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Article
The Validity of Heart Score and Life Style Factors of Evaluation for Patient with Chest Pain in Emergency Department

Authors: Hadeel Fadil Farhood --- Safaa Jawad kadhem --- Walla Taleb Oumran
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2017 Volume: 14 Issue: 3 Pages: 422 -435
Publisher: Babylon University جامعة بابل

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Abstract

Chest pain is one of most common reasons for attended patients to emergency department. The risk of chest pain in the emergency department is critical. An acute coronary syndrome needs to be distinguished from a variety of other cardiac and non-cardiac diseases that cause chest pain and the rate of hospitalization in high-cost units. Risk for chest pain patients at the emergency department is recommended in several guidelines. The history, ECG, age, risk factors, and troponin So we can diagnose the patients with chest pain at the emergency department and identify both low and high risk patients for an acute coronary syndrome (ACS) by using HEART score and life style. Distribution all patient attended to ED with chest pain in Heart score, application of Heart score to patient with chest pain to evaluate the critical cases and to decrease the intervention with not critical. The study is prospectively cohort study. Clinical data from 282 patient present with chest pain in emergency department were analyzed and who had a major adverse cardiac event within 6 weeks (Acute Myocardial Infarction, Coronary Artery Bypass Graft, Percutaneous Coronary Intervention) from (1/10/2016) to (16/2/2017). In Marjan city of medicine, we analyzed 282/940 patient were 78 (27.3%) discharge home and 204 (72.7%) admitted to hospital. Patient with absent of risk factor 116 p (41.1%), 166 (58.9) presented of risk factor were all suffer from chest pain, age, risk factor, past medical, serum troponin, electrocardiogram, distributed with heart score low, medium high. There was a relation between score element its higher with troponin level (43.64) and lower with one RF (5.77). 136 patient reached to the end point and 146 patients did not reached to the end point were all highly significant. Chest pain is most common cause that lead patient attended to ED and that pain is duo to many causes some are life threaten and some not for decrease the cost, and good diagnosis and decrease uses of coronary care unit bed so that need do the necessary management to patient that complain of chest pain.

Keywords

Chest pain --- Percutaneous --- ACS


Article
Post Tonsillectomy Pain Relief: Comparative Study between Peritonsillar Infiltration of Bupivicain and Intramuscular Diclofenac
تخفيف الم مابعد رفع اللوزتين مقارنة مابين مادة البافكايين الموضعي والدايكلوفيناك العضلي

Author: Anas Ahmed Saleh انس احمد صالح
Journal: Tikret Journal of Pharmaceutical Sciences مجلة تكريت للعلوم الصيدلانية ISSN: 18172716 Year: 2017 Volume: 12 Issue: 1 Pages: 62-67
Publisher: Tikrit University جامعة تكريت

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Abstract

Hospital based study carried out on (40) patients from both sexes, aged (4-26) years,underwent Tonsillectomy by dissection method during the period extend from (June2012 to September 2012). The Patients were divided into two groups- Group A (18)patients: include those with pre-incisional – infiltration of bupivicain with subsequent(spray) post operatively on Tonsils bed at evening and next morning. Group B (22)patients: include those patients with diclofenac intramuscular injection, half hourbefore operation with subsequent doses at evening and next morning. (Result): nodifference in history of post- operative nausea and vomiting regarding the two groups.The mean operative time for group (A) was (28.9) minutes, while the mean operativetime for group (B) was (29.5) minutes. Both groups showed no difference regardingreactionary bleeding (bleeding occurs within 24 hours) or secondary bleeding(Bleeding occurs after 6-8 days due to infection). Group (A) showed low score of painin immediate post-operative time but it was not significant, while group (B) showedlow score of pain in most of the cases at evening, it was significant. No difference inboth groups in the next morning both showed low score of pain. Conclusion:intramuscular diclofenac is more potent as pain relief if compare with Bupivicaininfiltration. Aim of study: To identify the effect of infiltration of bupivicain for posttonsillectomy pain-relief and in compare to intramuscular injection of diclofenac.


