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Article
Missed ureteric injuries

Authors: Zaid S. Khudher زيد سعد الدين خضر --- Abdul-ghafoor S. Abdul-kareem عبد الغفور سليمان عبد الكريم
Journal: Annals of the College of Medicine Mosul مجلة طب الموصل ISSN: 00271446 23096217 Year: 2006 Volume: 32 Issue: 1&2 Pages: 12-17
Publisher: Mosul University جامعة الموصل

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Abstract

Objective: ureteric injuries may be missed and present as a complication.
Design: A case series study.
Setting: Retrospective study conducted during the period from January 1998 to March 2002 in the urosurgical departments at Al-Jumhoori and Al- Salaam teaching hospitals, Mosul.
Participants: Ten cases of missed ureteric injuries were consulted for or referred to the urosurgical departments, during or after their initial surgical procedures either from the general surgical or gynecological departments.
Results: There were (6) males and (4) females; mean age was (25 years). Eighty percent of cases diagnosed post operatively. They were missed for variable duration from 24 hours to 2 months. Complications like urinary fistula, loin abscess, fever or loin pain were diagnosed. Two cases were diagnosed and managed intra operatively. The cause of injury was bullets in (50%) of cases, gynecological operations in (30%) and RTA in (20%). Lower parts of the ureter was involved more frequently (60%) specially in pelvic surgery, while the whole ureter was involved by missiles. Both sides were equally implicated. Missed or improperly treated ureteric injury carries high morbidity like hospital stay, re-exploration (70%) and loosing renal unit function. Uretero- common iliac artery fistula is a rare but serious complication reported in one of the cases.
Conclusion: Sound knowledge of pelvic anatomy, preoperative ureteric stenting, isolated uterine artery ligation, keeping the ureteric injury in mind and deliberate ureteric identification during shell injuries decrease the chance of missed ones and their sequelae.

Keywords

Ureteric injuries --- missed


Article
Glyceryl Trinitrate Versus Misoprostol for Termination of First Trimester Missed Miscarriage

Authors: Ibtissam Y.Al-Saffar --- Eman Marouf
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2009 Volume: 8 Issue: 3 Pages: 242-248
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:BACKGROUND:Missed abortion refers to a pregnancy that can manifest as an anembryonic gestation or fetal demise prior to 20 weeks' gestation. Medical management has been used as a treatment options.A common medical regimen used to evacuate the uterus is vaginal misoprostol (Cytotec) in single or multiple doses.OBJECTIVE:To compare the therapeutic efficacy and adverse effects of intravaginal administration of a nitric oxide donor (glyceryl trinitrate) with that of a prostaglandin (misoprostol) to induce cervical changes in women with missed miscarriages to terminate their pregnancies.METHODS:A prospective, randomized comparative trial conducted at Al-Yarmouk Teaching Hospital, Department of Obstetrics & Gynaecology/ Baghdad-Iraq, enrolled Sixty women with first trimester missed miscarriages that requested pregnancy termination. They were randomly selected to receive either two tablets of 500 μg glyceryl trinitrate vaginally (n = 30) or 200 μg misoprostol tablet vaginally (n = 30), every 3 hours to a maximum of four doses or until reaching desirable cervical changes. Baseline vital signs were recorded and repeated with monitoring for adverse side effects every 3 hours until finishing therapy.RESULT:The difference in cervical changes between the two groups was statistically not significant (p > 0.05). The successful outcome taken as cervical dilatation ≥ 10 mm, incomplete, or complete miscarriage was achieved in 30% of women in the glyceryl trinitrate and in 53% of women in the misoprostol group which was statistically not significant ( p>0.05).Systolic & diastolic blood pressure, temperature & heart rate were lower with glyceryl trinitrate than misoprostol, but the differences were not significant (p>0.05).The most frequent side effect associated with glyceryl trinitrate administration was headache, which occurred in 27/30 women, compared with only 5/30 women in misoprostol group; relative risk 5.42 (p <0.05). Women treated with misoprostol reported mainly lower abdominal pain; relative risk 4.2 (p <0.05).CONCLUSION:Although glyceryl trinitrate was less effective than misoprostol when used prior to termination of missed miscarriage, the difference was statistically not significant. Moreover glyceryl trinitrate caused less adverse effects than misoprostol and it could have a role in the management of this obstetrical problem.


