Print ISSN: 0027-1446

Online ISSN: 2309-6217

Volume 42, Issue 1

Volume 42, Issue 1, Winter and Spring 2020, Page 1-98

Ki-67 Expression in Breast Cancer, Its Correlation with ER, PR and Other Prognostic Factors in Nineveh Province

Hatem Abd-AlMajeed Al-Nuaimi; Elaf Hamdi; Banan Burhan Mohammed

Annals of the College of Medicine, Mosul, 2020, Volume 42, Issue 1, Pages 1-10
DOI: 10.33899/mmed.2020.127375.1037

Objectives: The aggressiveness of malignant tumors of breast can be correlated with the proliferation of neoplastic cells, and this detected by immunohistochemical study of proliferative index (Ki-67). American Society of Clinical Oncology (ASCO) does not recommend the use of Ki-67 routinely to predict the outcome of breast cancers, therefore the aim of current study is to detect the expression of Ki-67 in patients with primary breast cancer in Nineveh Province/North of Iraq and to correlate it with estrogen and progesterone receptors in addition to other prognostic factors.
Methods: In this retrospective-case series study eighty cases of histologically proven primary breast carcinomas were included. The cases were collected from hospitals and private laboratories in Nineveh Province / North of Iraq and studied Immunohistochemicaly for Ki-67, estrogen receptor (ER) and progesterone receptor (PR) were done on tissue sections embedded in paraffin wax. An area with the maximum proliferation was chosen to evaluate Ki-67 and the cases with ≥20% positive nuclei were considered as high Ki-67 expression while those with <20% positive nuclei were considered as low Ki-67 expression.(10-14).
The findings of Ki-67 were correlated with the age of the patients, histological type, grade of the tumors and with the estrogen and progesterone receptors.
Results: The Ki-67 immunoreactivity was highly expressed in (45%) of the cases. Estrogen and progesterone receptors observed in (77.5%) and (67.5%) of the cases respectively. The Ki-67 was significantly associated with grade of tumor, estrogen receptor and progesterone receptor (P= 0.0057, 0.037 and 0.006 respectively). While the association with patientsˈage and histological types were not statistically significant.
Conclusion: Ki-67 expression shows a significant direct correlation with grade of tumors and a significant inverse correlation has been shown with a well-known predictive factors, (estrogen and progesterone receptors).

Impact of Sacubitril and RAAS inhibitors on p53 expression in rat-induced heart failure. A new approach for ischemic heart disease therapy

Kawa Dizaye; Rojgar Ali; Rafal Al-Rawi

Annals of the College of Medicine, Mosul, 2020, Volume 42, Issue 1, Pages 11-18
DOI: 10.33899/mmed.2020.126595.1021

Background: p53 is a well-known protein that prevents cancer formation, which is recognized as the main protein in the adaptation to many harmful stimuli, like oxidative stress. Among actions of p53, studies have shown that it has an important role in the development of heart failure (HF), and arteriosclerosis. Several clinical studies were done to investigate the role of p53 in the progression of HF and with the intention to improve management of heart failure.
Objective: The purpose of this work was to investigate the mechanisms of myocardial injury that precipitates heart failure that is mediated by both β-adrenergic signaling and p53, then compare the results with administered sacubitril and angiotensin system blockers.
Thirty female albino rats were allocated into five groups; group I: served as a control group; group II: were injected with isoproterenol for HF induction; and groups III, IV, and V (HF treated groups ) whereas rats received sacubitril alone, combination of sacubitril with ramipril and combination of sacubitril with aliskiren respectively, orally on daily basis.
Results revealed that rats of group II (HF induced) were significantly (P = 0.002) showed more myocardial injury and higher nuclear p53 expression compared to rats of the control group. Furthermore, rats of group III, IV, V (HF treated groups) showed significantly (P = 0.037) less myocardial injury and significantly (P = 0.015) less nuclear p53 expression compared to rats of the group II.
It was concluded that rats received either sacubitril alone or with combination of ramipril or aliskiren for HF treatment were alleviated myocardial injury and lower nuclear p53 expression.
It was concluded that anti-p53 approach may provide a novel therapeutic strategy for human ischemic heart diseases and myocardial infarction.

