aerobic bacterial isolates were two times the anaerobic bacterial isolates. The type of growth was heavy among patients in comparison to scanty growth among controls. The most common microorganism in each group were Staph. epidermidis, Gardnerella vaginalis, and Bacteroides species.Conclusion: Aerobic and anaerobic microorganisms are associated with urethritis in men. The confluent growth and dramatic response after treatment by appropriate antibiotics confirm the roles of the isolated bacteria in development of NGU in men. Key words: Urethritis, nongonococcal urethritis, aerobic & anaerobic bacteria.

Bacterial etiology of chronic osteomyelitis involving anaerobes

Mahmood A. Aljumaily; Haitham M. Al-Habib

Annals of the College of Medicine, Mosul, Volume 36, Issue 1, Pages 106-113
DOI: 10.33899/mmed.2010.8933

ABSTRACTObjective: To identify common bacterial causes in chronic osteomyelitis, to verify the role of anaerobic microorganisms in chronic osteomyelitis, and to assess the reliability of swab from discharging sinuses, and from abscess aspirate in chronic osteomyelitis.Material and Methods: The study included 184 patients suffering from chronic osteomyelitis, 141 males and 43 females, ranging in age between 4-78 years with mean 40.5 years. The patients presented with chronic discharging sinus in 152 patients or acute flare up in 32 patients; they were divided according to causes into two broad categories haematogenous in 52 patients and exogenous in 132 patients. Specimens were taken from infected bone debridement during surgery, other specimens taken from sinus discharge or aspirated from bone abscesses. All specimens were inoculated on different culture media and incubated both aerobically and anaerobically.Results: The majority of cases of chronic osteomyelitis involved long bones specially the femur and tibia (64.6%). Aerobic microorganisms were found in 134 patients (73%), staph. aureus and pseudomonas were the commonest aerobic isolates. In fifty cases (27%), the causative microorganisms were anaerobic. Anaerobes were found to be mixed with aerobes in 34 cases (68%), while pure anaerobes were obtained in 16 cases (32%). Peptostreptococcus and Bacteroides were the dominant anaerobic isolates. The reliability of culture of abscesses aspirate in comparison with bone debridement culture is 93.3%. The reliability of culture of sinus discharge in comparison with bone debridement culture is 42.7%, while for anaerobic infection is 26%. Conclusion: Chronic osteomyelitis commonly affect adult males in long bones. The exogenous causes were the commonest. Aerobic isolates were the major cause, and anaerobic bacteria were an important other causative agents. Anaerobes usually isolated in prolonged persistent infection and pure anaerobes in older patients. The cultures of aspirate from bone abscesses were reliable way in diagnosis, while cultures from discharging sinuses had low diagnostic reliability and lower for anaerobic infection.Keywords: Osteomyelitis, chronic, aerobic, anaerobic, microorganisms.

Effects of dietary supplementation on bonehealing in bisphosphonate treated rabbits

Hazim K. AL-Allaf; Kassim S. Ibrahim; Mahmood A. Aljumaily

Annals of the College of Medicine, Mosul, Volume 36, Issue 1, Pages 114-120
DOI: 10.33899/mmed.2010.8930

ABSTRACTObjective: The aim of this study was to evaluate the effect of the daily oral administration of vitamin D, calcium, fluoride and vitamin C as dietary supplementation on bone healing in bisphosphonate treated experimental animals (rabbits).Material and methods: Eight young male rabbits divided into two groups after induction of open ulnar osteotomy, both groups received weekly 1 mg/ kg BW of alendronic acid (alendron) orally starting 6 days before osteotomy for five weeks, the experimental group received daily dose of vitamin D, calcium, fluoride and vitamin C as dietary supplementation from the second post operative day for four weeks. The control group received ordinary diet. At the end of the fifth week the animals' sacrificed and the specimens taken for radiological and computerized tomography (CT) scan densimetry and histomorphometric evaluation carried out for the callus at site of osteotomy. Results: All ulnar bone osteotomies in both groups united at the end of the fifth week macroscopically and radiologically. The callus density was measured in site of osteotomy by CT scan densimetry, its mean in the experimental group was 681 ± 219 and in the control group was 492 ± 233. The difference between the experimental and control group was significant, (P value<0.05). The histological examination of the bone at site of osteotomy showed healing with woven bone predominantly and some lamellar bone and cartilage. The mean of histomorphometric evaluation of healing in site of osteotomy were 9.07 ± 0.80 in experimental group, while in control group were 8.70 ± 0.80. The difference between two means was not significantConclusion: The present study demonstrates that a daily oral administration of vitamin D, calcium, fluoride and vitamin C as dietary supplementation in bisphosphonate treated rabbits enhance bone healing by increase callus density. Keywords: Dietary supplementation, bisphosphonate, vitamin D, calcium, fluoride, vitamin C, bone healing.