Article
Effects of Backpack Loads on Kids Posture

Authors: Sadiq Jafer Abbass --- Duha Qais Abd-ul-Amir
Journal: AL-NAHRAIN JOURNAL FOR ENGINEERING SCIENCES مجلة النهرين للعلوم الهندسية ISSN: 25219154 / eISSN 25219162 Year: 2017 Volume: 20 Issue: 4 Pages: 876-886
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

Kids carrying heavy loads as a part of everyday activity may be related to bend their trunks forward to maintain body posture and balance while walking. This study was to determine a correlation between the weight of a child's backpack, their body weight, and certain features of their body posture. The study group consisted of 6 children, in age of primary school. The anthropometry (age, length, weight) were taken for each volunteers. A school backpack was specially built for the present study. Walking gait was filmed in three cases: (zero kg, 3 kg and 6 kg) backpack.Posture was analyzed by using (Kenova and MATLAB) computer programs.The results show that the forward inclination of the trunk increases when the load and the walking distance are increased, this forward inclination segment may impose greater stress over the vertebral column (ligaments and intervertebral disks) and increase the risk of back problems. Spine and back health may be adversely affected by load carriage and it may be important to use spinal curvature as a measure of posture for load carriage. This study shows that the backpack load cause a lumbar asymmetry by 10 to 20 degree according to the load which has a significant amount of back pain in kids.

الاطفال اللذين يحملون أحمال ثقيلة كجزء من نشاطاتهم اليومية من الممكن ان تؤدي الى إنحناء ابدانهم الى الأمام للمحافظة على هيئة الجسم والتوازن اثناء المشي. هذه الدراسة كانت لتحديد العلاقة المتبادلة بين وزن حقيبة الظهر للأطفال، مع وزن أجسامهم وتعيين الملامح لوضعية أجسامهم. تمت الدراسة بالاستعانة بستة أطفال متطوعين طبيعيين في مرحلة الدراسة الابتدائية، تم حساب الانثروبومترية (العمر والطول والوزن) للمتطوعين. تم اختيار حقيبة الظهر المدرسية لهذه الدراسة. تم تصوير خطوات المشي من المستوي الجانبي لثلاث حالات هي (صفر كغم و3 كغم و6 كغم) لحقيبة الظهر. تم تحليل وضعية الجسم باستخدام برنامجي الحاسوب (كينوفا وماتلاب). أظهرت النتائج زيادة في الأنحناء للأمام لجذع الجسم عند ازدياد الثقل ومسافة المشي، وهذا الأنحناء يفرض إجهاد عالي على العمود الفقري (الأربطة والأقراص الفقرية) والتي بدورها تزيد من خطر الإصابة بمشاكل الظهر. بينت الدراسة أن حمل الثقل يؤثر سلباً على العمود الفقري وصحة الظهر، ومن المهم استخدام انحناءات العمود الفقري لقياس وضعية

Keywords

posture --- spine --- gait analysis --- back pain --- kids.


Article
Role of MRI in acute lower back pain

Author: Najat Adel Hashim
Journal: Muthanna Medical Journal مجلة المثنى الطبية ISSN: 2226146x Year: 2017 Volume: 4 Issue: 2 Pages: 147-157
Publisher: Al-Muthanna University جامعة المثنى

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Abstract

A group of 501 patient who referred unit from orthopedic were subjected to MRI examination and the MRI results were evaluated. All patients with radicular pain, neurological signs or traumatic patients were excluded from this study. A 501 patients complain from acute lower back pain , mean age 33.49+8.38 range (20-70), 229 (46%) male and 272 (54%) female, in combined MRI finding with age of patients, we found large number of patient have disk prolapsed (191), with mean age 36.50, while patient with normal MRI or just muscles spasm were mean age (31.79), so the MRI not effect in outcome of young patient (below 31 years old ) with a lower back pain. In conclusion; lumbo-sacral MRI exam have minimal effect in outcome of young patient with acute lower back pain (less than 3wks).


