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Article
Bronchiectasis in northern lraq clinical and bacteriological characteristics during acute exacerbation

Author: Rami M. A. Al-Hayali رامي محمد عادل الحيالي
Journal: Annals of the College of Medicine Mosul مجلة طب الموصل ISSN: 00271446 23096217 Year: 2005 Volume: 31 Issue: 1 Pages: 10-16
Publisher: Mosul University جامعة الموصل

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Abstract

Context: Bronchiectasis is a relatively common disease in developing countries, The pathogens responsible for its acute exacerbations vary from one area to another.Objectives: To study the characteristics of patients with bronchiectasis in Northern lraq, and to identify the types of pathogens responsible for the acute exacerbations.Design: Case series study.Setting: Respiratory Care Unit and general medical wards in lbn-Sina Teaching Hospital inMosul, during the years 2002-2004.Patients and Methods: Fifty patients with bronchiectasis (16 males and 34 females) presenting during an acute exacerbation underwent clinical and radiological evaluation with sputum Gram (Gm)stain and culture.Results: The cause of the disease was readily identifiable in 367o of patients. Tuberculosis was the predominant aetiology. Streptococcus pneumoniae and klebsiella pneumoniae were the commonest pathogens. Gm negative bacilli were responsible for 36% of cases overall, and were especially important in those with long standing disease (≥15 years) Pseudomonasaeruginosa was related to more extensive disease. Most of the isolates were sensitive tociprofloxacin and cefotaxime.conclusion: Gm negative bacilli should be considered in antibiotic selection during acuteexacerbation of bronchiectasis, especially in long standing and extensive disease.Keywords: bronchiectasis, Gram negative bacilli


Article
Effect of amlodipine on serum lipid profilein hypertensive patients

Authors: Rami M. A. Al-Hayali رامي محمد عادل الحيالي --- Ashraf H. Ahmed اشرف هاشم احمد
Journal: Annals of the College of Medicine Mosul مجلة طب الموصل ISSN: 00271446 23096217 Year: 2009 Volume: 35 Issue: 1 Pages: 8-12
Publisher: Mosul University جامعة الموصل

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Abstract

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.

الخلاصةأهداف البحث: أجريت هذه الدراسة لتقييم تأثير عقار الاملودبين كعلاج أحادي لمرضى ارتفاع ضغط الدم الشرياني على مستوى الكولسترول، الدهون الثلاثية، البروتين الشحمي عالي الكثافة، والبروتين الشحمي منخفض الكثافة. المشاركون وطرق العمل: أجريت الدراسة على 33 مريضا مصابا بارتفاع ضغط الدم الشرياني، 25 مريضا منهم من الذكور و 8 من الإناث. تم قياس مستوى الكولسترول، الدهون الثلاثية، البروتين الشحمي عالي الكثافة، والبروتين الشحمي منخفض الكثافة قبل وبعد شهرين من بدء العلاج بعقار الاملودبين.النتائــــج: أظهرت نتائج الدراسة عدم وجود فرق معنوي في مستوى القيم المقاسة قبل وبعد العلاج.الاستنتاج: العلاج بواسطة عقار الاملودبين لايؤثر على مستوى الدهون في الدم وقد يكون علاجا مناسبا لمرضى ارتفاع ضغط الدم اللذين يعانون من اضطرابات في مستوى الدهون.


Article
Systemic inflammatory response syndrome (SIRS) in Mosul: Clinical characteristics and predictors of poor outcome

Authors: Sabah Shallal صباح شلال --- Rami M. A. Al Hayali رامي محمد عادل الحيالي
Journal: Annals of the College of Medicine Mosul مجلة طب الموصل ISSN: 00271446 23096217 Year: 2011 Volume: 37 Issue: 1&2 Pages: 25-33
Publisher: Mosul University جامعة الموصل

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Abstract

Objectives: Systemic inflammatory response syndrome is one of the most important causes of intensive care unit (ICU) morbidity and mortality worldwide. The aim of this study is to explore the spectrum of diseases responsible for SIRS admission in Mosul, and to identify the mortality rate and the factors associated with poor outcome.Methods: Fifty patients with sepsis or non-infective SIRS were studied during the period from June 1st to November 30th 2009. Patients were collected from the medical ICU and the general medical wards in Ibn-Sina Teaching Hospital in Mosul,. Acute physiology and chronic health evaluation II (APACHE II) score was utilized to assess the severity of illness on admission. The patients included in the study received the standard medical care according to their condition, and were followed to delineate the cause of their illness, the percentage of microbiological confirmation, the duration of hospital stay, the mortality rate and the factors that influence their outcome.Results: Sepsis represented 86% of cases of SIRS, of which 82% of them were caused by community acquired infections. Pneumonia was responsible for 48.8% of sepsis cases, followed by acute pyelonephritis and intra-abdominal infection. Sepsis was microbiologically confirmed in 44.2% of patients, and blood culture was positive in 18.6% of patients. Impaired consciousness, anaemia, hyperglycaemia and high blood urea were associated with excess mortality rate; while positive blood culture and hypoalbuminaemia correlated with high APACHE II score. The overall mortality rate was 44%. Patients with severe sepsis had a mortality rate of 55.2%.Conclusion: SIRS is an important cause of hospital admission in Mosul, with associated high mortality rate. ICU admission should be seriously considered for patients with certain risk factors that predict poor outcome.

