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Article
Single Dose Methotrexate as a Primary Treatment of Ectopic Pregnancy
استخدام جرعة عضلية واحدة من دواء ميثوتريكسيت كعلاج اولي للحمل خارج الرحم

Author: Hanan Dh. Al-Jeboury د. حنان ضايع الجبوري
Journal: IRAQI JOURNALOF COMMUNITY MEDICINE المجلة العراقية لطب المجتمع ISSN: 16845382 Year: 2008 Volume: 21 Issue: 3 Pages: 228-236
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Objectives: To determine the efficacy of single-dose intramuscular methotrexate as the primary treatment of ectopic pregnancy.Study design: A hospital based- cohort clinical study.Setting: The study was carried out in the Department of Obstetrics and Gynecology in Al-Yarmouk teaching hospital.Methods: A hospital based- cohort study was done from October 2004 to November 2005 in AL-Yarmook teaching hospital to a total of 82 women referred because of clinical suspicion of ectopic pregnancy. 35 women were excluded because they needed surgical interference, the remaining 47 patients with clinical suspicion of ectopic pregnancy, made using a combination of β-hCG titers with ultrasound. 50 mg intramuscular methotexate regimen was given, β-hCG levels were measured on days 1,4,7 and then weekly . If β-hCG levels were not dropping enough after 1 week, a second dose of methotrexate given. Successful treatment was defined as the resolution of ectopic pregnancy with a single dose without surgical interference. Results: Our over all success rate was 78.7 %( 37/47 women). The median pretreatment serum β-human chorionic gonadotropin level was lower in those women in whom treatment was successful compared with those women with treatment failure (974 vs. 3804 mIU/mL, P<0.05). In our study 37 of 47 patients with ectopic pregnancy the level of β-hCG dropped.Six of 47 patients the dose needed to be repeated for another one week and the level of β-hCG monitored after another one week and was droping; the remaining 4 patients need surgical interference. Conclusion: Single dose of IM methotrexate was associated with a high success rate in selected cases of ectopic pregnancy especially after exclusion of factors which causes treatment failure.Key words: Ectopic pregnancy, Methotrexate

هدف الدراسة: لتحديد فاعلية جرعة عضلية واجدة من دواء ميثوتريكسيت كعلاج اولي للحمل خارج الرحم. تصميم الدراسة: دراسة مستقبلية .مكان الدراسة: اجريت هده الدراسة في قسم النسائيات والتوليد في مستشفى اليرموك التعليمي.طريقة العمل: دراسة تحري اجريت فى مستشفى اليرموك التعليمي قسم النسائية والتوليد للفترة من تشرين اول 2004 الى تشرين ثانى 2005 حيث تم فحص 82 مريضة تعانى من اشتباه حمل خارج الرحم .تم استبعاد 35 مريضة للحاجة الى تداخل جراحى طارئ.تم ادخال 47 مريضة فى البحث حيث تم تشخيص الحالة بواسطة قياس مصل الدم لهرمون الحمل(اج, سي,جي)مع فحص بواسطة جهاز الامواج فوق الصوتيةالمهبلي.استخدم جهاز الامواج فوق الصوتية المهبلي لتشخيص الحالات وتم الاخذ بالاعتبار وجود مايلي :حمل في اول 6 اسابيع ,عدم وجود نبض الجنين,الحمل اقل من 4 سم في الطول .تم اعطاء 50 ملغم عضلي من دواء الميثوتركسيت لكل مريضة ضمن الدراسة بعدها تم قياس نسبة هرمون الحمل في اليوم الاول ,الرابع ,السابع وبعدها اسبوعيا.تم اعطاء جرعة ثانية من العلاج للمرضى الذين لم تتغير نسبة هرمون الحمل لديهم بعد اسبوع من الجرعة الاولى .لنتائج: نجاح العلاج تم تعريفه. باضمحلال الحمل خارج الحمل باستخدام جرعة واحدة من دون الحاجة الى التداخل الجراحى .كان معدل النجاح هو 78.7% (37 مريضة من 47) .وكان معدل هرمون الحمل قبل بدأ العلاج اقل في المرضى الذين استجابوا للعلاج مقارنة بالذين فشل العلاج معهم (974 مقارنة 3804) . 6 مرضى كانوا بحاجة الى جرعة ثانية من دواء الميثوتركسيت لان نسبة هرمون الحمل لم تقل في الاسبوع الاول من الجرعة الاولى .4 مرضى كانوا بحاجة الى تداخل جراحى اثناء فترة مراقبة الهرمون .الاستنتاج: نستنتج من مقارنة النتائج ان جرعة واحدة عضلية من دواء الميثوتركسيت لها الامكانية على رفع معدل نجاح علاج حالات مختارة من حمل خارج الرحم خاصة بعد اخراج العوامل التى تؤدى الى فشل العلاج.