Wide local excision and sentinel lymph node biopsy in early breast cancer in Duhok city

Sardar Hassan Arif; Ayad Ahmad Mohammed

Annals of the College of Medicine, Mosul, 2020, Volume 42, Issue 1, Pages 19-26
DOI: 10.33899/mmed.2020.126969.1025

Objectives: Breast conservation surgery widely in form of wide local excision and sentinel lymph node biopsy in the management of patients presenting with early breast cancer.
The aim of this study is to analyze the effectiveness of the of the breast conservation surgery and sentinel lymph node biopsy using the methylene blue dye.
Methods: this retrospective cross sectional study conducted at Nov.2014 – Dec.2019 Ninety-six females Patients with stage I and II breast cancer were included in this, patients with stage III and IV, clinically suspicious axillary lymph nodes, and male patients were excluded from this study.
Injection of methylene blue dye done around the breast mass. Resection of the breast tumor done until negative margins achieved, then dissection of the axilla was done and the stained lymph node or nodes were excised and were sent for frozen section examination, when the result was negative no further axillary dissection were done, but when result was positive we did axillary lymph node dissection.
Results: The current study showed a sensitivity of 93%, specificity of 82%, positive predictive value of 85%, negative predictive value of 92%, and the accuracy of the procedure was 88%.
The most frequent complication was seroma formation and wound infection in 12.5% and 7.3 % respectively, some dye related complications were reported including tattooing of the skin in 10.4% of patients, blue urine in 3.1% of patients and mild allergic reactions in 2% of patients.
Conclusions: The technique of wide local excision and SLN biopsy using the methylene blue dye is safe and effective technique for breast conservation surgery especially in the regions were no facilities are available for the radiolabeled colloid.

The assessment of glycemic control and renal function in ischemic heart patients

Ehsan Hassan Aldabbagh; Akram Ahmad

Annals of the College of Medicine, Mosul, 2020, Volume 42, Issue 1, Pages 27-34
DOI: 10.33899/mmed.2020.127368.1036

Background: Ischemic heart diseases are considered as the leading cause of death throughout the world and a major cause of hospital admissions. Diabetes mellitus together with hypertension are among the modifiable risk factors.
Aims of the study: To assess the glycemic control and renal function tests of patients with ischemic heart diseases.
Methods: Fasting blood samples were obtained from seventy one cases of ischemic heart disease who were admitted to cardiac care unit, mean age 60.9 years old, sera were used to measure urea, creatinine and glucose by enzymatic colorimetric method while blood with anticoagulant used for glycated hemoglobin measurement by ion exchange resin quantitative colorimetric determination and urine samples were obtained for analysis of protein/creatinine ratio by turbidimetric method. Measurement of micro albumin in urine is based on immunoassay with flouresence detection.Statistics included t-test and linear regression.

Effectiveness of antiplatelet thromboprophylaxis in myeloma patients using immunomodulators in Kurdistan region-Iraq

Rezhen Botany; Ahmed K. Yassin; Firiad Hiwaizi; Abid M. Hassan; Hisham A. Getta; Najmaddin Salih Husen Khoshnaw; Sana D. Jalal; Akram M. Mohammed; Kawa M. Hasan; Dana A. Abdulla; Ameer I.A. Badi; Nassir A. S. Al-Allawi; Banaz M. Safar; Basil K. Abdulla; Rawand P. Shamoon; Truska A. Amin; Zeki A. Mohamed; Ali I. Mohammed; Diveen J. Hussein; Nawsherwan S. Mohammed

Annals of the College of Medicine, Mosul, 2020, Volume 42, Issue 1, Pages 35-41
DOI: 10.33899/mmed.2020.126833.1023