Article
Intra-peritoneal Xylocaine Spraying for Postoperative Pain Control in Laparoscopic Cholecystectomy: A prospective study at Al-Yarmouk Teaching Hospital

Author: Ghassan Ali Mohsen Al Kizwini
Journal: Mustansiriya Medical Journal مجلة المستنصرية الطبية ISSN: 20701128 22274081 Year: 2017 Volume: 16 Issue: 3 Pages: 83-90
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Background: The concept of minimal access surgery was introduced to achieve several objectives; among which was to minimize post-operative pain by bringing access trauma to the lowest possible level without compromising the clarity of the operative field. Objectives: To study the effect of using local intraperitoneal application of xylocaine, in 2 different concentrations applied directly as near as possible to the intra-abdominal operative field in laparoscopic cholecystectomy, on post-operative pain control. Patients and methods: 110 patients with symptomatic gall stone disease were treated with laparoscopic cholecystectomy. These were divided into 3 groups, the firstgroup, of 40 patients, was operated upon using the classical steps of that surgery and the final step was always to wash the field with normal saline followed by sucking extra fluid before terminating the surgery. In the second group (36 patients) a step was added; and that is the application of local Xylocaine (3 ml of 2% solution-without adrenaline- diluted with 7 ml of normal saline to a total of 10 ml- i.e. 0.6% solution) sprayed as near as possible to gall bladder bed (after excising the gall bladder) and kept in. In the third group (34patients), 5 ml of the 2% Xylocaine were diluted up to 10 ml (ending with a 1% solution) sprayed in the same way. These 3 groups were followed postoperatively regarding the level of pain and magnitude of post-operative pain control and the amount of post-operative analgesia needed for each of them.Results: The first group of patients who did not receive intraperitoneal xylocaine, expressed higher levels of post-operative pain, and needed higher (or more frequent) doses of post-operative analgesia, than the 2nd and the 3rd groups who did receive intra-peritoneal xylocaine sprays. This was expressed as better post-operative pain control in these patients. There was no significantdifference in pain control between the 2nd and the 3rd group patients. Using this simple technique will add no more than a minute or two to the time of the operation at its end. Pain control will be significantly aided if subcutaneous Xylocaine was also used in addition at the port site wounds. Conclusions: Using local intraperitoneal xylocaine sprayed at the gall bladder bed in laparoscopic cholecystectomy (as the end step after excising the gall bladder) gives a better post-operative pain control and decreases the need for higher or more frequent doses of post-operative analgesia.


Article
Impact of Age, Procedural Duration and Impaction Type on Pain and Trismus After Surgery of Mandibular Wisdom Tooth

Author: Ahmed Salah Hameed Al-Noaman
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2017 Volume: 14 Issue: 2 Pages: 353 -360
Publisher: Babylon University جامعة بابل

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Abstract

This study assessed the impact of patient's age, duration of surgical procedure and type of impaction on pain and trismus after surgery of impacted mandibular wisdom tooth.Successive patients with impacted mandibular wisdom tooth were recruited. Winter's classification was used to classify impacted teeth. Surgical removal of impacted teeth was done using local anesthesia. The effect of age, duration of surgical operation and pattern of impaction on post-operative pain and trismus was studied after 3 and 7 days. Visual analogue score (VAS) was used to assess pain, trismus was measured as the inter-incisal distance using manual caliper and duration of surgical procedure was defined as the period between incision and finishing of suturing. Seventy nine patients with age ranged 15 to 41 years were recruited. The highest percentage were male gender (57%). The highest pain VAS score was recorded in the age group (30-41) after 3 days and the lowest mouth opening was seen in the same population after 3 and 7 days. The mean of operation time was 38.5 and its effect after < 20 minutes recorded the least pain score and trismus after 3 and 7 days. Highest pain score and more trismus were related to horizontal impaction on day 3 (p=0.04, p=0.000); whereas lowest pain value and better mouth opening were related to vertical impaction.Postoperative pain and trismus increased with advancing age, operation time and horizontally impacted tooth and trismus did not resolve within short time and may last for more than 10 days..