Factors affecting success of trial of labour afterprevious one lower segment Caesarean section

Raida M. Al-Wazzan

Annals of the College of Medicine, Mosul, Volume 36, Issue 1, Pages 121-129
DOI: 10.33899/mmed.2010.8925

ABSTRACTObjective: The aim was to analyze the different factors associated with successful trial of labor after previous one lower segment cesarean delivery in our institution. Patients and methods: A Prospective case-series study was done at Al-Batool Maternity Teaching Hospital, Mosul on 476 women with previous one lower segment Caesarean delivery subjected to trial of labour between January 2009 and mid June 2009.Results: Successful trial of labour and vaginal delivery was reported in 82%. The factors that were found to be significantly associated with successful trial of labour are: parity of 2-4, history of previous vaginal delivery and particularly history of vaginal birth after Caesarean, fetal malpresentation as the indication of previous Caesarean, inter-pregnancy interval longer than 12 months, gestational age ≤ 40 weeks, cervical dilation ≥4 cm, cervical effacement ≥50%, station lower than –1 and intact membrane at time of admission, clear liquor and neonatal weight < 4000 grams.Conclusions: The factors present in woman's obstetric history and during her intrapartum course in the current pregnancy and birth weight that had significant differences in this study can be used as predictor of successful trial of labour and will help obstetrician to identify women who are more likely to attempt trial of labor and have a successful vaginal birth after previous one lower segment Caesarean delivery. Keywords: Caesarean section, vaginal birth after Caesarean (VBAC), trial of labour after Caesarean delivery (TOL), prior Caesarean delivery.

Comparative study of Olopatadine 0.1% and Lodoxamide 0.1% in treatment of seasonal allergic conjunctivitis

Azzam A. Ahmed

Annals of the College of Medicine, Mosul, Volume 36, Issue 1, Pages 138-145
DOI: 10.33899/mmed.2010.8919

ABSTRACTObjective: Olopatadine hydrochloride 0.1 % ophthalmic solution and Lodoxamide 0.1 % ophthalmic solution are two topical anti-allergic medications with slightly different modes of action. This study compared the efficacy, tolerability and safety of these agents in the treatment of allergic conjunctivitisMethods: This was a three weeks prospective, randomized, double-masked, active-controlled, parallel group comparison study of Olopatadine hydrochloride 0.1 % ophthalmic solution (Patanol) and Lodoxamide 0.1% (Alomide) in patients with seasonal allergic conjunctivitis. Subjects were dosed twice daily for three weeks with either Olopatadine or Lodoxamide. Signs and symptoms were assessed on day five (visit 2) and 21 (visit 3). Efficacy variables included the responder rate (patient with excellent or good global efficacy on day 5 and 21), signs and symptoms, and patient and investigator-rated global efficacy. Comfort was rated immediately after instillation of the first drop and at each follow-up visit. Frequency of adverse events was the safety assessment.Results: The study enrolled 66 patients, and 63 patients completed the study. The responder rate was higher with Olopatadine than with Lodoxamide on both fifth day (72% vs 54% for patient assessment and 88% vs. 55% for investigator assessment), and day 21 (91% vs. 55% for patient assessment and 94% vs. 42% for investigator assessment). Global efficacy ratings were higher for Olopatadine –treated subjects than Lodoxamide –treated patients. Severity scores for hyperemia and itching were significantly lower for Olopatadine-treated group. Comfort ratings were comparable between the two treatment groups. Common adverse events included burning/stinging and headache.Conclusion: Olopatadine hydrochloride was superior in treating the signs and symptoms of allergic conjunctivitis. Both treatments were safe and well tolerated.

Hydatid cyst in the scrotum: a case reportand review of literature

Nashwan K. Mahjob

Annals of the College of Medicine, Mosul, Volume 36, Issue 1, Pages 146-148
DOI: 10.33899/mmed.2010.8926

ABSTRACTA rare case of hydatid cyst in the scrotum in a man of 20 years old was recorded, the case was diagnosed as a hydrocele, but the histopathological examination proved to be a hydatid cyst. Hydatid cyst of scrotum is very rare event (1). This is the fourth reported case of hydatid disease in the scrotum in all medical literatures as far as the time of publishing this article. Hydatid cyst in the scrotum should be put in mind in any case of scrotal swelling especially in endemic areas(2). Keywords: Hydatid cyst, scrotal mass..

Management of transverse vaginal septum in a neonate Case report and review of literature

Majid Khalid Al-Sultan

Annals of the College of Medicine, Mosul, Volume 36, Issue 1, Pages 149-152
DOI: 10.33899/mmed.2010.8937

ABSTRACTA 2 days old female neonate was admitted to the Pediatric Surgery Center at Al- Kanssa teaching hospital on the third of June 2009 with abdominal mass. After clinical examination and investigations, operation was carried out on the sixth of June 2009 and intra operative diagnosis of vaginal atresia caused by transverse vaginal septum was carried out, which is a rare condition occurring 1 in 70,000 – 100,000 live births. Cruciate incision of the septum with marsupialization was done without vaginostomy and latter vaginal reconstruction..

Congenital epulis (congenital gingival granular cell tumor)

Moutaz Al Ani; Mohammed S. Saeed

Annals of the College of Medicine, Mosul, Volume 36, Issue 1, Pages 153-156
DOI: 10.33899/mmed.2010.29088

Congenital epulis or congenital gingival granular cell tumor is a rare lesion of newborn, also known as Neuman's tumor. Congenital epulis mostly occurs as a single mass but rarely as multiple. It arises from the mucosa of gingiva either from maxillary or mandibular alveolar ridge. The exact histogenesis of congenital epulis is still uncertain, but the biologic behavior of this lesion is compatible with embryonic hamartoma, so that surgical excision is the treatment of choice. The presented case describes a mass in the anterior region of maxillary alveolar ridge in a 15 day old healthy female, which causes a feeding problem and hinders normal closure of the mouth. Tumor was excised surgically under general anesthesia. The excised material was sent for histopathological examination and the diagnosis of congenital epulis was performed.

Keywords: Congenital epulis, congenital gingival granular cell tumor, newborn.