Print ISSN: 0027-1446

Online ISSN: 2309-6217

Volume 40, Issue 1

Volume 40, Issue 1, Summer and Autumn 2018, Page 1-63

Bcl-2 over-expression in urothelial tumors of the bladder. An immunohistochemical study

Annals of the College of Medicine, Mosul, 2018, Volume 40, Issue 1, Pages 1-6
DOI: 10.33899/mmed.2018.159184

Objectives: The aim was, to evaluate the frequency of Bcl-2 over-expression in urothelial tumors of the bladder in Mosul city, to correlate the over-expression with age and sex of the patients, and grade and stage of the tumors, and to compare the results with those of others.
Methods: A retrospective case-series study was performed on 50 urinary bladder urothelial tumors. The samples were collected from Al-Jamhuri Teaching Hospital in Mosul city, during a period of 8 months from November 2012 through June 2013.
Results: The patients' age was in the range of 23-91 years with a mean of 62.64 year, male:female ratio (9:1). Approximately half of them were in the seventh decade (42%). Bcl-2 immunoreactivity was observed in 42% of the cases, it was positive in 4/11 of papillary urothelial neoplasm of low malignant potential cases, 9/23 of low grade cases, and in 8/15 of high grade cases, and was negative in the one case of papilloma. It was observed in 2/2 of Tis stage, 4/14 of cases with Ta stage, 9/21 of T1 stage, and 6/11 of T2 stage. It was negative in the 2 cases of T4.
Statistically Bcl-2 over-expression was not significantly related to the age and sex of the patients, as well as the grade, and stage of the tumors. However, it was mainly found in the 6th decade of life (42.8%), in males (90.5%), in low grade (42.9%), and in stage T1 (42.9%).
Conclusion: Bcl2 over-expression was found in 42% of bladder urothelial tumors. Bcl2 over-expression mainly was observed in the 6th decade of life (42.8%), in males (90.5%), in low grade carcinoma (42.9%), and stage T1 (42.9%). Age and sex of the patients, and grade, and stage of the tumors had no significant correlation with Bcl2 over-expression..

Risk factors of acute otitis media among children in Mosul

Annals of the College of Medicine, Mosul, 2018, Volume 40, Issue 1, Pages 7-14
DOI: 10.33899/mmed.2018.159190

Context: Acute otitis media (AOM) is the most frequent diagnosis in the children visiting offices. The prolonged and recurrent episodes of AOM may lead to hearing impairment and delayed speech development, which will influence the child's performance at school.
Aim: The aim of this study is to identify the risk factors of acute otitis media in preschool children attending ENT clinics at Al-jamhory Teaching Hospital in Mosul.
Methods: To achieve this aim, a case control study design was adopted. The sample of the present study included 150 children (cases) who have been diagnosed by the responsible ENT specialist according to the otoscopic examination with another 150 children (controls) who were diagnosed not to have AOM. Period of data collection was from 1st of October 2011 to the 1st of April 2012.
Results: The present study showed that the highest frequency of acute otitis media occurred in the age group 1-2 years 39 patients (26%), and more frequent AOM attacks occurred in males. Clinical presentation among the cases were fever, otalgia, otorrhea, irritability, loss of appetite, vomiting, diminished hearing, and few patients presented with tinnitus and vertigo. The significant risk factors for AOM were day care attendance, bottle feeding for the 1st 6 months of life, supine bottle feeding, pacifier use in the second 6 months of life, parental tobacco smoking, preterm baby, and allergy. No association was found between craniofacial anomaly and occurrence of AOM in the present study.
Conclusion: Day care attendance, bottle feeding during the 1st 6 months of life, supine bottle feeding, pacifier use in the second 6 months of life, parental tobacco smoking, preterm baby, and allergy were found to be a significant risk factors for AOM among study population.
Recommendation: Additional studies on potential measures to prevent AOM through the reduction of risk factors are needed..