Article
Non Traumatic Acute Abdominal pain (100 days study in Emergency Department)

Author: Taqi Saadoon Atiyah *
Journal: Al-Kindy College Medical Journal مجلة كلية الطب الكندي ISSN: 18109543 Year: 2017 Volume: 13 Issue: 2 Pages: 90-97
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Abdominal symptoms are possibly the most frequent of all symptoms encountered in surgical practice. Pain is the most common of all abdominal symptoms. Causes of acute abdominal pain include both medical and surgical. Most symptoms arise from intra-abdominal organs or systems while some may originate extra abdominally and are then referred to the abdomen. Medical causes of abdominal pain are encountered more frequently.Objective: To study the causes of acute abdominal pain in patients attending emergency department in Al- Imamain Al- Kadhimain Medical City.Type of the study: A prospective cross sectional studyMethods: The patients attending Emergency Department in Al- Imamain Al- Kadhimain Medical City over the period from April-2014 to April 2016. There was a one day call duty per week managed by the same surgical team (total one hundred days study). Onlypatients above 12 years old with acute non-traumatic abdominal pain were included in this study.Results: The total number was 1217 patients over hundred days study. Their age ranges from 12-83 years; average age was 36.18 ±17 year. There was slight female predominance, 638 (52.42%) female patients and 579 (47.58%) male patients. The most common cause of abdominal pain was acute appendicitis 252 (20.70%), followed by ureteric colic 251 (20.62%), and acute cholecystitis249 (20.46%). Conservative management was done for 836 (68.69%) patients, while operative management done for 379 (31.14%) patients. Postoperative mortality was 8 (2.11%) patients.Medical causes of acute abdominal pain were found in 48 (5.74%) patients.Conclusion: Not all the patients attending surgical emergency department needs operations. Causes of acute abdominal pain include both medical and surgical diseases, some of the medical diseases are very serious like acute viral hepatitis, myocardial infarction , and diabetic ketoacidosis; and should not submit those patients to unnecessary operations with serious and may be fatal postoperative complications. General urine examination is a must in all patients with acute abdominal pain. Electrocardiography (ECG) may be needed in old patients.


Article
A comparative study to evaluate the analgesic effect and some vital signs effects of intravenous (Remifentanil - Morphine – Paracetamol)
دراسة مقارنة لتقييم تسكين الالم والتأثير على بعض العلامات الحيوية للأدوية الوريدية (ريميفنتانيل - المورفين - البراسيتامول)

Author: Zahraa Abdul Kareem Mohammed زهراء عبد الكريم
Journal: karbala journal of pharmaceutical sciences مجلة كربلاء للعلوم الصيدلانية ISSN: 70272221 Year: 2017 Issue: 13 Pages: 267-277
Publisher: Kerbala University جامعة كربلاء