الأهداف: متلازمة الاستجابة الالتهابية المجموعية (وبضمنها الإنتان) واحدة من أهم أسباب المراضة والوفيات في وحدات العناية المركزة في العالم أجمع. الهدف من هذه الدراسة التحري عن طيف الأمراض المسببة لمتلازمة الاستجابة الالتهابية المجموعية في الموصل وتحديد نسبة الوفيات والعوامل المقترنة بالحصيلة السيئة.طرق العمل: تمت دراسة خمسين مريضا مصابا بالإنتان أو الحالات غير المعدية من متلازمة الاستجابة الالتهابية المجموعية في الفترة بين 1 حزيران و 30 تشرين الثاني 2009. تم جمع المرضى من وحدة العناية المركزة الباطنية وأجنحة الباطنية العامة في مستشفى ابن سينا التعليمي في الموصل. استخدم حرز (أباشي 2) لتحديد شدة الاعتلال عند الإدخال. خضع المرضى للعناية الطبية القياسية كل حسن حالته، وتم تعقبهم لتحديد سبب مرضهم ونسبة الإثبات المايكرو بيولوجي وفترة بقائهم في المستشفى ونسبة الوفيات والعوامل المؤثرة في حصيلة حالتهم.النتائج: مثل الإنتان 86٪ من حالات متلازمة الاستجابة الالتهابية المجموعية، كان 83٪ منهم حالات عدوى مكتسبة في المجتمع. كان الالتهاب الرئوي هو المسبب لـ 48,8٪ من حالات الإنتان، يليه التهاب الحويض والكلية الحاد والأمراض المعدية داخل البطن. تم إثبات الإنتان مايكرو بيولوجيا في 44,2٪ من المرضى وكان زرع الدم موجبا في 18,6٪ من المرضى. ظهر اعتلال الوعي وفقر الدم وفرط سكر الدم وارتفاع نسبة اليوريا فيه عوامل مقترنة بزيادة نسبة الوفيات، بينما نتيجة زرع الدم الموجبة ونقص ألبومين الدم مرتبطتان بارتفاع حرز أباشي. نسبة الوفاة الإجمالية كانت 44٪، ووفيات المرضى المصابين بإنتان شديد 55,2٪.الاستنتاج: متلازمة الاستجابة الالتهابية المجموعية سبب مهم لدخول المستشفى في الموصل مقترن بنسبة وفيات عالية. يجب النظر بجدية إلى إدخال المرضى الذين لديهم عوامل اختطار معينة تنبئ بحصيلة سيئة إلى العناية المركزة.

Keywords

SIRS --- ICU


Article
Fever of unknown origin: A prospective study in Northern Iraq

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Abstract

ABSTRACT
Objectives: A wide variety of diseases are likely causes of fever of unknown origin (FUO). No fixed guidelines exist to direct the workup in these cases. We followed a diagnostic protocol to study the causes of FUO in Iraq, and to evaluate the contribution of clinical assessment and various investigations in making the final diagnosis.
Methods: From March 2002 to September 2009, fifty five consecutive patients with FUO were admitted in a tertiary referral centre in Mosul, Iraq. The patients underwent a series of clinical and diagnostic evaluation in a prospective study, in an attempt to diagnose the underlying cause of fever. The benefit of history taking and clinical examination as directors of the diagnostic workup and the yield of various laboratory and imaging techniques were assessed.
Results: Infections were the commonest causes of FUO (32.7%), followed by non-infectious inflammatory diseases (NIID) (25.4%), malignancies (16.4%) and miscellaneous causes (5.4%). No diagnosis was made in 20% of cases. Of infections, tuberculosis was the most important single cause of fever, while various vasculitides and non-Hodgkin's lymphoma were the commonest NIID and malignant disease, respectively. Symptoms of the patients were of little benefit in directing subsequent investigations, but the physical signs were more useful; finding enlarged lymph nodes was significantly associated with malignant diseases (p=0.009). Anaemia, high ESR and elevated liver enzymes were common and bear no significant association with any disease category. Chest radiograph and abdominal ultrasound were helpful initial imaging studies. CT scan of the chest was shown a useful diagnostic procedure.
Conclusion: Together with infections, NIID are important causes of FUO in Iraq. Careful physical examination and a systematic approach on investigations are usually rewarding in reaching the diagnosis.

