Annals of the College of Medicine Mosul

ABSTRACT Objectives: 1- To determine the association between Hodgkin\\'s lymphoma and Epstein-Barr virus. 2- To determine if it is related to certain age groups or specific histologic subtypes. 3- To compare the pattern with other developing or developed countries. Methods: Biopsies of seventy cases with Hodgkin\\'s lymphoma were collected from the pathology laboratories. The clinical data, including the patient’s age, sex, site of lymph node affected and the histological classification according to the REAL classification, were retrieved from the pathologic reports. Immunoperoxidase stains for LMP-1 were performed on 40 cases. Results: The mean age of all cases was 26.7 years, with a median of 25 years. There were 36 males and 34 females. The largest age group was seen in 15 - 40 years accounting for 68.5%. The third decade took the peak incidence (21/70, 30%). Nodular sclerosis Hodgkin\\'s lymphoma was the most common subtype representing 58.5% of all the cases, followed by mixed cellularity (37.2% of cases). The lymphocyte depleted subtypes in 2.8%, whereas lymphocytic predominant seen in 1.4% of cases. Latent membrane protein-1 was observed in 37.5% of Hodgkin\\'s lymphoma. The most frequent association was observed in lymphocytic depletion subtype (50%), followed by mixed cellularity subtype (45%). The least frequent association was in nodular sclerosis type (27.7%). The highest rate of EBV expression was seen in the pediatric age group (< 15 years; 66.6%) and the lowest rate was among young adults (15-40 years; 26.9%). Older age group (> 40 years) has a rate of EBV expression (50%) which is higher than the young adult patients, but lower than the pediatric age group. Epstein-Barr virus positive cases were mostly males (73.3%) compared to females (26.7%). Conclusion: Hodgkin\\'s lymphoma in our locality, in comparison with earlier studies, shows changing pattern with a gradual trend to those of developed countries including peak age group and subtypes. Moreover, Epstein-Barr virus is seen in slightly more than one third of cases and mostly seen in childhood, mixed cellularity and lymphocytic depletion subtypes with a male predominance

ABSTRACT Objective: To evaluate the antiemetic effect of ginger versus metoclopramide in children receiving cancer chemotherapy. Methods: A sample of 50 patients aged 6 – 14 years attending the Haematooncology unit in Ibn Al – Atheer Children\\'s Teaching Hospital in Mosul city and receiving chemotherapy for their malignancies were included. They were randomly subdivided into 2 groups and received different types of treatment including ginger and metoclopramide. Results: The study showed that cancer was more common in female than in male with male to female ratio 0.85/1. Acute lymphoblastic leukemia was the most common type of cancer and constituted 60% of the cases and it revealed that response rate was higher in those treated by ginger compared to metoclopramide (72% and 32% respectively); response was found to be higher in males than in females (86.6% and 50% respectively). Conclusions: Nausea and vomiting are common problems in children receiving chemotherapy. Ginger (Zingiber officinale) appears to be promising in controlling these problems.

ABSTRACT Aims of the study: To evaluate the expression of the Bcl-2 oncoprotein in patients with primary breast cancer, to correlate it with estrogen and progesterone receptors and various prognostic parameters. Patients and methods: Fifty two cases of primary breast cancer in which the estrogen and progesterone receptors statuses were previously tested by immuno-histochemical staining, were included in this retrospective study. The cases were collected from Al- Jamhori Teaching Hospital, Nineveh Private Hospital and Private laboratories. The expression of Bcl-2 oncoprotein was evaluated immunohistochemically; the findings were correlated with the estrogen and progesterone receptors, the age of the patients, size, type and grade of the tumor, lymph node status and vascular invasion. Results: Bcl-2 oncoprotein was detected in 24 cases of primary breast cancer (46.2%). In this study the majority of estrogen and progesterone receptors positive cases, (87.5%) and (83.3%) respectively, showed positive Bcl-2 oncoprotein expression, (P<0.001) and (P=0.0002) respectively. A significant association was found between Bcl-2 and tumor type (P=0.017). Bcl-2 oncoprotein was directly correlated with the age of the patients (P=0.0047), and inversely with the grade of the tumor and vascular invasion (P value = 0.0092, <0.001) respectively. No significant correlation with tumor size nor with lymph node status could be found, (P=0.078) and (P=0.19) respectively. Conclusions: Bcl-2 oncoprotein was positive in 46.2% of primary breast cancer. This study revealed a significantly direct correlation between the Bcl-2 and the estrogen and progesterone receptors. A significant association was found between Bcl-2 oncoprotein and tumor type. Bcl-2 was directly related to the age of the patients, and inversely related to the grade of the tumor and vascular invasion.