Article
Misoprostol for termination of first trimester missed abortion

Author: Maha Assim AL- Azzawy مها عاصم العزاوي
Journal: Al-Qadisiyah Medical Journal مجلة القادسية الطبية ISSN: 18170153 Year: 2009 Volume: 5 Issue: 7 Pages: 121-141
Publisher: Al-Qadisiyah University جامعة القادسية

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Abstract

Background: misoprostol is prostaglandin E1 analogue that can be given by oral, sublingual, vaginal or rectal route. It is cheap and can be stored at room temperature and because of its utero-tonic action, it become an important drug in obstetric and gynecological practice.Objectives: to evaluate the effectiveness of intravaginal followed by oral misoprostol tablets for medical termination of missed abortion between 8 – 13 weeks.Methods : a prospective study of (60) women with diagnosed missed abortion admitted to AL- Zahraa General hospital – Wassit Governorate Iraq from July 2006 through July 2007 . 800 micrograms (4 tablets) of misoprostol inserted in the posterior fornix of the vagina after moisture with normal saline followed by oral 400 micrograms (2 tablets) 6 hours later. Another 400 micrograms were given orally 6 hours from the last dose for those patients whodid not respond to the previous two doses.Results: (48) patients (80%) had complete expulsion . (21) Patients (35%) after the vaginal dose. (15) Patients (25%) respond after the first oral dose and (12) patients (20%) after the second oral dose. (6) Patients (10%) had incomplete abortion; the remainder (6) patients (10%) failed to respond within 24 hours of starting treatment and require surgical evacuation. The mean time for expulsion was 10 hours. Conclusion: first trimester missed abortion medical termination by misoprostol is effective, save and a practical Methods .

الميزوبرستول هو مثيل البروستوكلاندين- اي 1 ويمكن ان يعطى عن طريق الفم وتحت اللسان و عن طريق المهبل وعن طريق الشرج. يعتبر هذا العقار رخيصا و ممكن خزنه في درجة حرارة الغرفه و بسبب فعاليته في احداث تقلصات رحميه اصبح عقارا مهما في مجال النسائيه و التوليد.الهدف من الدراسة هو لتقييم فعالية الميزوبرستول وذلك بأعطائه عن طريق المهبل يليه اعطائه عن طريق الفم لانهاء الاسقاط المنسي طبيا بين 8 – 13 اسبوع. هذهِ دراسه مستقبليه تضمنت ستون امرأه مشخصه بحالة اسقاط منسي ادخلوا مستشفى الزهراء العام في محافظة واسط / العراق للفتره بين تموز 2006 و تموز 2007 . 800 مايكروكرام ( اربع حبوب) من الميزوبرستول توضع في الجزء الخلفي من المهبل بعد ترطيبها بالنورمال سلاين تليها جرعه عن طريق الفم (400 مايكروكرام) بعد ستة ساعات . وجرعه فمويه اخرى بعد ستة ساعات من الجرعه الاخيره للمرضى الذين لم يستجيبوا للجرعتين الاوليتين.النتائج 48 مريضه (80%) حصل اسقاط كامل. 21 منهن(35%) بعد الجرعه الاولى. 15مريضه (25% ) بعد الجرعه الفمويه الاولى و 12 مريضه (20%) بعد الجرعه الفمويه الثانيه .6مريضات (10%) انتهوا بأسقاط ناقص و 6 مريضات (10%) لم يستجيبوا للعلاج بعد مرور 24 ساعه على بدأ العلاج واحتاجوا الى تداخل جراحي لانهاء الحمل. كان معدل وقت انهاء الاسقاط المنسي هو عشرة ساعات .يستنتج من الدراسة انهاء الحمل الطبي في حالات الاسقاط المنسي في الجزء الاول من الحمل بواسطة الميزوبرستول هي طريقه فعاله و امينه وعمليه.