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Abstract

Background: Pain is problematic in intensive care units (ICU) patients because produces adverse psychological and physiological response that includes increased heart rate, blood pressure, respiratory rate, neuroendocrine secretion and psychological distress. Opioid medications play role in pain control, but may cause a harmful effects on some vital signs. The primary goal of acute pain management are pain control and attenuation of the negative physiological and psychological consequences of unrelieved pain. Objectives: To compares effect of Paracetamol, morphine & remifentanil and their activity as analgesic on some vital sings.Patients & Methods: A prospective study was carried out in intensive care unit in AL Hussein medical city in Karbala during the period from first of November 2016 to the 28Th of February 2017. 30 patients of both sex were involved in this study, aged from 18 to 65 years old. Eligible patients were randomly selected & classified to three groups A, B & C (10 patients each). Group A received Morphine intravenous bolus doses (1 mg/30 min), group B received Remifentanil infusion dose (0.1 mcg/ kg/ min), and group C received Paracetamol infusion dose (1g /6 hourly). Data including pain score, pulse rate & blood pressure, were recorded pre-treatment & then same data were taken & reported at 2 hours interval for 12 hours. The data were statistically analyzed by using T-test.Results: It was found that Paracetamol has no significant effect on systolic, diastolic blood pressure and pulse rate (136 ± 4.65, 75 ± 2.96 , 94 ±4.39 ) respectively as it's mean ±standard deviation values compared with pre-treatment values that represent control (138 ± 3.73, 80 ± 2.96, 99 ± 3.41), but with morphine group (124 ± 3.02, 67 ± 3.20, 89 ±5.87) & remifentanil group (111 ±5.64, 61 ± 1.33, 82 ±5.27) respectively, in which they have shown significant effect on these vital signs (systolic, diastolic blood pressure and pulse rate) compared with their pre-treatment values (138 ± 3.73, 80 ± 2.96, 99 ± 3.41). In addition, it was found that Paracetamol has less significant effect on pain score (face, legs, activity, cry, consolability) FLACC scale (4 ± 0.31) at (2,4,6,10,12) hours intervals compared with its pre-treatment value (5 ± 0.18) which means that paracetamol has lower analgesia than the two other drugs, morphine(2 ± 0.32) and remifentanil(2 ± 0.26) respectively, that have significant effect on FLACC scale at (2,4,6,8,10,12) hours intervals, compared with their pre-treatment values. Conclusion:. Paracetamol as analgesic has more vital signs stability compared with morphine & remifentanil but it has less analgesic effects compared with the other two drugs.

نبذه عن الدراسة: الالم يشكل مشكلة وعائق للمرضى في وحدة العناية المركزة لأنه يسبب تأثيرات ضارة نفسية و فسلجيه تتضمن زيادة في نسبة دقات القلب , ضغط الدم , نسبة التنفس وافرازات الصماء العصبية ، وازعاج نفسي. علاجات الافيون لها دور في السيطرة على الالم ولكن يمتلك تأثيرات ضارة على بعض الاشارات الحيوية. الهدف الاساسي من معالجة الالم الحاد هي السيطرة على الالم والتخفيف من العواقب النفسية والفسلجيه الناتجة من الالم الغير قابل للشفاء. أهداف الدراسة: مقارنة تأثير البراسيتامول, المورفين الريميفنتانيل وفعاليتهن كمسكن على بعض الاشارات الحيوية . طرائق جمع المعلومات في هذه الدراسه: الدراسة تمت في وحدة العناية المركزة لمدينة الحسين (ع) الطبية في كربلاء خلال فترة تتراوح من 1 تشرين الثاني 2016 الى 28 شباط 2017. 30 مريض من كلا الجنسين شاركوا هذه الدراسة, اعمارهم تتراوح من 18 الى 65 سنة. المرضى المؤهلين تم اختيارهم عشوائيا وتم تقسيمهم الى ثلاث مجموعات أ, ب, ج (10 لكل مجموعة). مجموعة أ استلمت جرعات وريدية من المورفين (1 ملغم لكل 30 دقيقة) , مجموعة ب استلمت جرعات وريدية من الريميفنتانيل (1 ميكروغرام لكل كلغم في الدقيقة) ومجموعة ج استلمت جرعات وريدية من البراسيتامول (1 غم لكل 6 ساعات) . النتائج تضمنت مقياس الالم(عبر استخدام معيار فلاك)، معدل النبض , ضغط الدم التقلصي والانبساطي , حيث سجلت النتائج عند اعطاء الدواء ثم تكرار جمعها كل 2 ساعة الى 12 ساعة . البيانات تم تحليلها احصائيا باستخدام فحص تي. النتائج: لقد وجد أن البراسيتامول المعطى لمجموعة المرضى أ لا يمتلك اي تأثير واضح على ضغط الدم التقلصي والانبساطي و معدل سرعة النبض (136 ± 4.65,75 ± 2.96, 94 ±4.39 ) بالمقارنة مع مجموعة السيطرة (قبل اعطاء الدواء) والمتمثلة بالقيم التالية (138 ± 3.73, 80 ± 2.96, 99 ± 3.41), , لكن مع المورفين (124 ± 3.02, 67 ± 3.20, 89 ±5.87) و الريميفنتانيل (111 ±5.64, 61 ± 1.33, 82 ±5.27) بالتناوب والمعطى للمجاميع الاخرى والتي لها تأثير واضح على هذه الاشارات الحيوية (الضغط التقلصي والانبساطي ومعدل سرعة النبض) مقارنة مع مجموعة السيطرة. بالإضافة الى ان البراسيتامول له تأثير قليل في تقليل الالم (4 ± 0.31) عند الفترات(2, 4, 6, 10) ساعة مقارنة مع مجموعة السيطرة (5 ± 0.18) وهذا يعني ان البراسيتامول يمتلك تأثير مسكن للألم اقل من الادوية الاخرى وهي المورفين (2 ± 0.32) والريميفنتانيل (2 ± 0.26) والتي تمتلك تأثير واضح على مقياس الالم عند الفترات(2, 4, 6, 8, 10, 12) ساعة مقارنة مع مجموعة السيطرة. الاستنتاج: البراسيتامول كمسكن يعتبر اقل تأثيرا على العلامات الحيوية (الضغط التقلصي والانبساطي ومعدل سرعة النبض) مقارنة بالدوائين الاخرين الريمفنتانيل والمورفين وبذلك يكون البراسيتامول اكثر استقرارا من ناحية تأثيره على هذه العلامات الحيوية (الضغط الانبساطي والتقلصي ومعدل سرعة النبض). لكن البراسيتامول يمتلك تأثير مسكن للألم قليل مقارنة ببقية الادويه المذكوره .