Risk factors for development of transient tachypnea of newborns

Annals of the College of Medicine, Mosul, 2018, Volume 40, Issue 1, Pages 15-19
DOI: 10.33899/mmed.2018.159185

Background: Transient tachypnea of the newborn (TTN) is a frequently encountered form of neonatal respiratory distress. The underlying mechanism involves residual lung fluid that is delayed in clearance. TTN primarily occurs soon after birth and can last from 24 to 72 hours. Risk factors for TTN include elective cesarean section, male sex, late prematurity, low birth weight, macrosomia, polycythemia, maternal asthma and maternal diabetes. Treatment is often supportive with observation and potential oxygen supplementation.
Objective: To identify the risk factors associated with development of transient tachypnea of newborns who were delivered either normally or through cesarean section, at 36 weeks or beyound and to compare the results with those of others.
Patients and methods: This is a case -control study of 200 newborns suffering from respiratory distress during a period from the 1st of September 2011 to the 1st of September 2013 in the neonatal intensive care unit at AL-Kansaa Teaching hospital in Mosul. The perinatal history of newborns was analyzed. TTN was diagnosed on clinical basis and by exclusion of other diseases affecting the respiratory system including sepsis. The study included 200 healthy newborns as control.
Results: Multivariate analysis identified that the development of TTN was significantly associated with elective cesarean section 56% (p-value=0.001), male sex 66.5% (p- value=0.001), late prematurity 21% (p-value=0.009), maternal diabetes 8% (P-value=0.014), maternal asthma 10.5% (p-value=0.01), birth asphyxia (low APGAR score) 9.5% (p-value=0.005), low birth weight 16.5% (p-value=0.003), prolonged labor or using (forceps or vacuum) 22% (p-value=0.037) and in vitro fertilization 2.5% (p-value =0.024).
Conclusion: Transient tachypnea of newborns is strongly related to elective cesarean section, male sex, late prematurity, maternal diabetes, maternal asthma, birth asphyxia, low birth weight (1500-2500g), prolonged labor or using forceps or vacuum and in vitro fertilization..

Effects of Bee Propolis on Blood Pressure Record and Certain Biochemical Parameter in Healthy Volunteers

Annals of the College of Medicine, Mosul, 2018, Volume 40, Issue 1, Pages 20-26
DOI: 10.33899/mmed.2018.159191

Objectives: To evaluate the effect of encapsulated bee propolis supplementation 500 mg twice daily for 2 months on blood pressure record, fasting serum glucose, lipid profile and serum uric acid in otherwise healthy volunteers in comparison to controls.
Design: The study was conducted from October 2017 to April 2018, subjects included in the study was healthy non-obese from different areas in Mosul city, so as the control.
Subjects and methods: Forty apparently healthy subjects (Sixteen male and twenty–four female) were included in this study. Blood pressure (BP) were recorded, body weight and body mass index (BMI) were calculated, then a blood sample was taken with assay of fasting serum glucose (FSG), lipid profile {Total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL –C), while serum low density lipoprotein (LDL –C), very low density lipoprotein (VLDL-C) and atherogenic index (AI)} were calculated by using certain equations and serum uric acid (SUA), was measured for both the intervention and the control groups.
After 2 months of supplementation with encapsulated bee propolis 500 mg twice daily, the BP, body weight, BMI, LDL-C, VLDL-C and AI were calculated and FSG, TC, TG, HDL and SUA were measured for the intervention group. All data were presented as means± standard deviation (SD) of mean. Independed t –test of two mean was used. Dependent t – test of two mean was applied for the differences in the intervention group (before and after). Chi square test of independence was used for categorial variables. P–value≤0.05 was considered statistically significant.
Results: Initially, at the start of the study, there was insignificant difference between the interventions and the control groups with regard age, sex, weight, BMI, systolic and diastolic BP, serum TC, HDL- C, LDL –C, AI and SUA, with a significant differences in FSG, TG, and VLDL. By comparison before and after supplementation in the intervention groups, there was a significant decrease in the systolic and diastolic BP record, FSG, TC, TG, LDL –C, AI, SUA, with a significant increase in body weight and HDL –C.
Conclusion: Bee propolis supplementation at a dose of 500 mg twice daily for 2 months carries a beneficial effects on BP record, FSG, lipid profile, and SUA, which should be taken in preventive medicine, since hyperglycemia, hyperlipidemia and hyperureciemia, contributed to the development of atherosclerosis, cardiovascular and cerebrovascular diseases.