Article
A STUDY OF SERUM MAGNESIUM AND CALCIUM LEVELS IN MISSED ABORTION

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Abstract

Background:Pregnancy is considered as a physiological stress, normal static metabolism of a woman is changed into dynamic anabolism, calcium (Ca) is the first most abundant cation in the human body, whereas magnesium (Mg) is the fourth most abundant one, role of calcium and magnesium in enzymatic activity of cell to release energy is well established.Objective:To assess the relation of serum magnesium and calcium levels in cases of missed abortion.Methods:Eighty two pregnant women at their 1st and 2nd trimester of pregnancy (before 24 completed weeks of pregnancy), 42 of them with missed abortion compared with 40 normal pregnancies served as a control group. Calcium analysis done using manual colorimetric method while magnesium analysis was done by magnesium calmogite method at the hospital laboratories.Results:Serum calcium was found to be insignificantly altered while serum magnesium was found to be significantly reduced in cases of missed abortion compared with normal pregnancy. Serum Ca/Mg ratio was found to be significantly elevated in cases of missed abortion compared with normal controls.Conclusion:Estimation of serum magnesium and Ca/Mg ratio in selected pregnancies can be valuable parameters for predicting missed abortion.Keywords:Missed abortion, Serum Calcium, Serum Magnesium.


Article
Role of Serum Progesterone in the Diagnosis of Ectopic Pregnancy and Missed Abortion

Authors: Abdulrazak H Alnakash --- Zeina Abdulsahib
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2015 Volume: 14 Issue: 1 Pages: 22-27
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:BACKGROUND: diagnosis of early pregnancy failure (ectopic pregnancy and missed abortion) still challenging even by using of serial B-HCG and ultrasound. Serum progesterone hormone level value is regarded as one of the important diagnostic tools in the diagnosis of many obstetrical and gynecological conditions; one of these is early pregnancy failure.OBJECTIVE: To assess the role of serum progesterone level in early diagnosis of ectopic pregnancy and missed abortion.PATIENTS AND METHODS: The study is conducted at Al-Elwiyah Maternity Teaching Hospital throughout the period between (April 2010 –July 2011). Ninety women participated in the study, they are at their early weeks of gestation (6-10) weeks. Their ages were between 18-40 years. thirty of them served as a control group (normal intrauterine pregnancy) and sixty pregnant women included in the study group and subcategorized into 2 groups. thirty women with suspected sub-acute or chronic cases of ectopic pregnancy according to ultrasound and β-HCG results and 30 women served as suspected missed abortion. blood samples were taken from the three groups followed by another blood samples after two-day interval to measure of serum progesterone levels. the results were compared among the three groups at first and second readings. p-value, standard deviation and 95% confidence interval calculated and statistically analyzed.RESULTS: P-value of the serial measurements of serum progesterone levels in two-day interval in the three groups was statistically insignificant. while serum progesterone levels of both ectopic pregnancy and missed abortion were greatly lower than serum progesterone levels of normal intrauterine pregnancy in both first and second readings, with statistically significant deference, P-value is CONCLUSION: Serum progesterone levels has a useful role in diagnosing ectopic pregnancy and missed abortion.


Article
MEDICAL TREATMENT OF EARLY MISSED MISCARRIAGE AND ANEMBRYONIC PREGNANCIES: A PROSPECTIVE STUDY OF OUTPATIENT MANAGEMENT USING MISOPROSTOL ALONE

Authors: Zainab Baqer Abdullah --- Nada H Al-Jassim
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2016 Volume: 22 Issue: 2 Pages: 100-104
Publisher: Basrah University جامعة البصرة

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Abstract

Abstract Medical treatment using misoprostol has been recommended as an alternative to surgical evacuation for missed miscarriage in the first trimester in order to avoid anesthesia, surgical operation and hospitalization. Our aim is to assess the efficacy and safety of vaginal misoprostol in out-patient management of early miscarriages. This prospective study included patients with missed miscarriage of ≤10 weeks gestation. The protocol used 800 microgram of misoprostol on day 1 at clinic, followed by another dose of 800 microgram of misoprostol on day 2 if miscarriage was not complete. The included 150 patients, had missed miscarriage or anembryonic pregnancies. The success rate defined has complete miscarriage without need for surgical evacuation and without shortterm complications. Complete expulsion occurred within 2 days in 90.7% of cases. There were 14 patients needed surgical evacuations and admission to hospital (5 for method failure, 2 for incomplete miscarriage and 7 according to women decision). No one required blood transfusion. In conclusion, it is possible to use misoprostol as an out-patient treatment, since it gives satisfactory efficacy and is sufficiently safe.


