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Article
The Role Of Emergency PCI In The Management Of Acute STEMI The Local Experience In Al-Nassiriya Heart Center

Authors: Ali Khalid Almaliki --- Ali Jabbar Alibrahemi --- Tahsin Ali Al-kinani
Journal: Mustansiriya Medical Journal مجلة المستنصرية الطبية ISSN: 20701128 22274081 Year: 2017 Volume: 16 Issue: 2 Pages: 1-7
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Background: Primary PCI is an emergent percutaneous catheter intervention in the setting of STEMI,without previous fibrinolytic treatment .It is the prefered strategy in patients with STEMI.Aim: To evaluate the immediate and intermediate procedural and clinical outcome in a local experience.Methods: This is a descriptive cross sectional study carried out in a tertiary cardiac center for 301 patirnts with acute myocardial infarction. Fifty patients(16.6%) were followed up prospectively for one month up to one year in the outpatient clinic.Results: primary PCI was done in 294 patients (97.6%) and rescue PCI was done in 7 patients (2.4%). Ischemic time is ranging from one hour to twenty four hours (mean 5.02±3.27) . Procedural success rate was 100%. Mortality rate was 5.3% mostly because of cardiogenic shock. Conclusion: Primary PCI should be the standered of care for patients with STEMI.

Keywords

Primary PCI --- immediate --- long term --- outcome


Article
EVALUATION OF INTUSSUSCEPTION IN CHILDREN: OUR EXPERIENCE IN 47 CASES

Authors: Mohammed M.M. Al-Ani محمد ماهر العاني --- Sadek H. Ghani صادق حميد غني --- Omar k. Maklef عمر خشان مخلف
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2017 Volume: 15 Issue: 3 Pages: 250-261
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

Background:Intussusception is the most common cause of intestinal obstruction in infants and young children.Objective:To review the clinical, epidemiological, management pattern and outcome of intussusception.Methods:A retrospective descriptive review of 47 patients who were diagnosed and managed for intussusception during the period from January 2012 to October 2014 in Al-Ramadi Teaching Hospital for Maternity and Children. Data were collected from the Pediatric Surgery Unit records, which include demographic characteristics of the patients, history of preceding gastroenteritis or respiratory infection, clinical signs and symptoms, imaging studies, type of management, operative finding, outcome and mortality. Data were analyzed by Epi Info7TM, using chi-square to obtain p value which regarded significant when it was < 0.05.Results:Records of 47 patients were reviewed; (68.4%) were under one year of age. Peak incidence between 6-12 months of age (55.3%). Male: female ratio was 2.35:1. 27 patients (57.4%) were from rural area, peak seasonal incidence occurred in summer and winter, 41 patients (87.2%) presented with abdominal pain, a palpable abdominal mass was detected in 24 patients (51%), red currant jelly stool reported in (74.5%). Ultrasonography were done for 39 patients and showed an abdominal mass suggestive intussusception (as a target sign or pseudo kidney mass) in 34 patients (87.1%). (95.7%) of patients treated by surgical reduction, while only two patient reduced by hydrostatic enema, Meckle's diverticulum were the commonest pathological lead point (44.4%). No intussusception- associated death was recorded.Conclusion:Colicky abdominal pain was the most presenting symptoms and red currant stool was a significant sign especially in children ≤ 12 months. Majority of cases presented after 24 hours were from rural area, seasonal peaks occurred in summer and winter months and surgery remain the mode of management.Keywords:Intussusception, clinical, epidemiological, management pattern and outcome. Citation:Al-Ani MMM, Ghani SH, Maklef OK. Evaluation of intussusception in children: our experience in 47 cases. Iraqi JMS. 2017; Vol. 15(3): 250-261. doi: 10.22578/IJMS.15.3.6


Article
The Intra-Uterine Insemination in Al-Yarmouk Infertility Center: A Five- Year Records Review