Objective: To evaluate the effectiveness of antiplatelet drugs in preventing thrombosis in multiple myeloma patients treated by immunomodulatory drugs
Methods: The study includes a hundred seventy six patients of symptomatic multiple myeloma treated in hematology unit of three centers in Kurdistan region of Iraq from February 2014 to July 2019. Demographic data were obtained from patient’s file, including the type of immunomodulatory drugs, antiplatelet use, thrombotic events and their site, presence of other comorbidity, and whether the thrombosis was before or after the diagnosis of multiple myeloma.
Background and objectives: Multiple myeloma is a malignant disease that affect both gender and associated with increased risk of thrombosis, one of the effective method of treating myeloma is through using immunomodulatory drugs especially when combined with high dose dexamethasone with in turn boost the risk of thrombosis, in this study we investigate the effect of antiplatelet in preventing thrombosis.
Methods: This is a retrospective study that include 176 cases that are collected from cancer centers at Kurdistan region of Iraq from Feb/2014 to Jul/2019 information gathered through questionnaire.
Results: Regardless the type of therapy in the study sample 11.1% who were taking anti-platelet therapy developed thrombotic attack compared with 46.9% who were not taking the anti-platelets therapy. The incidence of the thrombotic attack among those myeloma patients who used immunomodulatory drugs was 9.6% who were on anti-platelet drugs which is significantly lower than the rate (52%) among patients not taking the anti-platelet drugs.
Conclusions: As multiple myeloma is a malignant disease and treatment with immunomodulatory drugs associated with increased risk of thrombosis, antiplatelet drug is an effective measure when used as a prophylaxis for preventing thrombosis.
Keywords: Multiple myeloma, Thrombosis, Antiplatelet

susceptibility of yeast species to different concentration to fluconazole in leukemic and non- leukemic cancer patients

Zahraa Qasim

Annals of the College of Medicine, Mosul, 2020, Volume 42, Issue 1, Pages 42-49
DOI: 10.33899/mmed.2020.127200.1027

Aim : Isolation and identification of yeast species in leukemic and non leukemic cancer patients and conduct the in vitro fluconazole susceptibility in different concentrations.
Patients and methods: This study included 100 oral swabs samples from cancer patients 50 of them were leukemic cancer patients group I, while group II patients were 50 non-leukemic cancer patients. Group I patients attending the hematology department in Ibn-Sina teaching hospital, and group II patients attending oncology and nuclear medicine teaching hospital in Mosul city. The clinical specimens were collected during period (June - December 2013).The patients included in this study were females only. Isolation and identification of yeast species depend on the classical methods. All the isolated yeast species were tested for their susceptibility to fluconazole concentrations (flu.10mcg, flu. 25mg, flu 50mcg) using standard disc agar diffusion method.
Results: C. albicans 28(52.8%), C. topicalis 1(1.9%), Cryptococcus laurentii 1(1.9%) all of them were higher in group I than group II, in addition C.parasilosis 1(1.9%) was higher in group II than group I, while C. glabrata was the same in group I 1(1.9%) and group II 1(1.9%). Fluconazole sensitivity test ranged from 40(38.1%), 34(32.4%), 31(29.5) to fluconazole discs potency 50mcg, 25mcg, 10mcg in both groups of cancer patients.
Conclusion: C. albicans, C. topicalis, Cryptococcus laurentii all of them were higher in group I than group II, in addition C.parasilosis was higher in group II than group I, while C. glabrata was the same in group 1 and group II. The sensitivity test to fluconazole were dose dependent with no significant difference between the three concentration to fluconazole

Congenital heart disease and pulmonary hypertension among Down syndrome pediatric patients

Khaleel Ibrahim ALSUWAYFEE; Mohammed AHMED; Qusay Norry MOHAMMED

Annals of the College of Medicine, Mosul, 2020, Volume 42, Issue 1, Pages 50-56
DOI: 10.33899/mmed.2020.126534.1017