Article
The Success Rate of Expectant Management in The Treatment of 1st Trimester Missed Miscarriage

Author: Maysaloon Adnan Abd-Alrazzaq
Journal: Karbala Journal of Medicine مجلة كربلاء الطبية ISSN: 19905483 Year: 2016 Volume: 9 Issue: 2 Pages: 2455-2461
Publisher: Kerbala University جامعة كربلاء

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Abstract

background: the expectant management has been considered possible alternative to surgical treatment (dilatation & curettage) of 1st trimester pregnancy missed miscarriage. Aim of study: to determine the successfulness & safety of 2 weeks expectant management for 1st trimester pregnancy missed miscarriage.Patients & methods: in this study was selected early pregnancy missed miscarriage, pregnant women ≤8weeks & pregnant women from 8-12 weeks.150 cases of missed miscarriage were collected but only 128 women agreed for expectant management after counseling. Which they are randomly selected managed expectantly over 7-14 days periods.Results: The results were found that the expectant management being successful in 65.6% (84/128) cases while being unsuccessful in 34.4% (44/128). 128 patients of this study attended follow-up to the karballa maternity hospital and were triaged by assessments of symptoms. 80 0f the patients ≤8 weeks the success rate was 100%,which is statistically highly significant =0.001 while 48 of patients 8-12 weeks success rate only 8.3% (4/48) while not success 91.7%(40/44)Discussion: Expectant management of 1st trimester missed miscarriage has been found now days to be a good alternative to other methods for treatment of missed miscarriage.It is safe, effective with good success rate which is 65.6% which is statistically highly significant. P=0.001Conclusion: Expectant management appears to be sufficiently successful, safe and effective to be offered as an option for women with 1st trimester missed miscarriage.


Article
A 5‑year Study of Re‑laparotomies, Planned and Unplanned, in Al‑Hillah Teaching General Hospital

Author: Kadhim CH. Hasan, Ali Kamal Abdul‑Aemmah
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2018 Volume: 15 Issue: 1 Pages: 25-27
Publisher: Babylon University جامعة بابل

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Abstract

Objective: The aim of this study was to evaluate the incidence of re laparotomies (RLs) among laparotomies performed within 5-year period,the indications, and the main factors affecting the mortality rate. Materials and Methods: This retrospective study was conducted by evaluatingfile records of patients undergoing RL following abdominal surgery (2012–2016). The patients including, age, sex, type of the first surgicalprocedure, the cause of the re-exploration, the time interval between the index operation and the RL and the performed procedures, and theoutcome were recorded. Results: Fifty-nine patients were included in the study, 83% were male. The mean age was 34.66 years. The meanduration between first operation and RL was 11.55 days. About 83.05% patients underwent RLs in the early period. The incidence of RLs was1.62%. The indication for RLs was abdominal sepsis 23.72%, followed by intestinal obstruction 20.33% and missed injury 16.94%. The rateof RL among patients sustaining trauma was 37.28%, males 90.9%. Conclusion: We concluded that the incidence of RL is consistent withthe literatures. The most :common indication was sepsis. Early intervention is the most important factor that can reduce the mortality whenre-exploration is required.


Article
Trauma; frequency of missed intra-abdominal injuries in Al-Sulaimaniyah Teaching Hospital/ Emergency Department

Authors: Salam Nizam Aldeen Shams Aldeen سلام نظام الدين شمس الدين --- Hiwa O. Ahmed هيوا عمر احمد
Journal: Annals of the College of Medicine Mosul مجلة طب الموصل ISSN: 00271446 23096217 Year: 2012 Volume: 38 Issue: 1 Pages: 15-19
Publisher: Mosul University جامعة الموصل