Article
Electrocardiography (Holter) study of patients with panic attacks

Authors: Abdulhamza Rajooj Hmood --- Sami A. Al-Badri
Journal: Karbala Journal of Medicine مجلة كربلاء الطبية ISSN: 19905483 Year: 2014 Volume: 7 Issue: 2 Pages: 1870-1877
Publisher: Kerbala University جامعة كربلاء

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Abstract

background: many patients complaining of palpitations seem to have normal electrocardiography (ECG).Aim: to study the 24-hours electrocardiography of patients with panic attacks.Material and Methods: fifty patients with panic attacks were studied by Holter monitoring for 24 hours each.Results: Holter monitoring showed ectopic beats in all 50 patients. No other arrhythmia was recorded.Smoking was significantly associated with having more ectopic beats per day.Discussion: panic attacks are not well understood. Some link it to autonomic instability. Some studies had found that some people diagnosed with panic disorder are having paroxysmal supraventricular tachycardia (PSVT). No one of the 50 patients we studied had PSVT. On the other hand, all of the 50 patients had several ectopic beats per day.Conclusion: it seems that ectopic beats are very common among patients with panic attacks.Keywords: panic, Holter, ectopic

Keywords

panic --- Holter --- ectopic


Article
Partial Mole in Ectopic Pregnancy

Author: Rawaa D. AL-Janabi
Journal: Iraqi Journal of Embryos and Infertility Researches المجلة العراقية لبحوث الأجنة والعقم ISSN: eISSN: 26166984 / pISSN: 22180265 Year: 2016 Volume: 6 Issue: 1 Pages: 8-12
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

Background:Gestational trophoblastic disease is a wide spectrum of abnormal pregnancy that includes: Complete molar pregnancy (CMP), partial molar pregnancies (PMP), invasive mole (IM), chorioncarcinoma (CHC), and placental site trophoblastic tumors (PSTT. Hydatidiform mole is an abnormal gestation characterized by the presence of hydropic changes affecting some or all of the placental villi. Hydatidiform mole arises as a result of the abnormal fertilization of an ovum. Tubal ectopic hydatidiform mole is a rare lesion and few cases have been reported.


Article
Ectopic pregnancy, A Prospective Study In Al-Batool Teaching Hospital In Mosul – Iraq