Article
Clinical Study to Evaluate the Prevalence of TMD Before and After Delivery of Complete Denture

Author: Jabber Jasim Kareem جبار جاسم كريم
Journal: Tikrit Journal for Dental Sciences مجلة تكريت لعلوم طب الاسنان ISSN: 20731213 Year: 2017 Volume: 5 Issue: 1 Pages: 98-108
Publisher: Tikrit University جامعة تكريت

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Abstract

Temporomandibular disorder (TMD) is a broad term that encompasses number of clinicalproblems including the temporomandibular joints, the masticatory musculature and relatedstructures, or both. The etiology of TMD is ambiguous since the signs and symptomswhich exist in patients with natural teeth may also being observed in edentulous patients.Thus, TMD is a multifactorial problem with varying symptoms combinations and rates.Relationship between removable complete dentures and tempromandibular joint disorder indifferent gender and age groups. A total of 30 patients (15 female and 15 male) whosubmitted to Prosthodontics Department, College of Dentistry, Al-MustansiriyahUniversity to make a new complete denture. The age of participants ranges from (40-80)years with the mean age (65.8) years. Two clinical examiners conducted the patient’sexamination; the first examiner takes on a questionnaire to identify the TMD symptomssigns and. Clinical examination of the patients was assessed through part I, II of researchdiagnostic criteria pre and post one and two months of applying the prosthesis. The clinicalevaluation of prosthesis done by the second clinical examiner related to (retention, stability,fitness, occlusion and centric relation) was evaluated twice at predetermined intervals of 1and 2 months after construction and delivery of denture.Evaluation performed by using Dawson's bimanual technique and recorded within clinicalcase sheet for complete denture records. The present study shows that the highestfrequency of TMD obtained in age group of 70-80 years old followed by age group of 60-69 years old at all intervals, internal derangement (ID frequency) significantly higher infemales than male patients (p=0.02). There is significant statistical difference regarding theMyofacial pain dysfunction (MPD) frequency according to the time of using the dentures,those patients with Diabetes Mellitus (DM) formed the highest percentage (39.1%) of thosewhom presented with MPD followed by those with Hypertension (HT) (32%) and thosewith history of HT and DM represent (17.4%) onlyThe results also illustrated that prosthesis properties (retention, stability, fitness, occlusionand centric relation) show significant relation with TMDs improvement post one and twomonths. Most patients with complete denture perceived improvement in the sign andsymptoms of TMDs.