Authors: Waleed A. Al-Ani --- Hiba Q. Khalil --- Mary M. Sabri
Journal: Mustansiriya Medical Journal مجلة المستنصرية الطبية ISSN: 20701128 22274081 Year: 2017 Volume: 16 Issue: 3 Pages: 39-44
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Background: Intra uterine insemination is an assisted reproductive technique using husband or donor sperms, at the time of ovulation in natural or stimulated cycle, to be placed in the uterine cavity or in the cervical canal. It is a common procedure used for the treatment of infertility.Objectives: To identify factors that can predict successful outcome inintrauterine insemination and the socio-demographic characteristics of couples visiting intra uterine insemination department in Al–Yarmouk Infertility Center through five-year records review.Patients & Methods: A descriptive study (review of records) was conducted on all available records of infertile couples (259 couples), undergone intra uterine insemination treatment for their infertility problems in Al-Yarmouk Infertility Center, from 2007 through 2011. The necessary data were collected from only 124 couples with complete information.Results: The overall pregnancy rate was 27.4% (34 cases) in whom 4.8% were delivered successfully; the miscarriage rate was 4%, and no ectopic pregnancy or multiple pregnancies were encountered. Four significant variables were identified for successful outcome: duration of infertility (<10 years 45.2 vs. 5.6%), type of infertility (secondary infertility 46.7 vs. 21.3%), number of trials (twiceand more 68.1% vs. 15.7%), and progressive motility of sperm after preparation (couples with >50% normal progressive motility 37.3 vs. 18.5%).Conclusions: Intrauterine insemination provides better results in couples with secondary infertility, shorter duration of infertility, increasing number of trials, and in those with 50% normal sperm motility or more


Article
Predictors of poor first trimester outcome in asymptomatic women : the value of embryonic heart rate , mid sac diameter / yolk sac ratio & mid sac diameter / crown rump length

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Background: Ultrasound provides a powerful tool for assessing early pregnancy and detecting pregnancy failure at first trimester and promoting rapid effective management. Several criteria have been established to predict the pregnancy outcome particularly in symptomatic women . Aim: To evaluate asymptomatic women at the first trimester of pregnancy , to assess the efficacy of certain ratios as mid sac diameter (MSD) / yolk sac ratio & crown rump length (CRL)/mid sac diameter (as indicator of early first trimester oligohydramnios) in predicting poor 1st trimester outcome Type of the study: A cross-sectional study.Patients & Methods: A sixty three asymptomatic women were enrolled in this prospective study . Transvaginal sonography was performed for confirmation of pregnancy viability & exclusion of multiple pregnancies 6-8 weeks of gestation & follow up ultrasound repeated at the beginning of second trimester to confirm the continuation of pregnancy and viability of fetus. Several parameters assessed and tested against each others as embryonic heart rate , the size and morphologic criteria of gestational sac , yolk sac and the crown rump length Results: The women were classified into two groups: group A are those with successful outcome at the first trimester and group B are those with poor outcome of the 1st trimester . Decrease embryonic heart rate below 100 beat per minute and low mid sac diameter/ yolk sac size ratio of < 1.9 , were found to be significant predictors of poor outcome however mid sac diameter/crown rump length ratio was not found to have a similar significance Conclusion: In addition to the classical parameters assessed by trans-vaginal ultrasound, other important parameters need to be routinely applied as the embryonic heart rate that predict poor outcome when less than 100 bpm . In addition to the ratio of mid sac diameter to the yolk sac diameter which , if less than 1.9 , may point to abnormal first trimester fate.


Article
Preeclampsia and Consanguinity

Authors: Wisam Akram --- Fatin Al Defer
Journal: Mustansiriya Medical Journal مجلة المستنصرية الطبية ISSN: 20701128 22274081 Year: 2017 Volume: 16 Issue: 3 Pages: 1-10
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Type of the study: case controlAim: to evaluate the severity of imminent preeclampsia in consanguinity versus non consanguinity groupsDesign and patients methods: a highly selective criteria have been chosen for the women to be participated in this study. The study group (N=30) were not only cousins rather their parents were also cousins and most came from the rural area. While the control Group (N=30) were women in whm no consanguinity neither with couple nor their parents were selected. All women were primigravida 20- 30 years in age. They were all taken from labor ward after 37 weeks of gestation, and for each at admission systolic, diastolic blood pressure, serum uric acid, blood urea, blood platelets count and serum fibrinogen and SGPT with SGOT were initially taken at admission. Since all thepatients were in severe and imminent preeclampsia they were all pre prepared with MgSO4 as anti convulsant and during preparation serial reading were also taken for all the above parameters at 3 and 6 hours later to measure the area under curve profile AUC. Mean blood pressure was taken instead of systolic and diastolic and calculated by the well documented formula Results: The ODD ratio for the primary determinant of preeclampsia severity namely blood pressure and proteinurea were higher in the consanguinity group versus control; 6.58 for systolic; 6.73 for diastolic and 4.07 for protein/creatinine ration in urine, respectively. Serum uric acid and blood urea was also higher for their ODD ratio in the consanguinity group; 5.2 and 5.21 respectively.More importantly the markers of imminent preeclampsia were also significantly higher in the consanguinity group with odd ratio 2.22 and 2.61 for SGOT and SGPT respectively. Best subset regression was calculated for the best combination which correlates with mean blood pressure and serum SGPT with Blood urea combinations were having the lowest coefficient of Mallow (Cp); 32.23. From that independent variable a prediction table has been constructed to sort out all the patients with imminent preeclampsia who are most affected and near complications probably and expressed as column of intervals of bloodurea with corresponding 1,2.5, 5, 10, 90, 95,97.5 and 99 centile of serum SGPT. The area under 10th centile was shaded with green while above 90th centile with red and in between shaded with yellow color. It is probable that patients who’s reading in the red zone or upper yellow zone are at more risk for more serious complications of preeclampsia like adrenal hemorrhage and renal complications and better to expedite their delivery. Conclusion: this study hasshown that preeclampsia among consanguinity group was much more severethan those in non consanguinity couples. Yet by no mean that respect reflects the true picture in society. A table has been constructed and we over stress here that under no circumstances this table can be used for evaluating, modifying or changing the routine protocol of preeclampsia management.


