Annals of the College of Medicine Mosul

Objective: To examine the plasma level of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) in patients with hypertension and to evaluate the importance of plasma level of these hormones in predicting the left ventricular function in these patients.
Design: A case-series study.
Setting: Echocardiography Unit of Ibn-Sena teaching hospital and Medical college, Mosul. During the period from August 2004 to March 2005.
Participants: Sixty patients with essential hypertension, were divided into 3 groups depending on severity of the disease. Group I, included 17 patients, group II, included 24 patients and group III, included 19 patients. The study also included 30 apparently healthy volunteers as a control group.
Methods: Plasma ANP, BNP and left ventricular ejection fraction (LVEF%) were measured in hypertensive patients as well as in the control group. The ANOVA test was used to examine the difference in the mean of the studied parameters within patient groups themselves and between patient groups and control. Pearson correlation coefficient was used to study the correlation of the studied parameters within each group. All values are expressed as mean ±SD.
Results: The mean of plasma ANP was significantly higher in group III than that in control group (p<0.001) and group I (p<0.05). The mean of plasma BNP was significantly higher in group III than that in control group (p<0.0001), group I (p<0.0001) and group II (p<0.0001). Furthermore, the plasma BNP was significantly higher (p<0.01) in group II than that in control group. The mean of LVEF% was significantly lower in group III than that in control group (p<0.0001), group I (p<0.0001) and group II (p<0.001). There was a significant negative correlation between plasma BNP level and LVEF% in group III (r = - 0.62, p< 0.005).
Conclusion: The results of this study showed that plasma ANP and BNP levels are significantly increased in patients with severe hypertension. The results also indicate that BNP may be an excellent screening test for left ventricular dysfunction in hypertensive patients.

Objective: To evaluate the results of treating laryngeal squamous cell carcinoma using diode laser.
Design: Prospective study.
Setting: Department of ENT-Al Jamhuri Teaching Hospital.
Patients and Methods: Thirty one cases of squamous cell carcinoma of the larynx with age range between 32-66 years. The stage of tumour was Tis: 3, T1: 12, T2:14, & T3:2 cases . Lesions were excised or evaporated using diode laser with safety margin and followed for at least 36 months to evaluate cure rate, recurrences and its relation to site and stage of tumour, need for tracheostomy, complications and quality of voice.
Results: Diode laser was highly effective in treating early laryngeal cancer.Cure rates after 36 month follow up were 100%, 92% & 78% for Tis, T1 & T2 respectively. For more advanced lesions (T3) , the role of laser was limited only for debulking to avoid tracheostomy or biopsy taking in deep seated tumours as alternative to open biopsy. No major intraoperative or postoperative complications happened and no tracheostomy needed. Patients were discharged after twenty four hours. Voice quality was good after surgery in most cases.
Conclusion: Diode laser is safe in treating squamous cell carcinoma of the larynx and highly effective in early stages (Tis, T1, T2) and can avoid tracheostomy or open biopsy in more advanced lesions.

Objective: the role of fibrinolysis in idiopathic dysfunctional uterine bleeding (IDUB).
Design: prospective clinico-haematological study.
Setting: patients were collected in Albatool maternity teaching hospital; a haematological study was conducted in Ibn Sina teaching hospital in Mosul from 10th January to 10th of June 2004.
Participants: 53 patients with mean age of 40.5 years and a range of 15-54 years, complaining of idiopathic dysfunctional uterine bleedings(IDUB) served as experimental group, and 30 presumed healthy women served as a control group, their ages were between 18-45years. After exclusion of organic causes, drugs, IUCD, medical causes, and bleeding tendency, blood samples were tested for haemoglobin, plasma D-dimer test and plasma fibrinogen.
Results: D-dimer test was positive in 16 out of 53 cases (30.2%) of experimental group (Group 1). It was significantly positive (p< 0.005) in cases of idiopathic menorrhagia compared to the control group. D-dimer test was significantly positive in those with prolonged duration of vaginal bleeding >7days, compared to those with heavy periods and short duration of vaginal bleeding (p<0.05), D-dimer test was negative in the remaining cases (group II). The fibrinogen level was significantly lower in patients with positive D-dimer (p<0.05). Antifibrinolytic agent tranexamic acid was given to all patients in both groups; 93% of women responded to the treatment in group 1, while the response in group II was 54%.
Conclusion: Idiopathic menorrhagias appear to be due to increased fibrinolytic activity; such patients are likely to benefit from antifibrinolytic agents.