Early probing in congenital naso-lacrimal duct obstruction

Annals of the College of Medicine, Mosul, 2018, Volume 40, Issue 1, Pages 27-30
DOI: 10.33899/mmed.2018.159186

Aim: To evaluate the role of early probing in congenital naso-lacrimal duct obstruction (CNLDO).
Method: The medical records of patients who underwent nasolacrimal duct probing for CNLDO in ophthalmic theater of Al-Jamhori Teaching Hospital, between 1st January 2009 and 31st December 2010 were reviewed retrospectively. Nasolacrimal duct probing was performed on 76 eyes from 73 consecutive patients with CNLDO.
Results: Based on exclusion criteria, 76 eyes from 73 patients (30 males and 43 females), aged 6 to 84 months (mean, 15.67±13.58) were included. The success rate of the initial probing was 84.2% (64 of 76) for all patients, 92.15% (47 of 51) in the 6 to 12 month age group, 75% (12 of 16) in the 13 to 24 months age group, and 55.5% (5 of 9) among individuals older than 24 months.
Conclusion: The success rate of probing is very high in 6-12 months age group.

Assessment of health promoting behaviors in relation to physical activity in elderly

Annals of the College of Medicine, Mosul, 2018, Volume 40, Issue 1, Pages 31-35
DOI: 10.33899/mmed.2018.159192

Background: Health promotion refers to those behaviors in which a person is engaged in to prevent disease and maximize health, it is beneficial in older adult in reducing disability and improving quality of life.
Objective: To assess these behaviors in relation to health outcomes among old population for the last five years of their lives in Mosul city.
Methodology: After obtaining a formal consent from the participant, a random sample of 112 old persons were included in this case series study. They were collected from elderly home in Mosul and from two main health centers, data collected in a period from the first January to the end of March in 2011. Peers correlation was used to examine this relationship.
Result: The study founded that exercise is predictive for less Basic Activities of Daily Living limitation (washing, bathing, eating, dressing, getting in/out of bed), Balanced diet was also found to be predictive for fewer Limitation of Instrumental Activities of Daily Living (moving from room to room, walking out of door, shopping, doing own house work). Inverse relations were found between stress management and both BADL/IADL. It was also founded between subjectively related health with both exercise and healthy balanced diet.
Conclusion: The study concluded that old population in Mosul were poorly engaged in a real health promoting behaviors, mainly for exercise and balanced diet.
Recommendation: The study recommend that a special attention should be given for old population Through a health promoting centers to increase their years of healthy life.

The adjuvant effect of allopurinol with valsartan on the treatment of essential hypertension

Annals of the College of Medicine, Mosul, 2018, Volume 40, Issue 1, Pages 36-40
DOI: 10.33899/mmed.2018.159187

Background: Hyperuricemia is thought to contribute to development of hypertension, an elevation of uric acid in hypertension could be a consequence of reduced renal function, or elevated renal vascular resistance.
Objective: This paper aims to evaluate the adjuvant effect of allopurinol on blood pressure in newly diagnosed essential hypertensive patients with hyperuricemia.
Design: Double-blind randomized controlled clinical trial.
Patients and methods: Sixty newly diagnosed essential hypertensive patients with hyperuricemia in private clinic were enrolled in the study. They were randomly divided into two equal groups, group 1 was put on valsartan and allopurinol therapy, and group 2 was given valsartan and placebo therapy. Both groups were followed for four weeks duration. Blood pressure and serum uric acid levels were measured in both groups, before and after therapy.
Results: The systolic and diastolic blood pressures showed a significant reduction in group 1 with a mean difference of -24.20 ± 2.00 mmHg, for systolic blood pressure and -16.93 ± 4.73 mmHg for diastolic blood pressure. The reduction in serum uric acid was -3.25 ± 0.18, while the patients group that received valsartan and placebo did not show the same improvement.
Conclusion: The administration of allopurinol had beneficial effect on blood pressure, and can be used as adjunctive therapy for patients with hypertension, particularly if they have coexistent hyperuricemia..

Prospective randomized comparison of low pressure versus standard pressure pneumoperitoneum in laparoscopic cholecystectomy

Annals of the College of Medicine, Mosul, 2018, Volume 40, Issue 1, Pages 41-45
DOI: 10.33899/mmed.2018.159193