Author: Ghada Al-Daheen
Journal: Al-Kindy College Medical Journal مجلة كلية الطب الكندي ISSN: 18109543 Year: 2007 Volume: 4 Issue: 1 Pages: 63-69
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Ectopic pregnancy (EP) is the implantation of pregnancy at an extra uterine site. EP accounts for approximately 2 % of reported pregnancy. The largest risk factors are upper genital tract infection due to sexually transmitted diseases (STDs), as well as other risk factors as smoking, the use of intrauterine device, previous tubal or pelvic surgery, history of infertility, and the risk of age and parity. It is difficult to diagnose EP clinically. However diagnostic aids like B-hCG assessment and ultrasound scan has proved to be of great help. The treatment trends for ectopic pregnancy have changed to more conservative procedures like salpingostomy, segmental resection and fimbrial expression.
Methods: From September 2000 to September 2002, a prospective study was conducted to forty patients who were admitted at Al-Batool teaching hospital, as proven or suspected cases of ectopic pregnancy.
Complete assessment of the patients through detailed history and clinical examination was carried out, and accordingly patients were classified into unstable and stable groups.
The investigations has included pregnancy test (PT), ultrasound scan (USS), and laparoscopy.
The operative procedures were either salpingectomy, or conservative surgery in the form of salpingostomy and milking of the tubes.
Histopathological examination confirmed EP in all surgically treated patients.
Results: Forty cases of ectopic pregnancies were collected. 67.5 % were in the age group 26 – 35 year.
Women with higher parity had the highest percent with EP (37.5 %).
Twenty - seven cases (67.5 %) were clinically unstable.
USS was performed for twenty – six (65 %) patients with positive results in all, where twenty – one patients (80.76 %) had an adnexial mass.
Diagnostic laparoscopy was carried out in four cases (10 %) only.
Among the forty cases of EP the findings at laparotomy were as follows:
Tubal abortion was evident in four cases ( 10 % ). Intact ampullary pregnancy in fourteen patients (35 % ), two isthmic gestations (5 %), two ovarian pregnancies ( 5 %) , and one corneal pregnancy( 2.5 %). In seventeen cases (42.5 %) there was ruptured ectopic pregnancy. There was accompanying ovarian cysts in five patients (12.5 %),
The operative procedures included: Salpingectomy in thirty one patients ( 77.5 % ) , salpingostomy in two cases ( 5 % ), milking of the tube in four cases ( 10% ), and conservative removal of the products of conception from the ovarian tissue with adequate haemostasis in the two cases of ovarian pregnancy ( 5 % ).
The route of exploration and management was through opened laparotomy in all. Two cases that were treated through laparoscopy.
Conclusion: Early diagnosis of cases of ectopic pregnancy would reduce the morbidity and even the mortality of ectopic pregnancy. It allows more conservative form of treatment to be applied, and thus giving a better chance for the patient to preserve fertility.
Key word: Ectopic pregnancy, tubal pregnancy, risk factors in ectopic pregnancy


Article
Serum CA-125 in Ectopic Pregnancy

Authors: Lilyan W. Sersam --- Rasha Shakir Mahmood
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2013 Volume: 12 Issue: 3 Pages: 343-350
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT: BACKGROUND: CA-125 is a glycoprotein, its origin is uncertain during pregnancy. It rises during the first trimester andreturns to a non-pregnancy range in late pregnancy. OBJECTIVE: To compare CA-125 levels between tubal ectopic and normal intrauterine pregnancy, and to find it’susefulness in differentiating intact from ruptured tubal ectopic pregnancy. METHODS: This prospective case-control study was carried out on sixty healthy women with single normalintrauterine pregnancy (NIUP) of 6-10 weeks gestation and sixty women with tubal ectopic pregnancyof same gestational age which were further subdivided into twenty-five women with ruptured tubalectopic pregnancy (REP) and thirty-five women with unruptured tubal ectopic pregnancy (UREP). Thelevels of CA-125 were compared between these groups. RESULTS: The mean level of CA-125 in ruptured ectopic pregnancy group was 49.04±33.63 IU/ml and in unruptured ectopic pregnancy group was 24.3±16.89 IU/ml. The mean level of CA-125 in normalpregnant women (control group) was 53.95±31.2 IU/ml. There was a statistically significant differencebetween mean serum CA-125 levels of ruptured ectopic pregnancy and unruptured ectopic pregnancygroup (p< 0.05), also there was a statistically significant difference between mean of CA-125 level ofunruptured ectopic pregnancy group and control group (p <0.05), while there was no statisticallysignificant difference between ruptured ectopic pregnancy group and control group (p > 0.05).CONCLUSION: CA-125 level is significantly elevated in ruptured tubal ectopic pregnancy than the intact tubal ectopicpregnancy, this increase in CA-125 levels can be used as additional test to identify tubal rupture