To identify the relation between the presence of calcium pyrophosphate dihydrate crystals (CPPD) and clinical, laboratory, and radiographic findings in patients with osteoarthritis of the knee joint, an analytical study was done in 2001, which included 100 patients with osteoarthritis of the knee joint. Synovial fluid analysis with the examination of a wet preparation under polarized microscopy was conducted for each patient. The study included a comparison between CPPD positive patients and those who are negative for these crystals. CPPD crystals were identified in 48% of the patients. The study shows a significant association of CPPD crystals with genu-valgum deformity, limited flexion and extension, elevated erythrocyte sedimentation rate (ESR) and cloudy inflammatory synovial fluid with poor viscosity. We concluded that CPPD deposition is associated with more disabling and deforming arthritis of the knee joint. Clinical criteria are needed to identify patients with occult CPPD deposition disease.

Objectives: To investigate the plasma fibrinogen level and D-dimer reaction in patients with acute myocardial infarction (AMI) together with other haematological parameters.
Design: A prospective clinico-haematological study.
Setting: Intensive coronary care unit in Ibn-Sina teaching hospital in Mosul during a period of 4 months from October 2004.
Participants: Forty patients with acute myocardial infarction together with a control group of 40 subjects.
Main outcome measures: Basic haematological parameters, plasma fibinogen level and plasma D-dimer reaction tests. Biochemical tests including cardiac enzymes measurement as creatine kinase (CK) and asparate transaminase (AST) were performed.
Results: Plasma fibrinogen level, white blood cell count and neutrophils count were significantly higher in patients compared to control group with P values (<0.05) (<0.01) and (<0.05) respectively. Positive plasma D-dimer reaction was significantly more frequent in patients than in control group (p<0.05). High plasma fibrinogen level and positive plasma D-dimer reaction were seen in those with worse outcome with p-value (<0.05), (<0.05) respectively. Plasma fibrinogen was significantly higher in those with extensive infarction compared to others (p<0.05).
Conclusion: High plasma fibrinogen and positive plasma D-dimer reaction were more frequently seen in patients with complicated course of myocardial infarction.

Key words: Fibrinogen, D-dimer, acute myocardial infarction.

Objectives: 1. To derive a reference range for random urine protein:creatinine index (PCI) and albumin: creatinine index (ACI) in apparently healthy subjects, using different analytical methods. 2. To compare and assess the validity of sulphosalicylic acid (SSA) and pyrogallol red (PGR) methods for measuring urine protein as alternatives to immunoturbidimetric (IT) method for measuring urine microalbumin, in Iraqi diabetics with or without microalbuminuria (MA) or/and proteinuria.
Subjects and Methods: Random urine and fasting blood specimens were collected from 400 diabetics (256 females, 144 males) aged 8-87 years, including 48 type 1 and 352 type 2 diabetics. They were attending Al-Waffa Diabetic Clinic in Mosul during 6 months from 1st August 2002 to 31st January 2003. A control group of 145 apparently healthy volunteers (108 females, 37 males) aged 15-72 years were used for comparison. Urine protein was measured using SSA and PGR (for all diabetics and controls) and urine albumin using IT (for 112 diabetics and 75 controls). The statistical methods used included unpaired student Z-test and linear regression analysis. The validity indicators: sensitivity, specificity, negative and positive predictive values and accuracy rate were calculated.
Results: The frequency distribution of PCI and ACI showed log-normal distribution and following log transformation, the reference range for PCI was 20-235 mg/g using SSA and 18-205 mg/g using PGR, and for ACI was 4-55 mg/g using IT. The overall prevalence of proteinuria in the diabetics was 30% using SSA method and 35% using PGR method and MA was 27%. The SSA and PGR methods for measuring proteinuria were compared with IT method for measuring MA. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy rates were 93%, 96%, 90%, 98% and 95.5% respectively for PGR; and 80%, 95.1%, 86%, 93% and 91% respectively for SSA. A highly significant correlation (P < 0.001) was observed between ACI and PCI values (r = 0.85 using PGR, r = 0.88 using SSA) in all control and diabetic subjects. Prediction of ACI from PCI value can be made by multiplying the PCI value by 0.375 using PGR and 0.39 using SSA.
Conclusion: Proteinuria and MA are common among Iraqi diabetics. Simple and cheap methods, particularly the PGR method, have acceptable performance to be routinely implemented in diabetic care. It is recommended to measure random urine PCI in all diabetics during their regular visits to the diabetic clinic.
Keywords: Microalbuminuria, sulphosalicylic acid, pyrogallol red.