الأهداف: أمراض مختلفة قد تكون سببا للحمى مجهولة المصدر. لا توجد خطوط هادية محددة لتوجيه العمل التشخيصي في مثل هذه الحالات. اتبعنا منهجا تشخيصيا لدراسة حالات الحمى مجهولة المصدر في العراق، ولتقييم ما تسهم به العلامات السريرية ومختلف الفحوصات في التوصل إلى التشخيص النهائي.
الطريقة: بين آذار 2002 وأيلول 2009، تم إدخال خمسة وخمسين مريضا متعاقبا مصابين بحمى مجهولة المصدر الى مركز إحالة من المرتبة الثالثة في الموصل شمالي العراق. خضع المرضى لسلسلة من الفحوصات السريرية والمختبرية في دراسة مستقبلة لمحاولة تشخيص سبب الحمى. تم تقييم فائدة المعومات التي يعطيها المريض والفحص السريري كموجهات للعمل التشخيصي وحصيلة مختلف الفحوصات المختبرية والتصويرية التي تجرى في محاولة الكشف عن التشخيص النهائي.

Keywords

Fever --- FUO


Article
Prevalence of gastro-oesophageal reflux symptoms in patients with COPD

Authors: Mohammad K. Haj Hammo محمد خالد حاج حمو --- Dhia J. Al layla ضياء جبر الليلة --- Rami M. A. Al Hayali رامي محمد عادل الحيالي
Journal: Annals of the College of Medicine Mosul مجلة طب الموصل ISSN: 00271446 23096217 Year: 2006 Volume: 32 Issue: 1&2 Pages: 18-22
Publisher: Mosul University جامعة الموصل

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Abstract

Objective: To assess whether there is an increase in prevalence of gastro-esophageal reflux disease (GERD) in patients with chronic obstructive pulmonary disease (COPD), and the influence of reflux on the respiratory symptoms of these patients. Methods: A case control study that was conducted at the outpatient clinic of Ibn Sina Teaching Hospital in Mosul, and two private clinics, during the years 2002-2003. Sixty six patients with COPD and 50 sex- and age- matched controls were questioned about experiencing GERD symptoms, utilizing a modified questionnaire originally developed by Mayo clinic. COPD patients were asked whether they noticed an association between experiencing reflux episodes and worsening respiratory symptoms, and whether smoking a cigarette is associated with GERD symptoms. Results: COPD patients showed a significantly increased prevalence of GERD symptoms as compared with the control group (29(43.9%)vs. 11(22%), respectively), (p=0.014). COPD patients more frequently reported significant heartburn (43.9%vs. 20%; p=0.007), and regurgitation (25.8%vs. 6%; p=0.005).COPD patients who were still smoking were not statistically significant from those who have stopped smoking regarding experiencing GERD symptoms (46.7%vs. 30.8%; p=0.08). Fifty one percent (51.7%) of COPD patients noticed that their respiratory symptoms are worsened during episodes of heartburn or regurgitation. Conclusion: GER symptoms are more prevalent in patients with COPD, compared to control subjects.Keywords: COPD, gastro-oesophagael reflux disease.


Article
Pulmonary embolism, seasonal variations in admission to hospital, and the association of calf deep vein thrombosiswith pulmonary embolism

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Abstract

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.
Keywords: Pulmonary embolism, seasonal variations, deep vein thrombosis.

الأهداف: للبحث عن وجود أَو غياب التغير الموسمي في حدوث الجلطة الرئوية. كذلك لتَحليل تأثير العُمر، الجنس ووجود أَو غياب تخثّر الأوردة العميقة في الساق على حدوث الجلطة الرئوية، ولتَحليل التغييرات في تخطيط القلب ووجود أَو غياب جيب تسارع ضربات القلب في المرضى المصابين بالجلطة الرئوية الحادّة.الطريقة: مائة وثلاثة مرضى مصابين بالجلطة الرئوية الحادّة اللذين ادخلوا العناية المركزة والعناية التنفسية في مستشفى ابن سينا التعليمي بالموصل، دُرسوا بشكل رجعي، أثناء السنوات 2002-2007.النتائـج: لم يكن هناك تأثير موسمي في حدوث الجلطة الرئوية، عُمر المرضى يؤثر بشكل ملحوظ على الاصابة بالجلطة الرئوية. فاقتْ الاصابة عند الإناث عدداً على الذكور بشكل ملحوظ، يُمكن أَن يكون بسبب إحالة المرضى من مستشفيات النسائية والتوليد. كان هناك علاقة سلبية بين خثرة الأوردة العميقة للساق الواضحة سريرياً أَو من عدمه وتشخيص الاصابة بالجلطة الرئوية. الإرتباط بين الاصابة بالجلطة الرئوية وأشعة الدوبلر حول وجود خثرة الأوردة العميقة للساق ايجابي. كان هناك علاقة إيجابية بين الاصابة بالجلطة الرئوية وتسارع ضربات القلب.

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