Article
Treatment Of Acute Protruded Disc with Percutaneous Disc DecompressionAnd Transforaminal Epidural Steroid injection
علاج حالات الانزلاق الغضروفي الحاد باستخدام التداخل المحدود بازاله الضغط داخل النواة مع حقن الستيرويد فوق الجافية

Author: Ammar Najim Abood Alsamarria م.م.عمار نجم عبود
Journal: Diyala Journal of Medicine مجلة ديالى الطبية ISSN: 97642219 Year: 2017 Volume: 12 Issue: 2 Pages: 99-104
Publisher: Diyala University جامعة ديالى

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Abstract

Background: The primary goal to the surgical cureof theLower-back and radicular pain is common presenting complain of herniate lumber disc and compression of the nerve root by protrusion of disc material.Objective: To assess the effectiveness of epidural steroid injuction for low back pain in a compination with percutenous disc decompression in patients presenting to Baqubah Teaching Hospital in Diyala provenice, Iraq whom suffering from protruded disc with radicular pain.Patients and Methods: Depending on inclusion and exclusion criteria, fifty consecutive patients diagnosed as having protruded disc and whom used conservative therapy for six weeks with no improvement all were conducted in the Orthopaedic clinic in Baqubah city during 2013 till 2015, 25 patients use both method and 25 patients use only Decompressor. Results: The result were shown no significant differences between decompression and decompression+ESI for the age, sex, operating time, hospitalization, and stight leg rising test(S.L.R.T) but significant difference between decompression and decompression+ESI at p < 0.05 for time retain to work /day, numbness, and radition/pain with mean ± SD; (20.8 ± 7.4 and 15.8 ± 6.6 for time retain to work respectively), (1.3 ± 0.5 and 1.6 ± 0.5 for numbness respectively), (1.4 ± 0.5 and 1.8 ± 0.4 for radition/pain respectively). And the result revealed that the operating time was significant positive correlation with age and significant negative correlation with numbness and time retain to work/day significant negative correlation with numbness and radition/pain, while significant positive correlation with S.L.R.T, the data was taken depending on oswestry disability index (ODI) questioners. Conclusion: Used of both decompressor with epidural injection areprovided rapid relief of sciatica and low-back pain in the first three months after operation that improved the movement and early exercise.

خلفية الدراسة: حالات الانزلاق الغضروفي يكون الهدف من العلاج الجراحي لازالة الام اسفل الظهر والآلام النازلة الى الساقين وذلك بازالة الضغط عن الاعصاب المتاثر وكذلك الضغط عن الحبل الشوكي بازالة الغضروف المنزلق.اهداف الدراسة: لقياس فعالية استخدام التداخل المحدود بازاله الانزلاق الغضروفي الحاد مع حقن الستيرويد فوق الجافية في نفس الوقت والتي تم اجرائها في مستشفى بعقوبه التعليمي في محافظه ديالى.المرضى والطرائق: اعتمادا على خصائص محدده تم اختيار خمسين مريضا يعانون من انزلاق غضروفي حاد حيت تم معالجة خمس وعشرون منهم بالتداخل المحدود فقط والخمس والعشرون الاخرين تم معاجتهم باستخدام التداخل المحدود مع حقن الستيرويد فوق الجافية في نفس الوقت ومتابعه حالتم في أوقات معينة وتم هذا بين 2013 الى 2015 في مستشفى بعقوبة التعليمي.النتائج: أوضحت النتائج وجود استجابة جيده وملحوظة باستخدام الطريقتين معا وذلك من خلال الشفاء من الأعراض ألمرضيه وقصر فتره البقاء في المستشفى وكذلك سرعه العودة الى العمل حيت كانت القيمة العيارية اقل من 5 بالمئه .الاستنتاجات: ان استخدام التداخل المحدود مع حقن الستيرود معا يسرع من سرعة الشفاء وإزالة الآلام وذلك لما له تاثير مضاعف على ازاله الضغط عن العصب وفي نفس الوقت تقليل الالتهابات العصبية الناتجة عن الانزلاق.

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