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Article
The Effect of Acute Urinary Retention on The Accuracy of Serum Prostate-Specific Antigen Level Measurements

Author: Ehab Jasim Mohammad
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2012 Volume: 11 Issue: 1 Pages: 118-122
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:The level of PSA in serum is increased by inflammation of the prostate, urinary retention,prostaticinfection, benign prostatic hyperplasia,prostate cancer, and prostatic manipulation. [3]OBJECTIVE:To study the effect of acute urinary retention on the serum prostate-specific antigen (PSA)concentration.METHODS:Blood samples for serum PSA measurement were obtained (PSA1), and an indwelling urethralcatheter was inserted for 2 weeks. Before catheter removal, a second blood sample for measurementof serum PSA level (PSA2) was obtained. In patients who were able to void, a third sample wasobtained 3 weeks later (PSA3). In the first and second visits, digital rectal examinations (DRE1,DRE2) were performed to assess prostate volume. Mean PSA levels (PSA1, PSA2, and PSA3) andprostate volumes (DRE1, DRE2) were compared.RESULTS:Fourty-two patients with a mean age of 70.18 years (range 56 to 85 years) participated in thisstudy.mean PSA level at the time of AUR (PSA1) was 7.02 ng/mL (median, 5.8 ng/mL; range, 0.9 to30.4 ng/mL). The mean PSA2 level was 5.5 ng/mL (median, 3.9 ng/mL; range, 0.7 to 39 ng/mL),lower than the PSA1 level .This association was statistically non significant P > 0.05. The meanprostate volume at the time of DRE1 (43.4 mL; median, 45 mL; range, 30 to 60 mL) wassignificantly higher than at DRE2 (37.8 mL; median, 40 mL; range, 25 to 50 mL) (P < 0.001).PSA3 was measured in 42 patients 4 weeks after retention (2 weeks after catheter removal). In thisgroup of patients, mean PSA2 and PSA3 levels were 5.5 ng/mL and 5.1 ng/mL, respectively (median,3.9 and 3.5, respectively, P > 0.05).CONCLUSION:Acute urinary retention can increase serum PSA levels. In this series, we found that this effect maycontinue up to 2 weeks.


Article
Catheter Associated Fungal Urinary Tract Infection

Author: Ehab Jasim Mohammad
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2012 Volume: 11 Issue: 3 Pages: 326-329
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT: BACKGROUND: Fungal urinary tract infections are an increasing problem in hospitalized patients. There are specific criteria for evaluating urinary tract infections caused by bacteria.There are also specific guidelines for prevention of catheter associated bacteruria. No such criteria or recommendations are available for fungal urinary tract infections. OBJECTIVE: To evaluate the incidence of catheter associated fungal infection among all patients with catheter associated urinary tract infection and its risk factors. MATERIALS AND METHODS: From January 2009 to March 2011 (72) patients with indwelling urinary catheter for different indications with significant pyuria presented to urologic department at Al-Ramadi teaching hospital were included in this prospective study, all patients were subjected to urine culture for bacteria and fungi. The following information was obtained: age, sex, antibiotic therapy, immunosuppressive therapy, duration of catheterization and the presence of diabetes mellitus. The type of growth whether bacterial or fungal was noted. The age of patients ranges from 2 to 70 years. RESULTS: The age of patients ranged from 2 to 70 years (mean 34.6). Of 72 patients, 12 had diabetes mellitus, 18 patients were on long term antibiotic use and 15 patients on immunosupressants. Bacterial infection accounted for 70.9% of catheter associated urinary infection with E. coli is the most commonly isolated organism(41.6%), fungal infection accounted for 16.6% and mixed fungal and bacterial infection account for 12.5.Risk factors among patients with fungal infection were diabetes mellitus (47.6%), long term antibiotic use (42.8%) , immunosuppressive therapy (9.5%), and prolonged duration of catheterization (85.7%). CONCLUSION: Fungal infection constitutes a significant proportion of all catheter associated urinary tract infection and diabetes mellitus, long term antibiotic use, immunosuppressive therapy, and prolonged duration of catheterization are the most common risk factors.


Article
Early Detection of Bacteremia and Bacteriuria after Extracorporeal Shock Wave Lithotripsy By C-Reactive Protein Measurements

Author: Ehab Jasim Mohammad
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2017 Volume: 16 Issue: 1 Pages: 41-46
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT :BACKGROUND:Extracorporeal shock wave lithotripsy (ESWL) has long been accepted as the least invasive and reliable method in the treatment of urolithiasis. The success rates have been very high in renal and upper ureteral stones . OBJECTIVE:Is early detection of bacteriuria and bacteriemia after extracorporeal shock wave lithotripsy (ESWL) of calcium and infection stones by measurement of plasma C-reactive protein (CRP) levels.METHODS: A total of 150 patients who had infection stones (n 54) and calcium stones (n 96) were included in the study. All patients had sterile urine before ESWL. The mean age was 41.6+_ 4.85 and male/female ratio was 2.12. Blood cultures were obtained within 1 hour post-ESWL period. Urine cultures were obtained 3 times just after and on the first and seventh day of ESWL. RESULTS: Post-ESWL evaluations showed 6 positive blood cultures with 4(5.32%) patients in infection stone and 2 (2.66%) patient in calcium stone groups, whereas urine cultures revealed 12 (16%) positive results in infection stones and 8(10..66%) in calcium stones. The patients who had positive cultures also had elevated plasma CRP levels when compared to the levels in patients with negative cultures (p 0.000). CONCLUSION: Bacteriuria and bacteriemia after ESWL have been well-identified entities and may be responsible from some of the post-ESWL complications. CRP can be useful for early detection of such complications.