Objective: to investigate the occurrence of cryptosporidium oocyst in patients with malignant disease before and after receiving chemotherapy.
Methods: A follow up study of 107 patients before and after 2-3 months from receiving chemotherapy compared with 100 healthy subjects studied as a control.
Results:
1.The study revealed a significant increase of cryptosporidium oocyst (18.37%) in patients after receiving chemotheropy in comparison with (8.39%) in patients before receiving chemotherapy and (5%) in control group.
2.In our study we used lodine stain with simple modification by using the oil immersion power for the diagnosis and in this case we obtained excellent diagnosis for Cryptosporidium oocyst. This modification has been used for the first time for better diagnosis of cryptosporidium oocysts.

Objectives: To identify the causes, and the value of the clinical data and echocardiography in the diagnosis of cardiac tamponade ( CT).
Design: Prospective study of 31 cases with cardiac tamponade.
Setting: Coronary care unit, medical wards and echocardiographic department at Ibn-Sina teaching hospital, Mosul.
Subjects: Thirty one patients (19 males, 12 females) presented with (CT) ,selected according to the clinical and echocardiographic criteria .
Results: Chronic renal failure (CRF) was the main cause of CT constituting (35.5% of the cases) followed by tuberculosis and malignancy, each constituted 25.8% of the cases, systemic lupus erythematosis (SLE) constituted 6.5% and pyogenic infection and idiopathic each constituted 3.2%. Right atrial collapse was found in 28 cases (90%) by echocardiogram.
Conclusion: This study showed that CRF was the most common cause of CT and right atrial diastolic collapse was the most sensitive indicator.

Objective: To examine serum prolactin (PRL), luteinizing hormone (LH) and follicle stimulating hormone (FSH) levels in male patients with chronic renal failure (CRF) undergoing maintenance hemodialysis (HD) and their roles in the pathogenesis of infertility encountered in patients with CRF.
Design: Cross–sectional study.
Setting: Artificial Kidney and Dialysis Unit at Ibn-Sena teaching hospital, Mosul, during the period from July to September 2002.
Subjects: Thirty male patients with CRF undergoing maintenance HD and 30 apparently healthy volunteers (control group) were included in this study.
Method: Complete history and physical examination was performed for every patient included in this study with special emphasis on duration of illness, marital status and fertility. Serum PRL, LH, FSH levels were measured; unpaired t-test was used to assess the difference in the mean of serum level of these hormones between patients with CRF and control group.
Results: Serum PRL, LH and FSH levels were significantly higher (P< 0.0001, P< 0.0001 and P< 0.0001) in patients with CRF in comparison with the control group.
Conclusion: Abnormally high levels of serum PRL, LH and FSH are common in patients with CRF undergoing maintenance HD. This abnormality may play a role in the pathogenesis of infertility in these patients.

Bilateral infarction in the distal posterior cerebral arteries produces cortical blindness (blindness with preserved pupillary reaction). The patient is often unaware of the blindness or may even deny it (Anton's syndrome, which is a form of anosognosia due to compromize of the visual association centre)(1,2). Tiny islands of vision may persist, and the patient may report that vision fluctuates as images are captured in the preserved portions(1). Preeclampsia is associated with abnormalities of cerebral circulatory autoregulation, which increase the risk of stroke at near normal blood pressures(3). During focal brain ischemia, a gradation in brain perfusion exists such that a core of tissue is infarcted within minutes but a shell of surrounding tissue is only marginally ischemic. This ischemic penumbra may progress to infarction within minutes to hours(4).