Background: Postoperative shoulder tip pain occurs frequently following laparoscopic cholecystectomy. The origin of shoulder pain is partly understood, but it is commonly assumed that the cause is overstretching of the diaphragmatic muscle fibers due to high rate of insufflations. The aim of this study is to compare the frequency and intensity of shoulder tip pain between low pressure (7 mmHg) and standard-pressure (14 mmHg) pneumoperitoneum after laparoscopic cholecystectomy.
Setting: Aljumhori Teaching Hospital during the period from January 2011 to June 2012.
Design: A prospective randomized study.
Patients and methods: One hundred and forty consecutive patients undergoing elective laparoscopic cholecystectomy were randomized prospectively into two groups, either low pressure (group A) or standard pressure (group B) pneumoperitoneum, they were blinded to the research doctors who assessed the patients during the postoperative period by the visual analogue scale (VAS) of pain. Comparative analysis between the two groups included gender, mean age, operative time, complication rate and postoperative shoulder tip pain.
Results: The demographic data were nearly similar in the two groups. There were no significant intraoperative complications in both groups, likewise the mean operative time was nearly similar in either group. The mean frequency and intensity of postoperative shoulder tip pain assessed by visual analogue scale was less in group A than in group B.
Conclusion: No difference was found between low pressure and standard pressure pneumoperitoneum in the duration of operation and complication, but low pressure pneumoperitoneum tended to produce lower incidence and intensity of shoulder tip pain.

Objective Structured Clinical Examination for Undergraduate Surgery Finals in the College of Medicine, University of Mosul

Annals of the College of Medicine, Mosul, 2018, Volume 40, Issue 1, Pages 46-50
DOI: 10.33899/mmed.2018.159188

Background: The objective structured clinical examination is gaining popularity in most medical schools for its validity, reliability, and objectivity. It requires a lot of physical and financial resources and commitment.
Objective: To outline steps important to be considered when conducting objective structured clinical examination as an assessment skill for final undergraduate candidates in surgery with emphasis on the student's perception, satisfaction and acceptability.
Design: A purposive sample of 151 of 6th year undergraduate medical students attempted final objective structured clinical examination in Surgery.
Setting: Department of Surgery, College of Medicine, University of Mosul during the academic year 2011-2012.
Method: Purposive sample including 151 participants, who attempted objective structured clinical final examination in surgery for graduation. There were 65 males & 86 females. The examination was performed over 8 days. A well-organized ten objective structured clinical examination stations were chosen for assessment. The time allowed for each station was 6 minutes. An objective structured clinical examination organizing committee was established. The subjects for objective structured clinical examination stations were determined, a detailed plan of the students grouping and movement was established, and a notice for all students about objective structured clinical examination details was given. At completion of examination, students were given self-administered questionnaire and feedback to test their perception and satisfaction about the examination.
Results: Data of completed self-administered questionnaire were analyzed. Regarding station information, 78.8 %of students reported that the task questions in the stations are appropriate to the length of station, 82.7% replied that the stations are practical and 72.1% answered that the information in stations are clear. Reply from 86.7% was that the task was clearly stated, 82.1% responded that patient`s complaint in the clinical stations is brief and given in basic language, while 74.1% replied that findings are "well understood" and clearly described. Analyzing the stations structure, 80.7% of students stated that the number of the stations was enough and 84.7% agreed that the location of stations was good.
Conclusion: Objective structured clinical examination for undergraduates' surgical finals is a practical assessment tool even if large numbers of students are involved. Data of this study showed that overall student's perception, satisfaction and acceptability of objective structured clinical examination were encouraging.

Candida colonization in neonates admitted to neonatal intensive care unit (NICU) in Mosul

Annals of the College of Medicine, Mosul, 2018, Volume 40, Issue 1, Pages 51-55
DOI: 10.33899/mmed.2018.159194

Background: Candida species are important nosocomial pathogens in the newborns, particularly among the preterms. Colonization of the neonatal skin and gastrointestinal tract is the first step in the pathogenesis of invasive Candidiasis. Colonization of the infant occurs early in life and this is affected by a variety of common practices in the neonatal intensive care unit (NICU).
Objective: To determine colonization of Candida species in neonates admitted to NICU in Mosul city, and to identify the possible risk factors for colonization.
Patients and methods: A case series study was conducted in a Al Khansaa Teaching Hospital in Mosul city between September 2012 to March 2013. Fifty neonates who were admitted for several causes and stayed in the hospital for seven or more days were included in the study. Sterile cotton tipped swabs from oral, rectal and umbilical areas of each neonate were collected within 24 hours of admission, day five, day seven or thereafter when the neonate was discharged from hospital. Swabs were smeared on the surface of plates of Sabourauds glucose agar. Data was analyzed using Students "t" test, Chi-square test and Fisher's exact test wherever necessary.
Results: Candida colonization was seen in 70% of patients at different sites and times of samples collection. Colonization was more common in males than females. From the colonized neonates, 60% were full term and 40% were premature, and 74% had normal birth weight and 26% had low birth weight. Acquisition of Candida occurred in 63% of neonates within the first 24 hrs and by day five 94% of neonates were colonized. The remaining 6% were colonized after fifth days of admission. Male sex, normal birth weight and signs of vaginal candidiasis in the mother were found to be significant risk factors for neonatal colonization.
Conclusion: Candida colonization was seen in 70% of the study sample. Male neonates were colonized more often than females. Male sex, normal birth weight and signs of maternal vaginal candidiasis were significant risk factors for neonatal colonization with Candida.