ABSTRACT Objectives: There are currently more than 200 known mutations affecting the beta globin gene; about 20 mutations account for 90 % of beta globin gene mutations in the world, and each ethnic population has its own unique and frequency of beta globin mutations. Prenatal diagnosis requires identification of the mutation spectrum in each population, and then it is possible to do direct identification for these mutations in the majority of the population.The aim of this study is to characterize the spectrum of beta globin gene mutations in Ninawa governorate patients with beta- thalassemia major. Patients and methods: Twenty four thalassemic patients were included; they were transfusion dependent and they were diagnosed and registered in thalassemia center of Ninawa governorate. After DNA extraction from venous blood and PCR based DNA amplification, the allele\'s characterization was achieved by reverse hybridization to specific oligonucleotide probe designed to detect 22 beta-thalassemic mutations. Results: Out of the forty eight alleles studied, 42 (87.5%) alleles were characterized, while 6 (12.5%) alleles were undetermined. Eight alleles causing beta-thalassemia in Ninawa governorate were identified in these patients, and these alleles with their frequencies were: IVS 1.110 (G>A)(27.08%), IVS 1.6 (T>C)(14.5%), cod 8 (-AA)(12.5%), cod 39 (C>T)(12.5%), IVS 2.1 (G>A)(12.5%), cod 44 (-C)(4.16%), IVS 1.5(GÆC)(2.08%) and Cod 5(-CT)(2.08%). More than 1/3 of the families have more than one affected sibling. Eleven (45.83%) patients had homozygous alleles, and 12 (50%) patients with compound heterozygous alleles; In 1 (4.16%) patient the genotype was unknown

BSTRACT Context: Inguino-genital surgical disorders are common problems seen in daily surgical practice. The aim of this study is to determine the main surgical inguino-genital disorders among kindergartens and primary school boys less than 10 years of age in Mosul city. Methods: Arandom sample of kindergartens and primary school boys from both sides of Mosul city underwent a cross-sectional study between 1st of Oct. 2004 and 31st of Jan 2005. All boys were examined by specialized surgeons for the presence of surgical disorders in their inguino-genital region. The pathological findings were recorded and diagnosed disorders were further assessed by suitable investigative tools. The parents were informed about their children\\'s disorders and accordingly, a suitable management for each single disorder was discussed with them. Results: During the study period, 950 children were examined and (125) children were having various inguino-genital disorders. The prevalence of these conditions was (13.2%). The present study showed (7.7%) of the screened children were uncircumcised, (3.2%) were having undescended testes and (1.2%) has inguinal hernia. The surgical conditions were (54.4%) among the age of 6-7 years, (20.0%) among the age of (5-6) years and (1.6%) among the age of (9-10) years. The study revealed that 60% of the undescended testes were on the right side, and (36.7%) on the left side. Moreover (63.67%) of the hernias were right sided and (27.3%) were left sided. Conclusion and recommendations: Studying male children in schools for any surgical abnormalities, at the inguino-genital areas provides the opportunity for detection of the early conditions, further management of the main surgical cases that need correction and the prevention of any risk of complication

