Annals of the College of Medicine Mosul

BSTRACT Objectives: To calculate infant and under five mortality rates and to find out the most common causes of death among children. Methods: Study period: The study was done over a period of one month, during Dec. 2007. Study design: Rapid epidemiological survey using UNICEF “last birth technique”. Study setting: The study was done at Al-Hadbaa Primary Health Care Center in Mosul city. Study population: Data was collected from 1046 mothers in child bearing age (15-49 years), who were attending at the antenatal clinic by direct interviewing using a questionnaire form based on the model formulated by UNICIF for childhood mortality survey. Results: The present study showed that the estimated under five mortality rate is 107 /1000 of last live births which represents a rise of 2.5 fold since WHO Maternal and Child Mortality Survey was done at 1990 in Iraq. The Infant mortality rate was estimated to be 95.6 death / 1000 of last live births. The study also showed that the neonatal mortality (0-28 days) constitutes 40.9/1000 last live birth which accounts for 42% from all deaths that occur during 1st year of life. Other findings showed that more than a quarter of all causes of deaths among under five were related to respiratory problems and 15.5% of all causes were linked to congenital abnormalities. Diarrheal disease accounted for 8.6% of causes. Conclusion: Results showed that under five mortality is still considered a major health problem and reflecting defect in health system of the community, needs to be re-evaluated and minimized to be as least as possible.

ABSTRACT Objectives: To assess the effect of amlodipine, as monotherapy, in hypertensive patients, on serum lipid profile, as assessed by serum cholesterol, serum triglyceride, high density lipoprotein cholesterol (HDLC), and low density lipoprotein cholesterol (LDLC). Subjects and methods: Thirty three hypertensive patients were included in the study, 25 of them were males and 8 were females. Serum cholesterol, triglyceride, HDLC and LDLC were measured before and after 2 months of starting treatment with amlodipine. Results: No significant difference could be found between the pre and post treatment levels of all measured parameters. Conclusion: Treatment with amlodipine does not produce deleterious effect on lipid profile, so it may be a suitable therapy in a hypertensive patient with underlying hyperlipidaemia

ABSTRACT Objective: To study the incidence, sex, age, and seasonal distribution of Bell’s palsy in Mosul. Methods: A prospective study of patients with Bell’s palsy from outpatient and private neurological clinic and Neurophysiological Unit in Ibn Sena Teaching Hospital in Mosul conducted between September 2001 to August 2003. The patient's age, sex and time of occurrence of Bell’s palsy were recorded. Result: the total number of the patients was 469, male patients were 207 and females were 262. The higher number of cases was recorded in the cold months, adult affected more than other age groups. Conclusion: Bell’s palsy is the commonest cause of lower motor neuron facial nerve palsy; herpes simplex has been claimed as a cause of the condition. Keywords: Bell’s palsy; facial nerve; facial nerve paralysis

ABSTRACT Objectives: To investigate the effect of intake of dairy-products on the sebum lipid components and fatty-acid composition. Patients and Methods: Sebaceous cysts were obtained, by simple surgery, from the scalp, face and neck of 21 men (aged 25-50 y) and divided into two groups. The first group included 11 cysts for subjects consuming dairy products and the second group included 10 cysts for subjects not consuming dairy products. Simple lipids, phospholipids (PLs), triglycerides (TGs), cholesterol (C), cholesterol ester (CE) and fatty acids (FAs) were removed by organic solvents extraction. The sebum lipid components, TGs and C, were determined enzymatically and PLs were determined using a colorimetric method based on the formation of a phosphomolybdate complex. Lipid components were separated by TLC. The separated components were hydrolyzed and their FAs were esterified by super dried-acidified methanol. Fatty-acid methyl esters were identified by capillary gas chromatography. Results: Compared to the non-consumers group, the consumers group exhibited a significant increase in lipid contents, viz, PLs and C. Concerning the FA composition of CE, PLs and TGs, n6-polyunsaturated FAs showed a higher percentage, viz. C18:2 n6 and C9,t11 CLA, while n3-polysaturated FAs showed a significant decrease, viz. C20:5 n3. Conclusion: Consumption of dairy products affects the lipid content and the FA composition of sebum and C9,t11 Conjugated Linoleic Acid could be used as a marker for intake of dairy-product lipid. ا