Article
SERUM CREATINE KINASE AND ITS ISOENZYME CK-MB IN THE PREDICTION OF TUBAL ECTOPIC PREGNANCY

Author: Hala A Abdullateef هاله عبد القادر عبد اللطيف
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2013 Volume: 11 Issue: 2 Pages: 170-175
Publisher: Al-Nahrain University جامعة النهرين

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Background:Ectopic pregnancy is a major cause of maternal morbidity and mortality. Creatine kinase is an enzyme that its increase reflects tissue injury and could be useful in the diagnosis of tubal pregnancy.Objectives:To evaluate the diagnostic value of total creatine kinase in women with ectopic pregnancy, tubal rupture ectopic pregnancy, spontaneous abortion, and normal pregnancy and to investigate the possible discriminatory ability of creatine kinase-MB for diagnosis of tubal rupture ectopic pregnancy.Methods:Forty women with ectopic pregnancy, 17 with intrauterine abortion and 24 women with normal gestation were studied. The diagnosis of ectopic pregnancy was based on clinical assessment and transvaginal ultrasonography. Serum human chorionic gonadotropin levels were measured by enzyme linked immuno-sorbent assay. Total serum creatine kinase and creatine kinase-MB values were determined by spectrophotometrical analysis.Results:Creatine kinase and creatine kinase-MB levels were significantly higher in tubal ectopic pregnancy compared with both intrauterine abortions and normal gestations. When using creatine kinase-MB of 4.55 IU/ml as a cut-off value for the diagnosis of tubal ectopic pregnancy from control groups, sensitivity 81.64%, specificity 84.3%, positive predictive value 88.5% and negative predictive value 71.4%. Creatine kinase level in the ruptured ectopic pregnancy group was significantly higher than in the unruptured ectopic pregnancy, and normal pregnancy. When using creatine kinase of 29.43 IU/ml as a cut-off value for the diagnosis of ruptured ectopic pregnancy from unruptured groups, sensitivity 92%, specificity 100%, positive predictive value 100%, negative predictive value 96% and efficiency 97.4%.Conclusions:Women with ectopic had a significantly higher levels of creatine kinase-MB compared with women with normal pregnancy or intrauterine abortion and it has a high discriminatory ability for diagnosis of tubal rupture ectopic pregnancy.Keywords:Ectopic pregnancy, creatine kinase-MB


Article
Ventricular ectopic beats in structurally normal heart: When to stop investigations
دقات خارج الرحم البطيني في القلب الطبيعي هيكليا: متى لوقف التحقيقات

Author: Sabah Z. Zangana
Journal: Zanco Journal of Medical Sciences مجلة زانكو للعلوم الطبية ISSN: 19955588/19955596 Year: 2015 Volume: 19 Issue: 1 Pages: 910-914
Publisher: Hawler Medical Univeristy جامعة هولير الطبية

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Abstract

Background & Objectives: Ventricular ectopic beats (extra systoles, premature beats) are frequently found in healthy people. Ectopic beats in patients without apparent heart disease are more prominent at rest and disappear with exercise. Treatment is not necessary unless the patient is highly symptomatic. Methods: Patients having ventricular ectopic beats were assessed clinically, by ECG and by echocardiography. Those with normal structure hearts underwent exercise ECG and among those we selected 50 patients whose ectopics were suppressed by exercise then followed them for 5 years. The study started from 2000 to 2010. Results: During 5-year follow-up of the above mentioned patients, relevant complications such as dangerous ventricular arrhythmias, ischemic heart diseases or heart failure were not recorded. Conclusions: In patients having ventricular ectopic beats and structurally normal heart, the suppressibilty of the ectopic by exercise indicated their benign origin and may preclude further invasive investigations and even specific treatment.