Background: Down syndrome (DS) is the commonest chromosomal abnormality with high incidence of congenital heart diseases (CHDs). The most prevalent two CHD among DS most studies are complete atrioventricular canal (CAVC) (also called atrioventricular septal) defect and atrial septal defects (ASD). There is high incidence of pulmonary arterial hypertension (PAH) among DS children with CHD compared to non Down syndrome (NDS) children.
Aims: To measure the prevalence of CHD in general and the relative frequency of different types of CHD among DS children as well as the frequency, risk factors and characteristics of PAH in the studied sample.
Methods: It is an echocardiography (echo) based case control study conducted over a 7 months period from the 15th of May to the 14th of December 2019. Information and obtained data were recorded using a special form. Statistical analysis carried out using Microsoft excel 2013 and the statistical package for the social sciences (SPSS) 18 computer programs.
Results: The study involved 76 DS children (mean age in months 19.9±3.7 standard error of mean “SEM” ) and male /female gender ratio of 0.85/1 and 76 NDS children as control group with mean age 9.5± 2.03 SEM and gender ratio of 0.81/1. Congenital heart diseases were significantly higher among DS group 59% (P=0.003). The commonest CHD among DS children were CAVC and ASD .The PAH was significantly higher among DS children with high prevalence (30 %) (P=0.002) and odds ratio of 2.48 (95% CI 0.9-6.83). Complete atrioventricular canal defect, Patent ductus arteriosus (PDA) and age of > 6 months were the main risk factors for the development of PAH among DS children.
Conclusion: There is high prevalence of CHDs and their associated PAH among DS children especially in association with CAVC, PDA and age older than 6 months.

Detection of Toxoplasma gondii and Herpes simplex IgM antibodies in frequently aborted women during different seasons in Mosul city

Hisham Alkazzaz; nadia mahmood; karam aldabbagh

Annals of the College of Medicine, Mosul, 2020, Volume 42, Issue 1, Pages 57-61
DOI: 10.33899/mmed.2020.127248.1028

Background: Many women suffer from frequent abortions due to many causes; one of these causes is infection with different types of microorganisms. Toxoplasma gondii protozoan and Herpes simplex virus (HSV) are well-known causes of repeated abortion. However, it is unclear whether seasonal changes could affect the re-activation of latent infections with these microorganisms.
Objectives: To detect the percentage of active toxoplasmosis and HSV infections among frequently aborted women, and evaluate seasonal changes on such active infection.
Patients and method: Two hundreds women with frequent abortions were tested for anti-toxoplasma gondii IgM antibodies and anti-HSV IgM antibodies in two different seasons (100 patients in summer and 100 patients in winter) and were compared for variance.
Results: For toxoplasmosis, only 2% of studied women were positive for IgM antibodies in winter in comparison to 3% in summer with a total active infection of 2.5% in both seasons; however, for HSV about 12% were positive in winter and 10% were positive in summer with a total active infection of 11% in both seasons.
Conclusion: Seasonal variance showed no significant change on re-activation of latent infection of both Toxoplasma gondii and HSV in frequently aborted women. The rate of infection in frequently aborted women with HSV is higher than the rate of infection with Toxoplasma gondii in Mosul city.

Assessing the Effect of Ventriculo-peritoneal Shunt Treatment for Congenital Hydrocephalus

Mohammad Shaker; Najlaa Al-Sammak; Safwan Hashim Alhamdani

Annals of the College of Medicine, Mosul, 2020, Volume 42, Issue 1, Pages 62-67
DOI: 10.33899/mmed.2020.127286.1032