ABSTRACT Objective: To study the spontaneous healing of various types of traumatic perforations of the tympanic membrane in a prospective study carried out on patients with traumatic perforations of the tympanic membrane, presented to same author. Methods: Eighty patients with 84 traumatic perforations of the tympanic membrane were studied at Tikrit Teaching Hospital, during the period from Jan. to Dec. 2007. Diagnosis made by a history of trauma and otoscopic examination. Antibiotics were given to prevent or treat infections. Advice to keep the ear dry. Follow up the patients for a minimum of six months. Results: The male: female ratio was (2.6:1). Left ear perforation was more than right ear, (5%) were bilateral. The commonest cause was blast injury in 34 patients (43%), then hand slap in 22 patients (27.5%). The age of the patients was from 4-65 years, common age group affected was (21-30 years), they were 39 patients (49%). Spontaneous healing occurred in 69 cases (82%), persistent dry perforation in 8 cases (9.5%), and 7 cases (8.5%) ended with chronic suppurative otitis media. Fifty-six cases (81%) got complete healing within six weeks. All cases due to fractures of temporal bone got spontaneous healing (100%), then perforation by foreign body and instrumentation (89%), ear syringing, and hand slap was equal (88%), then due to ear suction (80%), and the lower incidence in blast injury were (75%). Healing of posterior and anterior perforations about equal (92%), (91%) respectively, then kidney shape perforation (85%), but none of 7 cases of subtotal perforations healed spontaneously. Conclusion: Conservative care for traumatic perforations of the tympanic membrane gives excellent chance for spontaneous healing. The factors affecting spontaneous healing include, large size perforations, ear infections, type of trauma, and Eustachian tube dysfunction.

ABSTRACT Objective: To assess the role of platelet indices mainly: Mean Platelet Volume (MPV) and Platelet Distribution Width (PDW) for the differential diagnosis of thrombocytosis. Methods: A prospective case series study conducted at Ibn–Sena Teaching Hospital in Mosul during the period from June 2003 to January 2005. Ninety two patients with thrombocytosis were analyzed for platelets indices using Coulter MS-9. A control group of sixty normal subjects were also included in this study for comparison.Results: Thrombocytosis was found to be due to two main causes: 12 patients with myeloproliferative disorders, and 80 patients had secondary reactive causes of thrombocytosis. Patients with myeloproliferative disorders had significantly higher Mean Platelet Volume (MPV) than those with reactive thrombocytosis. Also the Platelet Distribution Width (PDW) was higher in patients with myeloproliferative disorders than those with reactive thrombocytosis and control group. Conclusion: Platelet indices especially PDW seem to be a good variable for the differential diagnosis of thrombocytosis.

ABSTRACT Objective:The histological examination of the decidua can provide a clue in the diagnosis of intrauterine pregnancy. The purpose of this study is to describe the morphologic features observed in the decidual blood vessels of early pregnancy loss cases prior to 20 weeks gestation, and to compare these findings with Arias-Stella reaction and with changes found in endometrial biopsies of non-pregnant women as a control group. Material and method: A prospective case control study done at the Department of Pathology of Mosul Medical College, Histopathological Laboratories of Al-Khansa and Al-Zahrawi Teaching Hospitals and the gynecological units of Al-Khansa and Al- Batool Teaching Hospitals in Mosul. The study was conducted on 161 reproductive aged women with different clinical types of abortion admitted for uterine evacuation. The histopathological features in the decidua and decidual vessels of curettage specimens were described, graded and compared with that observed in endometrial biopsies of non pregnant women as a control group. Results: Out of a total 161 abortion specimens examined,10.6% of cases showed severe degree of obliterative endarteritis involving one or more decidual vessels. This finding was higher than the frequency of Arias-Stella reaction in the same specimens and none of these features were described in the control group . Conclusion: Obliterative endarteritis of decidual vessels can be used together with other morphological features for the possibility of occurrence of a pregnancy in the absence of chorionic villi, trophoblast and other emberyonic elements