ABSTRACT Objective: To look for the presence or absence of seasonal variation of pulmonary embolism (PE). To analyze the effect of age, sex and the presence or absence of deep vein thrombosis(DVT) and its risk factors on the occurrence of PE. To analyze the ECG changes and the presence or absence of sinus tachycardia in patients with acute PE. Method: One hundred three patients with PE were studied retrospectively, during the years 2002-2007 at the intensive and respiratory care unit and general medical units in Ibn-Sena Teaching Hospital. Results: One hundred three patients with PE were studied. The age of the patients correlates significantly with the presence of PE being highest between 21-50 year of age, with p-value of <0.001. There were no seasonal variations in the distribution of PE with P-value of 0.06. Females significantly outnumbered male patients with P-value of 0.002. There was no statistically significant association between the clinically evident DVT or its absence and the diagnosis of PE with p-value 0.278. The association between the presence of PE and positive doppler ultrasound for DVT were significant with p-value of 0.023. There was a significant association between the presence of PE and sinus tachycardia with p-value of <0.001, and negative correlation with the classical ECG changes. Conclusion: There was no seasonal variation in the distribution of PE. There was significant association between the presence of PE and positive doppler ultrasound for DVT. Sinus tachycardias were commonly present with acute PE. We need to have more sophisticated facilities for proper diagnosis of PE

ABSTRACT Context: Non-compliance to treatment among diabetic patients is a world-wide problem and its underlying risk factors can be the subject of many studies in different localities. Objective: To identify risk factors for non-compliance to treatment plan among type 2 diabetic men attending Al-Wafaa Center for diabetes in Mosul City. Methods: A case-control study design has been adopted. A special questionnaire form has been prepared and filled in by the investigator for each patient (case and control) through direct interview with patients. Results: Study results revealed a significant association between non-compliance and socio-economic strata, duration of disease >10 years, number of tablets >2 daily, frequency of taking medication >2, poor patient satisfaction about health personnel, body mass index >30 and sedentary life style activities. On the other hand, an inverse association was found between non-compliance and urban place of residence, marriage, 10 and 20 school level of education, taking medical treatment without herbals and type A personality. Conclusion: The study concluded that health care professionals are in need to identify risky patients for non-compliance and recommends to use the counseling approach of communication before applying any individual patient management plan characteristics.

ABSTRACT Objective: To evaluate the effects of low daily aspirin doses on uric acid (UA) level and renal functions in healthy adults. Methods: Healthy adults were randomized to receive 100 mg (n= 33), or 300 mg (n = 31) aspirin daily for one month. Laboratory tests included measurement of blood urea nitrogen (BUN), serum creatinine, and uric acid (UA) levels. Urine creatinine, urea and uric acid excretion were measured in a 24 h collection of urine, 24 hours urine uric acid, creatinine clearance (Ccr), were measured at baseline and then after 4 weeks of therapy. Results: After 4 weeks of therapy, 100 and 300 mg/d dosage, aspirin caused a 7% and 12% decrease in the rate of UA excretion respectively (P< 0.05). Patients at the dosage 300 mg/d but not the 100mg/day had an increase in serum levels of uric acid (UA), creatinine and urea with a significant decrease in 24 hour creatinine clearance and urinary urea excretion (P<0.05) when compared with the baseline. Conclusion: Because of the effects of 300 mg dose aspirin, in the lowering of kidney function and the potential of aspirin to cause dose-dependent impairment of renal function, patients taking low-dose aspirin therapy should be monitored for the development of impaired renal function.

ABSTRACT Objective: To compare the effects of nandrolone decanoate on the liver structure in male and female rabbits using histological and ultrasound examinations. Materials and methods: Forty-eight adult rabbits were divided into two groups, male and female groups, each included 24 adult healthy rabbits. The male group was subdivided into 4 subgroups, group A was the control group which received only normal saline, group B was given nandrolone decanoate 2mg/kg body weight, group C was given 4 mg/kg body weight of nandrolone decanoate, while group D was given 6 mg/kg body weight of the drug. The female group was also subdivided into 4 subgroups, group A1 was the control group, group B1 was given 2 mg/kg body weight, group C1 was given 4 mg/kg body weight, group D1 was given 6 mg/kg body weight of nandrolone decanoate. Results: All treated groups of both sexes showed a significant increase in body and liver weights in addition to dose related pathological changes ranging from mild to severe form, including vacuolar degeneration and fatty degenerative changes of hepatocytes. In addition, there was a dilatation and congestion of sinusoids, central venules and portal veins with mononuclear inflammatory cells infiltration. Focal areas of necrosis with chronic inflammatory cells infiltration were also noticed in different hepatic lobules. In spite of these histological changes in the liver no abnormal ultrasound findings of the liver were noticed. Conclusion: These changes indicate that the histological effects of the anabolic androgenic steroid nandrolone decanoate on the liver of adult male and female rabbits is the same in both sexes, but the treated female rabbit groups of medium and high doses (C1 and D1) showed more increase in body weight than male rabbit groups. There is no correlation between histological and ultrasound findings.