Context: Congenital hydrocephalus is one of the common neurological problems in infants, characterized by excessive accumulation of cerebrospinal fluid (CSF) in the central nervous system. Numerous babies delivered every day with this anomaly all over the world most of them in the developing countries. There are several forms of treatment; the commonest one is ventriculo-peritoneal shunt that transfers the CSF to the peritoneal cavity. It is associated with relatively low morbidity and mortality rates. Aim: This study aimed to evaluate the ventriculo-peritoneal shunt therapy outcomes for congenital hydrocephalus and find its complications.
Patients and methods: In this research, an observational case series study design had been adopted in Ibn-Sina teaching hospital applied on a convenient sample of 52 infants of both sexes with congenital hydrocephalus over a period of three years. Ethical consents were obtained from their parents. Then, clinical evaluation was done through head circumference and fontanel examinations followed by CT-scan and ultrasonic testing to confirm the diagnosis. All patients were subjected to the ventriculo-peritoneal shunt (VP) surgery with full coverage of appropriate antibiotics, and then they were followed for 6 months to assess the effectiveness of VP shunt in the treatment of hydrocephalus and to identify any complication associated with this surgery.
Results: Most cases (79%) were below 3 months of age and 55.5% of them were males. Only 13.5% of cases developed complications including upper and lower shunt obstruction, shunt infection (28.6% for each), and skin laceration in 14.2% of those 13.5% complicated cases. Most of these complications happened to infants older than 3 months of age.
Conclusion and recommendation: The study concluded that Ventriculo-peritoneal shunt was associated with low complication rate especially among young infants. Thus, it is recommended to adopt this procedure for the treatment of infantile hydrocephalus particularly among infants below 3 months of age.
Key words: Congenital, Hydrocephalus, Ventriculo-peritoneal, Shunt.

The Role of exercise ECG Test in determining the severity of CAD and the Jeopardy of Myocardium

khalid hameed

Annals of the College of Medicine, Mosul, 2020, Volume 42, Issue 1, Pages 68-75
DOI: 10.33899/mmed.2020.126925.1024


Objective: To assess the value of exercise ECG test in evaluating the severity of coronary artery disease and jeopardy of myocardium.
Methods: A prospective study of 75 consecutive patients were all had history of angina, and they underwent both treadmill test (TMT) and coronary angiography in Mosul Center for Cardiology and Cardiac Surgery in the priod from April 2013 to August 2014 .Those with significant angiographic coronary artery stenosis (61 patients) were divided into four groups according to the size of myocardium supplied by and the resulting jeopardized myocardium. This division depends on identity of involved vessel, number of vessels and the site of the lesion on the involved vessel. Also, the result of TMT with ST depression was classed into class A (ST segment depression involving ≥ 5 leads) and class B (ST depression involving < 5 leads). Correlation between the angiographic groups and the results of TMT regarding the number of leads showing ST changes was done.
Results: The study involved 53 (70.5%) male and 22 (29.5%) female patients. The sensitivity and specificity of TMT were 77% and 71.5%, respectively. There were significant difference between class A and class B in patients with group I angiographic changes (which is the most severe angiographic coronary artery lesions and the largest jeopardized myocardium) and in patients w ith group IV (which is the least severe of coronary lesions with the smallest jeopardized myocardium). These differences became more significant after excluding patients with myocardial infarction (MI) and/or patients who develop severe typical angina (STA) at low workload which preclude continuation of test before appearance of the ECG changes of ischemia. Also w hen comparing group I, II or III separately or collectively with group IV we noticed significant differences regarding both class A or class B, especially after excluding patients with MI and/or patients with STA at low workload.
Conclusion: Our data suggest that exercise ECG test can b e useful in determining the severityof coronary artery disease and size of jeopardized myocardium rather than the location of lesion or number of vessels involved.