ABSTRACT Objective: To determine the seasonal variation of glycemic level among diabetic patients in Mosul, and to define the seasons where blood glucose may surge or decline. Patients and methods: An observational retrospective case series study of seven hundred HbA1c% results pertaining to 653 randomly enrolled type 2 (96%), and type 1 (4%) diabetic patients which were collected over 28 consecutive months. The HbA1c% mean of each month separately, and the HbA1c% means of the months whose HbA1c reflects the glycemic control of the preceding season were estimated, plotted, and statistically compared. Results: The monthly HbA1c% means throughout the study period comprised a sinusoidal curve with higher values between early spring (March) to early summer (June) and lower values between early autumn (September) to early winter (January) of each year. Throughout the study period, the mean HbA1c% of all early springs (8.87% ± 1.57% SD) was the maximal, while the mean HbA1c% of all early autumns (7.81% ± 0.94% SD) was the minimal. Conclusion: Glycemic levels among diabetic patients in Mosul, as reflected by early spring's peak, and early autumn's trough of HbA1c%, are highest during winter and lowest during summer.

ABSTRACT Objectives: To examine the occurrence of fatty liver disease in diabetic patients type 1 and 2 disease and to focus the attention in our locality about this serious condition. Method:This prospective study of one hundred ten diabetic patients and one hundred patients as control was conducted in Ibn-Sena Teaching Hospital. Patients and control were referred from Al-Wafa Diabetic Center in Mosul, the outpatient department, and from the Medical Center of Mosul Medical College University of Mosul. All were referredfor clinical assessment and for ultrasound examination of their abdomen.Results: The patients include 34 patients with type 1 and 76 patients with type 2 diabetes. Of the 110 patients examined, 52.7% proved to have fatty infiltration in the liver by ultrasonography with no statistically significant difference between male and female. Patients with type 2diabetes mellitusweremore vulnerable to developfatty infiltration of the liver than type 1 diabetes mellitus, with statistically significant difference betweenthem. Eighty six percent of patients with NAFLD were type 2 diabetes and 13.7% were type 1 diabetic disease.The control group have NAFLD in 8% only. The age of the patients shows positivecorrelation and fatty infiltration in the liver increased with age. The longer the duration of diabetes mellitus makes the patients more likely to develop fatty infiltration in the liver. The postprandial blood sugar level correlates significantly with the presence offatty infiltration in the liverwhile thefasting blood sugar level does not. Conclusion: Nonalcoholic fatty liver disease is common in our diabetic patients, occurs in both type1 and type 2 diabetes. Ultrasound may be used for epidemiological studies for detection of NAFLD in diabetics

ABSTRACT Objective: To highlight the importance of laparoscopic evaluation in the etiology of infertility and to evaluate the etiology in primary and secondary infertility.Methods:This retrospective study included 1233 patients complaining of infertility, 919 patients had primary infertility and 314 patients had secondary infertility. All had been subjected to diagnostic laparoscopy at the Infertility Center in Al-Batool Teaching Hospital, Mosul. Results:Laparoscopy diagnosed pelvic abnormality in 87.27% of infertile patients which was statistically significant difference comparing to no abnormality detected in 12.73%. The ratio of positive findings in secondary infertility was significant in comparison with the positive findings in primary infertility. Single pelvic abnormality detected during laparoscopy among infertility patients was seen in 75.09% of cases and it was statistically different from multiple pelvic abnormality: 24.91%, and it was highly significant among primary infertility patients (77.24%) and among secondary infertility patients (30.87%). Among all infertile patients, ovarian factor was the most common (66.83%) followed by tubal factor (22.03%), endometriosis (4.46%), pelvic inflammatory disease (2.85%), pelvic adhesion (2.10%) and uterine fibroid (1.73%). Ovarian factor was highly significant in primary infertility while tubal factor and pelvic inflammatory disease were the highly significant in secondary infertility. Multiple pelvic pathology identified by laparoscopy showed the tubal factors associated with poly cystic ovary in 29.49% of cases (31.66% in primary infertility and 25% in secondary infertility with no significant statistical difference). Pelvic inflammatory disease associated with other pelvic abnormality 34.09% was highly significant among secondary infertility patients. Congenital uterine abnormalities was not seen alone, it was seen associated with other causes among primary infertility patients (9 cases 0.72%). Conclusion:Diagnostic laparoscopy is a valuable technique and is a mandatory invasive investigation for complete assessment of female infertility before the couple progresses to infertility treatment especially where assisted reproductive techniques were not available