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Abstract

Background: The most common reason for injuries to be missed is altered level of consciousness due to head injury or alcohol. Other reasons include severity of injury and instability requiring immediate operation, lack of symptoms at admission, technical problems, and low index of suspicion by the examiner. Missed injuries can occur at any stage of the management of patients with major trauma. Any delay in providing the necessary treatment may lead to increased morbidity and mortality.Objective: To find the frequency of missed intra-abdominal injuries and their mortality, to raise suspicion of potential missed injuries in order to avoid these preventable deaths. Methods: A retrospective study including 2978 patients with abdominal injuries out of 13201 traumatized patients in 2006. Records were reviewed for demographics, injury characteristics, and associated injuries, missed injuries, need and indications of reoperation, morbidity and mortality.Results: The study included 2978 trauma victims; 2195 males and 783 females, with a male to female ratio of about 4:1.Thier age ranged from 2- 87 years, median age 39.5 and peak age of trauma was 31 years. From 2978 patients with abdominal injuries, there were 28 deaths (1.06%), and four missed injuries (0.134%).Conclusion: A careful history taking, precise and repeated clinical examinations, complete diagnostic procedures, complete surgical explorations, and proper timing of reoperation are necessary for patients with blunt abdominal injuries, which are cornerstones in improving the quality of trauma care.Keywords: Trauma patient, missed injuries, missed abdominal injuries, small intestinal injuries, and preventable death.

الخلاصةخلفية البحث: ان أكثر أسباب الإصابات غير المشخصة هي تشوه الوعي عقب شدة على الرأس او الكحول، هناك أسباب أخرى مثل شدة الإصابة, والحالة غير مستقرة للمريض, حيث يحتاج الى تداخل جراحي فوري وغياب العلامات المرضية عند وصول المصاب ومشاكل تكنولوجية وعدم الانتباه لاحتمال الإصابة من قبل الجراح الفاحص. الاصابات غير المشخصة يمكن ان تحدث في أية مرحلة من مراحل العلاج وأي تأخير قي العلاج الضروري يمكن ان يؤدي الى المضاعفات أو الوفاة.هدف البحث: بيان مدى شيوع حالات إصابات البطن غير المشخصة واحتمال الوفاة كنتيجة, ولرفع الوعي حول احتمال حدوث هذه الأخطاء لتلافي حالات الوفاة التي يمكن تجنبها.طرق البحث: تم دراسة 2978 حالة إصابة على البطن من أصل 13201 حالات حوادث عولجتْ خلال سنة 2006, تم استقصاء المعلومات الشخصية ونوع الإصابة والإصابات المترافقة والحالات غير المشخصة وأسباب إجراء عملية لمرة ثانية والمضاعفات وحالات الوفاة.النتائج: شمل البحث (2978) من ضحايا الحوادث, (2195) ذكر و(783) أنثى, النسبة (4/1) . معدل عمرهم (2-70) سنة ووسط عمرهم (39,5) سنة وقمة العمر للإصابات (31) سنة.الاستنتاج: أٌخْذُ تاريخ المرض بدقة وفَحصٌ مفصّل للمصاب وباستمرار, وإرسالُ الفحوصات وإجراءاتٌ تشخيصية كاملة وإجراء العملية الجراحية مبكرا, في حالات إصابات البطن المغلقة, يؤدي الى تحسين الطرق العلاجية والاهتمام الجراحي.


Article
Dental Caries severity between students in AL-Mustansiria University / College of Dentistry

Authors: Dr. Rand S. AL-Ubaidi. B.D.S. ,M. Sc.(Prevention) د. رند العبيدي --- Dr. Mohammed K. Mahmoud. B.D.S., M. Sc.(Prevention) د.محمد قيس
Journal: MUSTANSIRIA DENTAL JOURNAL مجلة المستنصرية لطب الاسنان ISSN: 18138500 Year: 2011 Volume: 8 Issue: 1 Pages: 24-28
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

The aim of this study is to estimate the severity of dental caries among dentalschool students.Dental caries severity was conducted among 19-23 years old students in all classesin Al- Mustansiria University / college of dentistry. The total sample composed of 150students 30 students from each class (75 males total and 75 females total).Dental caries diagnosis was according to criteria of WHO(1).Results of the this study showed that none of the examined students were cariesfree; in another word, caries percentage was found to be 100%, DMFS valuesdecrease with advancing class level with on significant difference between all classesand increase in Fs values with a significant difference between females in all classesthis is attributed to the higher awareness regarding prevention of dental diseasesamong finish dental students.

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