Conservative treatment of acute appendicitis

Annals of the College of Medicine, Mosul, 2018, Volume 40, Issue 1, Pages 56-59
DOI: 10.33899/mmed.2018.159189

Objective: To define the value of Tamsulosin drug addition to antibiotics (Ceftriaxone and Metronidazole) in conservative treatment of nonperforated acute appendicitis.
Patients and methods: Prospective clinical study performed in Al-Jamhoory Teaching Hospital covering a period from Jan 2010 to Jan 2012. Formal consent from the patients and ethical approval were obtained. One-hundred and two patients including 74 males and 28 females, with age range of 17-45 years were admitted to the surgical unit number 3 complaining of acute appendicitis. Detailed clinical history was taken and clinical examination was carried out. All the patients had general urine examination (G.U.E), ultra sound (U.S) of the right iliac fossa and determination of serum c.reactive protein level. Those who had complicated appendicitis were excluded from the study. The patients were randomly divided into two groups A and B.
Group A: Fifty one patients were given 500 mg of Ceftriaxone and 500 mg Metronidazole, both I.V twice daily.
Group B: Fifty one patients were given the antibiotics regime plus Tamsulosin 0.4 mg orally once daily.
The patients who had good signs of response (decrease or disappearance of the abdominal pain, tenderness and rebound tenderness and return of appetite) in the first 24 hours of the treatment continued the treatment for further 5 days, if there was no good response immediate appendicectomy was done. There was follow up of discharged patients for 4 months.
Results: Group A: Forty-one patients out of 51 (80.39%) had a good signs of response (decrease or disappearance of the abdominal pain, tenderness and rebound tenderness and return of appetite) within the first 24 hours post presentation while 10 patients needed appendicectomy. Group B: Forty-nine patients (out of 51) 96.07% had good signs of response (decrease or disappearance of the abdominal pain, tenderness and rebound tenderness and return of appetite) within the first 24 hours post presentation and only 2 patients needed appendicectomy. Those who were discharged after conservative treatment were followed up for 4 months. Five patients in group A and 3 patients in group B had recurrence of symptoms and signs of acute appendicitis and appendicectomy was performed for them.
Conclusion: Tamsulosin added to antibiotics for treatment of acute appendicitis is safe and resulted in speedy recovery of the patients with reduced recurrence of the condition.

Evaluation of postoperative gum chewing role in stimulating bowel motility in colonic surgery

Annals of the College of Medicine, Mosul, 2018, Volume 40, Issue 1, Pages 60-63
DOI: 10.33899/mmed.2018.159195

Objective: Postoperative ileus (POI) after abdominal surgery is an inevitable consequence of various etiologies. It causes much discomfort to patients by resultant vomiting, abdominal distention, and prolonged hospital stay; thus, exploring efficient and cost effective solutions could reduce the patients' suffering and hospital stay. This study aimed to evaluate the effect of gum chewing on the duration of POI following colonic surgery.
Patients and methods: Ninety patients at Aljumhoory Teaching Hospital from October 2007 to October 2008, undergoing elective large bowel surgeries were randomly assigned to the study group (n=44) and the control group (n=46). Patients in the study group chewed gum 3 times daily for 20 minutes starting from the 1st postoperative day until the return of bowel function. The control group patients had standard postoperative treatment. All patients were assessed clinically and the data were collected using an inquiry forma for every patient.
Results: Study and control group patients were comparable at inclusion. The mean time for the passage of first flatus as well as the time for the first bowel movement was shorter significantly in the study group (by 20.4 hours, P=<0.01; by 22 hours, P=<0.01) respectively. The first feeling of hunger was also experienced earlier in study group cases (by 14.7 hours, P=<0.01). The postoperative hospital stay was shorter in the study group, but the difference was not significant (P=<0.1).
Conclusion: Early postoperative gum chewing significantly hastens the time of bowel function recovery following colonic surgery. Moreover, it is a cost-effective and well-tolerated treatment for POI.