BSTRACT Objective: To evaluate the antiemetic effect of ginger versus metoclopramide in children receiving cancer chemotherapy. Methods: A sample of 50 patients aged 6 – 14 years attending the Haematooncology unit in Ibn Al – Atheer Children's Teaching Hospital in Mosul city and receiving chemotherapy for their malignancies were included. They were randomly subdivided into 2 groups and received different types of treatment including ginger and metoclopramide. Results: The study showed that cancer was more common in female than in male with male to female ratio 0.85/1. Acute lymphoblastic leukemia was the most common type of cancer and constituted 60% of the cases and it revealed that response rate was higher in those treated by ginger compared to metoclopramide (72% and 32% respectively); response was found to be higher in males than in females (86.6% and 50% respectively). Conclusions: Nausea and vomiting are common problems in children receiving chemotherapy. Ginger (Zingiber officinale) appears to be promising in controlling these problems.

ABSTRACT Objectives: To evaluate p53 protein expression in colorectal tumors in Mosul city and correlates it with various clinicopathological parameters and to compare the results with other studies. Patients and methods: This is a pro and retrospective study of 53 samples of adenocarcinoma of colon with age range from 5 to 80 years. There were 38 males, with age range (5 to 80) years and 15 females with age range (18 to 70) years. The samples were collected from Al-Jumhuri Teaching Hospital, Nineveh Private Hospital and private labs during the period from September 2007 through May 2008. P53 protein was detected immunohistochemically by using the primary antibody (monoclonal antibody clone (DO-7¹) and ™ G|2 visualizing system/AP, Rabbit/Mouse (permanent red). Positive and negative controls were included in each run. The interpretation was done by a semi quantitative method. Results and conclusions: P53 protein expression was found in 49% (26 cases) of colorectal cancer. There was no correlation of p53 expression with age, sex, site, and size, but was significantly correlated with grade and stage (p value =0.001,0.044, respectively). By stepwise backward multiple logistic regression the grade was the only independent factor (p value =0.033)

ABSTRACT Aims of the study: To evaluate the expression of the Bcl-2 oncoprotein in patients with primary breast cancer, to correlate it with estrogen and progesterone receptors and various prognostic parameters. Patients and methods: Fifty two cases of primary breast cancer in which the estrogen and progesterone receptors statuses were previously tested by immuno-histochemical staining, were included in this retrospective study. The cases were collected from Al- Jamhori Teaching Hospital, Nineveh Private Hospital and Private laboratories. The expression of Bcl-2 oncoprotein was evaluated immunohistochemically; the findings were correlated with the estrogen and progesterone receptors, the age of the patients, size, type and grade of the tumor, lymph node status and vascular invasion. Results: Bcl-2 oncoprotein was detected in 24 cases of primary breast cancer (46.2%). In this study the majority of estrogen and progesterone receptors positive cases, (87.5%) and (83.3%) respectively, showed positive Bcl-2 oncoprotein expression, (P<0.001) and (P=0.0002) respectively. A significant association was found between Bcl-2 and tumor type (P=0.017). Bcl-2 oncoprotein was directly correlated with the age of the patients (P=0.0047), and inversely with the grade of the tumor and vascular invasion (P value = 0.0092, <0.001) respectively. No significant correlation with tumor size nor with lymph node status could be found, (P=0.078) and (P=0.19) respectively. Conclusions: Bcl-2 oncoprotein was positive in 46.2% of primary breast cancer. This study revealed a significantly direct correlation between the Bcl-2 and the estrogen and progesterone receptors. A significant association was found between Bcl-2 oncoprotein and tumor type. Bcl-2 was directly related to the age of the patients, and inversely related to the grade of the tumor and vascular invasion