Article
Types of Renal Stones in Al-Anbar Governorate
انواع حصى الكلى في محافظة الانبار

Author: Ehab Jasim Mohammad ايهاب جاسم محمد
Journal: Al- Anbar Medical Journal مجلة الأنبار الطبية ISSN: PISSN: 27066207 / EISSN: 26643154 Year: 2012 Volume: Vol.10 Issue: 2 Pages: 58-61
Publisher: University of Anbar جامعة الانبار

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Abstract

Background: Urinary calculi are the third most common affliction of the urinary tract, exceeded only by urinary tract infections and pathologic conditions of the prostate. The lifetime prevalence of kidney stone disease is estimated at 1% to 15%. Aim of study: to determine different types of renal stones in Al-Anbar Governorate.Materials and methods: from November 2008 till November 2010 (265) patients having upper tract stone disease were studied in Al-Ramadi Teaching Hospital.All these stones that were analyzed by chemical method were obtained from those patients either by spontaneous passage, medical expulsive therapy, Extracorporeal Shock Wave Lithotripsy [ ESWL], or by surgical operation.Results: In this study, the age of those patients ranges from 17-62 years old. The male to female ratio was 3:1. The distribution of stones in Al-Anbar Governorate was: Uric acid stone 50.6%, calcium oxalate stone 38.1%, calcium phosphate stone 5.3%, cystine stone 1.9%,mixed(calcium and uric acid) stone 4.1%.Conclusion: High incidence of uric acid stones in Al-Anbar Governoratewhich are more in males than in females .The main cause for these results is unknown, but dietary factor (proteins) may play a major role in stone formation in Al-Anbar Governorate.

خلفية البحث: حصى الجهاز البولي هو ثالث اكثر الأمراض شيوعا للجهاز البولي ,مسبوقا فقط بالتهابات المجاري البولية وامراض البروستات.ان مدى انتشار امراض حصى الكلى يقارب 1-15%. الاهداف: ان الهدف من الدراسة هو لتحديد الانواع المختلفة لحصى الكلى في محافظة الانبار. طرق العمل: شملت الدراسة على 2 مريض في مستشفى الرمادي التعليمي كانوا يعانون من امراض حصى الكلى للفترة من شهر تشرين الثاني 2008 ولغاية شهر تشرين الثاني 2010 تتراوح اعمارهم بين 17-62 سنة. تم تحليل جميع انواع الحصى بالطريقة الكيميائية, حيث اخذت من المرضى عن طريق طرح الحصى التلقائي, او بواسطة الادوية التي تساعد في طرح الحصى, او الحصى المطروح بعد التفتيت, او الحصى المستخرج بالعمليات الجراحية. النتائج: في هذه الدراسة, عمر المريض يتراوح بين 17-62 سنة وان نسبة الرجل الى المرأة كانت 1:3 . ان توزيع حصى الكلى في مرضى محافظة الانبار كان كالاتي: حصى الحامض البولي 50.6%,حصى اوكسالات الكالسيوم 38.1%,حصى فوسفات الكالسيوم 5.3%,حصى السستين 1.9%,حصى مختلط (الكالسيوم والحامض البولي) 4.1%. الاستنتاج: ان نسبة حدوث حصى الحامض البولي هي الاكثر شيوعا في محافظة الانبار وبنسبة عالية في الرجال اكثر من النساء. إن السبب الرئيسي لهذه النتائج هو غير معروف لكن العامل الغذائي(البروتين) يلعب دورا رئيسيا في تكوين حصى الحامض البولي.