Article
Women's Knowledge about long hours working complication on pregnancy outcome.
معارف النساء الحوامل حول مضاعفات ساعات العمل الطويله على ناتج الحمل.

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Abstract

Objectives: Assess pregnant women's Knowledge about complication of long hours working on Pregnancy outcome.Methodology: A descriptive study design , content A purposive (non probability) sample of (80) pregnant women's whom aged are ranged from (25-40 yrs) that was selected from North Oil Company ,from the period 152014 to 1042015. A constracted questionnaire consist of three parts sociodemographic characteristic, reproductive characteristic and women's knowledge about long hours working data were analysis thrugh application of discreptive and infreantial statestical approach.Result: The study findings demonstrate that the following variable was contributing significantly in the occurrence of complications on pregnancy outcome (fetus and mother health) which include (age, level of education, smoking, and working stat). In respictivly (67.3 %, 33%, 27.5%, 63.7%) Conclusions: long hours working can be interrupted as a one sources of complication among pregnant women who worked more than 40 hrs weekly. The study recomended.Encourage the females to take adequate completely rest from long working at least one month before delivery time.

الأهداف : تقييم معارف النساء الحوامل حول مضاعفات ساعات الدوام الطويلة على نتائج الحمل.المنهجية : دراسة وصفية . لعينة غرضية (غير الاحتمالية) مؤلفة من (80) امرأة حامل تتراوح أعمارهن بين 25-40 سنة, ممن يعملن في شركة نفط الشمال للفترة من 152014 الى 1642015. تم إعداد استمارة استبيان مؤلفة من ثلاث محاور تشمل الخصائص الديموغرافية والخصائص الإنجابية ومعارف النساء حول ساعات العمل الطويل . وقد تم تحليل البيانات من خلال تطبيق تحليل البيانات الإحصائية الوصفية (الوسط الحسابي والنسبة المئوية والتكرارات). النتائج : أشارت النتائج إلى إن المتغيرات ( العمر , المستوى التعليمي , التدخين وطبيعة العمل) بالتعاقب ( 67.3%, 33%, 27.5% و63.7%) . كانت ذات دلالة إحصائية واضحة في حدوث المضاعفات الخطرة على ناتج الحمل (صحة الام والجنين) الاستنتاجات : ساعات العمل الطويلة كانت عامل مؤثر كأحد أسباب الخطورة و الوفيات للنساء العاملات لاكثر من 40 ساعة اسبوعيا. أن أكثر من نصف العينة كانت معارفهم جيدة حول مخاطر العمل الطويل على ناتج الحملالتوصيات: أوصى الباحثون بمواصلة التثقيف والدورات التدريبية للفريق الصحي بصورة خاصة, لتحسين معرفتهم وليأخذو دورهم في تعليم وأعطاء النصائح والتوصيات للمرأة الحامل العاملة. وكذلك تشجيع الحوامل على اخذ استراحة تامة من العمل والدوام لمدة شهر على الاقل قبل موعد الولادة