Patients satisfaction to quality of health services of family doctors in family medicine centers in left side of Mosul city

Mohammad Yousif Mohammad; firas husam ali; ammar hazim yahia

Annals of the College of Medicine, Mosul, 2020, Volume 42, Issue 1, Pages 76-81
DOI: 10.33899/mmed.2020.126482.1015

Background:Patient satisfaction is related to clinical outcomes, patient retention, and medical malpractice claims. It affects the timely, efficient, and patient-centered delivery of quality health care. The aim of study was to assess the level of patients' doctors in family medicine centers in Mosul city.
Patients and Methods: A cross sectional study was conducted in order to achieve the aim of the present study in which the data was taken from the attendants to family medicine centers in left side of Mosul city by direct interview using specially designed questionnaire (The Bulgarian EUROPEP questionnaire) after receiving health services during a period of 8 months started from 1st of May 2018 up to 30th of January 2019.
Results:The study includes 580 participants. More than half of them their ages were between 20 – 40 years from both sexes (male = 175, female = 135) and 38.8% of them were having university graduation. The overall satisfaction to medical services delivered by family doctors was 79.7%, Continuity and confidentiality constituted the higher satisfaction rate in 97%, 96.6%, while Informativeness satisfaction constitute 89.7%. Accessibility and Acceptability had the lowest satisfaction rate compared to other domains
Conclusions:this study revealed high patients’satisfaction rate to doctors delivering health care at the family health centers in left side of Mosul city while there was lower satisfaction rate regarding Accessibility and Acceptability. Further wide scale studies are needed in the future and provision of appropriate infrastructure.
Key words: patient satisfaction, family medicine, health care.

Review study of the role of genetically modified Lactococcus lactis in prevention of type-1 diabetes mellitus

Abeer Mudhafar Al-Humaidhi; Ahmed Abdulkareem Shegaya; Ali Qusay Sagban; Hussain Ali Jaleel; Karrar Mahtar Ateha; Maitham Jaber Abdulhussain

Annals of the College of Medicine, Mosul, 2020, Volume 42, Issue 1, Pages 82-89
DOI: 10.33899/mmed.2020.127468.1040

Globally, type 1 diabetes mellitus is a common chronic autoimmune disease impacts a great number of individuals. It results from devastation of insulin-secreting beta cells of the pancreas described by incompetence to secrete insulin resulting in hyperglycemia that need a ceaseless treatment with insulin. Further, complications of type 1 diabetes can influence numerous organs and may prompt premature death. Therefore, the requirement to find new strategies for managing type 1 diabetes other than exogenous insulin administration got obligatory. Curiously, genetically modified Lactococcus lactis can incite immunological tolerance; downregulate mechanisms linked to adaptive immunity; and reduce disease-related inflammation, while leaving the remainder of the immune system flawless. This review aimed to overview genetically modified Lactococcus lactis, it's expressing proteins, pathogenesis of type 1diabetes, and therapeutic effects of genetically modified Lactococcus lactis in animal model of type 1daibetes, further, to display the possible mechanisms through which the genetically modified Lactococcus lactis can act. It has been presumed that targeting antigen-specific pathway utilizing genetically modified Lactococcus lactis has potential therapeutic impacts in experimental animals with type 1 diabetes mellitus. This could open up new and safe therapeutic prospects in autoimmune disease domain such as type 1diabetes mellitus.

Under-Graduate Oncology Education in Iraq: Roadmap for Improvement

Layth Yahya Ibrahim Mula-Hussain; Bassam Al-Zuhairy; Saif Al-Izzi; Alyaa Mula-Hussain; Muzahim Al-Khyatt

Annals of the College of Medicine, Mosul, 2020, Volume 42, Issue 1, Pages 90-98
DOI: 10.33899/mmed.2020.127346.1033

Oncology is a branch of medicine that specializes in the diagnosis and treatment of cancer and is divided into surgical oncology, radiation oncology, and medical oncology. Cancer is one of the leading causes of morbidity and mortality worldwide and there is a distinct shortage of adequately qualified oncologists in Iraq. Oncology education should be introduced at the beginning of medical school (college) as every doctor may face cancer patients in their training and practice after graduation. However, there is a gap in this area, as this branch is relatively new compared to other clinical branches. Holistic cancer care and a patient-centered approach should be the goal of modern oncology. Comprehensive under-graduate oncology education should be a critical component in medical education. This work is aiming to present a roadmap for an ideal oncology curriculum, which can be integrated and implemented into the Iraqi medical schools’ curricula.