Article
Prevention of Postcircumcision Meatal Stenosis

Authors: Ehab Jasim Mohammad --- Mohammad Maher Al.Ani --- Abdulsattar Jubair Ali
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2014 Volume: 13 Issue: 3 Pages: 365-369
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:BACKGROUND:Meatal stenosis is a condition that almost always is acquired after neonatal circumcision. Circumcision is one of the most common surgical operations throughout the world, and meatal stenosis is one its late complications. We evaluated the topical use of a lubricant jelly after circumcision in boys in order to reduce the risk of meatal stenosis.OBJECTIVE:To evaluate the use of lubricant in prevention of postcircumcision meatal stenosis and other complications.MATERIALS AND METHODS:From April 2010 to September 2012, 300 boys younger than 2 year old referred to AL-RAMADI TEACHING HOSPITAL IN ANBAR,IRAQ and my clinic, were involved in a randomized controlled trial. They were referred for circumcision. The parents in the study group were instructed to use petroleum jelly on the circumcision site after each diaper change for 6 months. In the control group, no topical medication was used. The children were followed up regularly and evaluated for meatal stenosis, bleeding, infection, and recovery time.RESULTS: Three hundred boys younger than 2 years old participated in the study. None of the children in the lubricant group developed meatal stenosis, while 91 (60.6%) in the control group developed postcircumcision meatal stenosis (P 0 .0000) which is statistically highly significant. Infection of the circumcision site was observed in 2 (1.3%) and 14 (9.3%) children of the lubricant and control groups, respectively (P 0 .0004) which is statistically highly significant . Two boys (1.3%) in the lubricant group and 29 (19.3%) in the control group had postcircumcision bleeding (P 0 .0007) which is statistically highly significant.Finally, the mean time of recovery in the lubricant group was 3.8 ± 1.2 days, while it was 6.9 ± 4.2 days in the control group (P = 0.03).CONCLUSION: Based on the findings of this study we can conclude that using petroleum jelly after circumcision is considerably effective for reducing postcircumcision meatal stenosis and other complications.


Article
Foreign Bodies in the Urinary Bladder: 10 Year Experience in Al-Ramadi Teaching Hospital

Authors: Niema Hamad Al-Heeti, Ehab Jasim Mohammad --- Waleed Nassar Jaffal, --- Yahia Hameed Majeed
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2013 Volume: 12 Issue: 1 Pages: 111-119
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:BACKGROUND: A wide range of objects have been inserted into the urinary bladder posing a challenge to urologists for diagnosis and management. Although it is not a fatal disease but can lead to serious complications. OBJECTIVE:To study the presentation, causes, diagnosis and treatment of urinary bladder foreign bodies.PATIENTS AND METHODS: From May 2001 to December 2011, 21 patients had been treated for intravesical foreign bodies at Al Ramadi teaching hospital , Anbar governorate / west of Iraq. All of the patients had underwent ultrasonography of the urinary tract , plain abdominal radiography and cystoscopy. The patient’s records were reviewed retrospectively and their clinical data were analyzed. RESULTS:A total of 21 patients with mean age of 39.2 years with male: female ratio (1:2.5). The most common presentation was recurrent urinary tract infection. Frequency, dysuria, Hematuria, difficulty with micturition, and urinary retention were the other complaints at presentation. The most common cause is iatrogenic (42.9%) followed by self insertion (33.3%), migration from outside the bladder (14.3%) and external trauma (9.5%). Definitive diagnosis of vesical foreign body was achieved by ultrasonography only in (9.5%), by plain abdominal radiography only in (28.6%),by both in (14.3%) of patients and cystoscopy was needed to establish the diagnosis in (47.6%), of them 5 cases had been erroneously reported to be bladder calculi. Intravesical foreign bodies had been removed endoscopically in 19 (90.5%) patients, and in the remaining 2 (9.5%), by open surgery. No significant complications were recorded postoperatively.CONCLUSION: Urinary bladder foreign bodies are not uncommon and should be suspected in patients presenting with chronic lower urinary tract complains. The incidence of iatrogenic foreign bodies in the urinary bladder is increasing. Radiological evaluation and cystoscopy are necessary to confirm the presence of foreign bodies and to determine the size, number, and nature of foreign bodies. Most urinary bladder foreign bodies can be removed by endoscopic and minimally invasive techniques without the need for open surgery


Article
Cytological Findings in Patients with Haematuria

Author: Alaa Abdulqader Abdulrazaq, Ehab Jasim Mohammad, Duraid Taha Abdulkareem, Waleed Nassar Jaffal
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2017 Volume: 16 Issue: 4 Pages: 340-344
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:BACKGROUND:Regardless of the accessibility of more up to date and more modern methods of investigations, urinary cytology still remains the most regularly utilized non-invasive investigation for the diagnosis of cancer of the bladder.OBJECTIVE:To assess the helpfulness of urine cytology in assessment of patients with hematuria for the presence of malignancy.PATIENTS AND METHODS:A total of 1560 recently voided urine samples got at private clinics from patients with hematuria, whether gross or microscopic, over a time of three years were incorporated in the study. Physical and microscopical (cytological) examination done for all samples.RESULTS:Among these cases of hematuria incorporated in the study, 23.7% (370 cases) were found to have positive finding of atypical cells. In these cases with atypia, 48.7% (180 cases) were proved to have malignancy both with cystoscopic findings and the histopathological biopsy. The remaining cases of atypia were found to be reactive, either due to instrumentation or foreign body. In an extensive number of cases of hematuria, that is, 1190 cases (76.3%) no atypical cells were identified.CONCLUSION:Urine cytology can distinguish urothelial cells changes and high grade bladder tumor so it is a good tool particularly with coordinated effort amongst clinician and cytopathologist. Urine cytology can be utilized as an adjunct test in assessment of patients with hematuria.

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