Article
5.DETECTION OF PARVOVIRUS B19 IN BAD OBSTETRIC HISTORY BY USING REAL TIME PCR

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Abstract

Background: Human parvovirus B19 (B19V) is a small single-stranded DNA virus. Infection during pregnancy can cause a variety of signs of fetal damage. The risk of adverse fetal outcome is increased if maternal infection occurs during the first two trimesters of pregnancy but may also happen during the third trimester.Objective: to determine the screen of parvovirus B19 in pregnant women with bad obstetric history by real time polymerase chain reaction (PCR).Methods: Two hundred Plasma and 200 placental tissue samples were collected from all pregnant women enrolled in this study. Three ml whole blood was collected in sterile EDTA-blood tube. Plasma was obtained by centrifugation of whole blood. Twenty-five grams of the placental tissue was homogenized with 10 ml of PBS by using tissue homogenizer for about 1 min at 4 °C. Results: 40 (20%) out of 200 plasma samples were real time PCR positive, the remainder 160 (80%) were real time PCR negative. Nineteen (9.5%) out of 200 placental tissue samples were positive for B19 real time PCR the remainder 181 (90.5 %) were real time PCR negative. All placental tissue positive (n=19) were positive by real- time PCR in plasma samples (n=40). Out of 40 pregnant women presented with positive parvoviruses results in current study demonstrated 21 (52.5%) gave abortion in first trimester and only 8 (20%) gave abortion in second trimester.Conclusion: Parvovirus B19 is common and highly distributed among pregnant ladies in this study and there is a significant association between B19 positivity and adverse pregnancy outcome.Keywords: Parvovirus B19, bad obstetric history, adverse pregnancy outcome, non-immune hydrops fetalisCitation: Abdulhassan LF, Hathal HD, Abdullah TH. Detection of Parvovirus B19 in bad obstetric history by using Real Time PCR. Iraqi JMS. 2017; Vol. 15(4): 350-357. doi: 10.22578/IJMS.15.4.5


Article
Neonatal outcomes in elective repeated caesarean section at term pregnancy
النتائج الوليدية في الولادات القيصرية الاختيارية المتكررة في الحمل الكامل

Authors: Vian Rbhass Sherwani فيان رهباس الشيرواني --- Ishraq Mahmood Shakir د.اشراق محمود شاكر
Journal: Diyala Journal of Medicine مجلة ديالى الطبية ISSN: 97642219 Year: 2017 Volume: 12 Issue: 1 Pages: 9-14
Publisher: Diyala University جامعة ديالى

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Background: Caesarean delivery is associated with adverse health outcomes on both women and newborn infant. Timing of elective caesarean delivery also had an effect on the neonatal outcomes.Objective: To find out the association between neonatal outcomes and gestational age and determining the favorable time for elective caesarean delivery.Patients and Methods: A hospital-based cross-sectional study was done from 1st July, 2014 to 31st January, 2015 at the maternity teaching hospital in Erbil. A convenience sample of 200 full term pregnant women was selected from those admitted to the hospital for elective repeated caesarean delivery. Gestational age was determined by 1st trimester ultrasound and last menstrual period. Data on fetal variables probably associated with neonatal outcomes were collected in especially designed questionnaire. Results: The rate of elective repeated caesarean section before 39th week of gestation was 81.5%. Mean weight of infants and mean Apgar scores of infants at delivery were increasing with gestational age P < 0.001. The rate of admission to neonatal intensive care unit was higher among those delivered at 37th than 38th week of gestation. No admission was reported among those delivered at 39th week of gestation (P=0.006). No significant variations in the duration of admission, status of infant on discharge, and rates of respiratory symptoms were demonstrated between those delivered at 37th and 38th week of gestation.Conclusion: The vast majority of elective caesarean delivery are performed early before 39th week of gestation, which is associated with high incidence of neonatal morbidity and mortality.

خلفية الدراسة: ترتبط الولادة القيصرية مع تأثيرات صحية سلبية على كل من النساء و الأطفال حديثي الولادة. كما أن توقيت الولادة القيصرية الاختيارية يؤثر أيضاً على النتائج الصحية للوليد.اهداف الدراسة : أيجاد العلاقة بين الحالة الصحية للوليد مع عمر الحمل, و معرفة التوقيت المناسب لأجراء الولادة القيصرية الاختيارية.المرضى والطرائق: تعد هذه الدراسة دراسة وصفية منفذة في المستشفى التعليمي للولادة في اربيل. تم اختيار عينة ملائمة متكونة من 200 امرأة حامل في الاسبوع الحملي 37 -42 من النساء الحوامل اللاتي ادخلن الى المستشفى لغرض اجراء الولادة القيصرية الاختياريةالمتكررة. تم تحديد العمر الحملي لهولاء النسوة الحوامل من خلال اجراء الفحص بالامواج فوق الصوتية في الثلث الاول من الحمل و بالاعتماد على تأريخ آخر دورة شهرية. تم جمع المعلومات حول المتغيرات الجنينية التي من المحتمل ان تؤثر على النتائج الوليدية (Neonatal outcomes) بواسطة استمارات استبيان اعدت خصيصاً لهذا الغرض. النتائج: كان معدل الولادات القيصرية الاختيارية المتكررة قبل الاسبوع الحملي 39 مساوياً لـ 81,5%. زيادة متوسط وزن و متوسط نتائج أبغار (Apgar score) للأطفال عند الولادة مع زيادة عمر الحمل(P < 0.001). كان معدل الرقود في وحدات العناية المركزة للأطفال حديثي الولادة عالياً بشكل ملحوظ للولادات في الاسبوع الحملي 37 مقارنة بالاسبوع الحملي 38. لم يسجل رقود لوحدات العناية المركزة للأطفال حديثي الولادة بين الولادات بالعمر الحملي 39 (P = 0.006). لم يسجل اي اختلاف واضح في فترات الرقود, الحالة الصحية عند الخروج من وحدات الرعاية المركزة, و معدلات العلامات التنفسية بين الولادات في الاسبوع الحملي 37 مقارنة بالاسبوع الحملي 38.الاستنتاجات: غالبية الولادات القيصرية الاختيارية تتم مبكراً قبل الاسبوع الحملي 39, و التي ترتبط مع ارتفاع معدل حدوث المراضة و الوفيات بين حديثي الولادة.