ABSTRACT objectives: Atherosclerotic coronary artery disease (CAD) is a major cause of death all over the world. Among patients with CAD there are many of them having diabetes mellitus which is regarded as a major additive risk factor. Diabetic patients who developed CAD carry high morbidity and mortality rates. The objective of this study was to analyze thecoronary angiographic outcome of patients with type two diabetes mellitus suspected to have coronary artery disease and comparing these resultswith non-diabetic patients. Methods: Patients referred to Mosul Cardiac Catheterization Unit of Ibn-Sena Teaching Hospital for coronary angiography were serially included until obtaining a total of 75 diabetic and 75 non-diabetic patients with predicted coronary artery disease and with different ischemic heart disease risk factors including obesity, smoking, hypertension and dyslipidemia. All of them underwent coronary angiography. Result: Diabetic patients showed more significant stenotic lesions. Moreover the lesions in the coronary artery were more diffuse with higher incidence of multivessel involvement in comparison to non-diabetic patients. Also diabetic patients show increasing incidence of the left main stem artery involvement which carry very high mortality rate. Conclusion: Diabetes mellitus is an independent risk factor for coronary artery disease associated with more advanced, serious and extensive obstructive atherosclerotic lesions in the coronary arteries

SUMMARY The renin – angiotensin system is a major contributor to both hypertension and associated pathophysiologic changes in the heart and cardiovascular wall (The target organ). Major basic and clinical trials have shown that ACE inhibitor and ARB are the main renin- angiotensin system blockers in use assist in controlling hypertension and reducing target organ damage, thus they should be used as a first-line treatment for hypertension. Moreover, ARBs specifically reduces the frequency of atrial fibrillation and stroke, thus it has emerged as a new preventive and therapeutic strategy for these conditions. In theory, combining ACE inhibitor and ARBs maximizes benefits because it offers more complete RAS blockage but this expectation was not confirmed by most recent clinical trials and was not translated into real patients benefits. Renin inhibition was introduced as a better step for reducing angiotensin II, because it offer complete blockage of the whole system. Early studies confirmed that renin inhibitors reduced blood pressure better than ACE inhibitors but further large clinical trials have been started and therefore in the near future, further clinical evidences will be available to confirm the antihypertensive, anti-inflammatory and antiatherosclerotic effects of renin inhibitor. List of abbreviations: RAS (renin – angiotensin system), ACE (angiotensin converting enzyme), ARB (angiotensin receptor blocker), AT1 (angiotensin II receptor type 1), AT2 (angiotensin II receptor type 2), AT4 (angiotensin II receptor type 4), LVH (Left ventricular hypertrophy), AF (atrial fibrillation), CCF (Congestive heart failure)

ABSTRACT The primary component of natural gas is methane (CH4). It also contains ethane (C2H6), propane (C3H8), butane (C4H10), and other sulfur containing gases, in varying concentrations. Suicide by domestic gas was forming more than 40 percent of the annual number of suicides in England and Wales in 1963. Jarvis et al. reported that women using gas stoves had double the respiratory problems of women cooking on electric stoves. I am reporting three cases of accidental cooking gas intoxication, with history of unconsciousness, with or without convulsion. The two males among our patients presented were ended up with neurological deficits like abnormal movements, disorientation and irritability. The 3rd patient recovered more or less completely but still she was complaining from mild weakness in the lower limbs. Natural gas carries an important cause of respiratory and neurological illnesses if the patients are exposed to it for enough time.