Article
Effect of exercise at a rate of play in the outcome and cognitive skills develop some disciplines for students performance plane precision ball
تأثير تمرينات بمعدل اللعب في الحصيلة المعرفية وتطوير دقة أداء بعض التخصصات المهارية للطلاب بالكرة الطائرة

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The problem for the search in the presence of weakness in basic skills performance of the plane of the ball accurately and it is far from specialization skills have no lack of mastery of performance, as well as the weakness of the theoretical information to this article which could lead to the inability of students to get a good degree in performance skills practical for this article, which led to the preparation exercises at a rate depending on the game play and the law to increase the performance of the specialized skills of some basic volleyball skills accurately. The objectives of the research has identified the following: -1-preparation exercises at a rate of play in the development performance of some interdisciplinary skills for students plane ball accuracy2-identify the impact of exercises at a rate of play in the development of the performance of some interdisciplinary skills to students the plane accuracy of the ball?Whereas major hypothesis as follows: -1-for exercises at a rate of playing a positive influence in the development of some disciplinary skills to the students performs accurate ball flight.Within the theory and previous studies, the researchers dealt with several issues which gave a clear idea of the following concepts: (a rate of exercise play, specialization skills plane of the ball) as well as referring to previous studies related to the search topic. The researchers used the experimental curriculum design groups, reaching the research community (90) students of the third stage in the Faculty of Physical Education and Sports Science-University of Karbala, was chosen as the research sample amount (28) students were divided into two groups, a control and experimental by 14 student at each group.

تكمن مشكلة البحث في وجود ضعف في دقة أداء المهارات الأساسية بالكرة الطائرة وإنها بعيدة عن التخصص المهاري لها أي قلة التمكن من الأداء فيها، فضلا عن ضعف المعلومات النظرية الخاصة بهذه المادة الأمر الذي قد يؤدي إلى عدم تمكن الطلاب من الحصول على درجة جيدة في الأداء المهاري العملي لهذه المادة، الأمر الذي أدى بالباحثون إلى إعداد تمرينات بمعدل لعب وحسب قانون اللعبة لزيادة دقة أداء التخصص المهاري لبعض المهارات الأساسية بالكرة الطائرة. أما أهداف البحث فقد تحددت بالاتي:-1-إعداد تمرينات بمعدل اللعب في تطوير دقة أداء بعض التخصصات المهارية للطلاب بالكرة الطائرة 2-التعرف على تأثير تمرينات بمعدل اللعب في تطوير دقة أداء بعض التخصصات المهارية للطلاب بالكرة الطائرة؟في حين تمثلت فرضية البحث بالآتي:-1-للتمرينات بمعدل اللعب تأثير ايجابي في تطوير دقة أداء بعض التخصصات المهارية للطلاب بالكرة الطائرة.وضمن الدراسات النظرية والسابقة فقد تناول الباحثون موضوعات عدة أعطى فيها فكرة واضحة عن المفاهيم آلاتية: (التمرينات بمعدل اللعب، ، التخصص المهاري بالكرة الطائرة) فضلا عن تطرقه للدراسات السابقة ذات العلاقة بموضوع البحث. واستعمل الباحثون المنهج التجريبي بتصميم المجموعتين المتكافئتين، وبلغ مجتمع البحث(90) طالبا من طلاب المرحلة الثالثة في كلية التربية البدنية وعلوم الرياضة-جامعة كربلاء، وتم اختيار عينة البحث البالغة(28) طالبا تم تقسيمها إلى مجموعتين ضابطة وتجريبية وبواقع (14) طالبا في كل مجموعة

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