Keywords

Heart --- Arrhythmia --- Ectopic --- ECG --- Kirkuk


Article
Diagnostic Efficacy of Transvaginal Colour Doppler Sonography in Ectopic Pregnancy

Author: Lilyan W. Sersam
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2007 Volume: 6 Issue: 1 Pages: 63-70
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:BACKGROUND:Ectopic pregnancy continues to be a major cause of maternal morbidity and mortality . A dramatic increase in incidence over time has been reported in several countries. The advent and wide application of ultrasound has greately improved the possibility of non- surgical diagnosis of ectopic pregnancy . Images obtained by the higher frequency and better resolution transvaginal ultrasound scan (TVS) probes facilitates the earlier diagnosis of ectopic pregnancy. The addition of Doppler ultrasound have revolutionised the non-invasive diagnosis of ectopic pregnancy.METHODS:Patients presenting to Al-Yarmouk Teaching Hospital with clinical suspicion of ectopic pregnancy were evaluated using TVUS. Colour flow imaging was performed and resistance indices (RIs) of the artery blood flow were calculated . The pulsatility indices (PIs) of both uterine arteries were also measured and serum β-hCG was quantitated . The Doppler flow results were correlated with surgical findings at laparoscopy or explorative laparotomy .RESULTS:Forty-seven women were enrolled .Six patients with intrauterine gestation were excluded . Tubal pregnancy was diagnosed by TVUS in 28 of 32 patients with ectopic pregnancy, while 30 of 32 patients were diagnosed by colour Doppler sonography. Colour flow in the trophoblastic tissue was detected in 59.3% of the tubal pregnancies, and the mean (±SD) RI of the trophoblastic flow was (0.49 ±0.1) . The RIs tended to decrease at higher β- hCG levels. The average PI of the uterine arteries was (2.29 ± 0.3) . The PIs of the ipsilateral uterine arteries were significantly lower than the contralateral ones. The sensitivity of colour Doppler in the diagnosis of ectopic pregnancy was (93.8%) with accuracy of (85.4%)CONCLUSION:Colour imaging is a good supplementary diagnostic tool in modern management of ectopic pregnancy . The addition of colour Doppler flow imaging to transvaginal sonography allows increased sensitivity in the detection of ectopic pregnancy.


Article
ROLE OF ECTOPIC PROLACTIN ON THYROID HORMONES LEVEL IN A SAMPLE OF IRAQI INFERTILE WOMEN WITH UTERINE FIBROIDS

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Background :A large number of traditional investigations and bioassay of hormones have been practiced in the diagnosis and management of infertility for a long time. Measurements of prolactin and thyroid stimulating hormone have been considered important components of the evaluation of women presenting with infertility.Objectives:To study the effect of prolactin hormone produced from uterine fibroid(s) on thyroid hormones levels and role of these hormones.Methods:One hundred three women with uterine fibroid were entered to the Obstetrics and Gynecology Department in Al-Kadhimyia Teaching Hospital in Baghdad-Iraq from the 15th of June 2007 to December 30th 2010. Fasting serum prolactin, total T3, total T4, and thyroid stimulating hormone (TSH) were estimated using MiniVIDAS [ELFA (Enzyme Linked Fluorescent Assay)] kits.Results:Forty five out of 103 (43.69%) women were found with primary infertility and the rest 58 (56.31%) with secondary infertility. Serum thyroid hormones mean ± standard deviations were found normal before and after surgery in both primary and secondary infertile women. Level of serum prolactin was found elevated about 9 folds in primary infertile women and 8 folds in those with secondry infertility before surgery more than their levels after. No significant difference was found between thyroid hormones before and after surgery in both infertile groups, unlike their prolactin which was found highly significant with p value <0.001 in both groups.Conclusion:It can be concluded that, first, the increase in prolactin level was due to an ectopic production from uterine fibroid(s), and second, there is no effect or role of this prolactin on their thyroid hormones function. Third, their infertility could be due to the presence of prolactin secreting fibroid(s).Keywords:Infertility, Ectopic prolactin, Thyroid hormones, Uterine fibroids


Article
Methotrixate for nonsurgical management of ectopic pregnancy

Author: Ariana Kh. Jawad اريانا كاظم جواد
Journal: Al-Qadisiyah Medical Journal مجلة القادسية الطبية ISSN: 18170153 Year: 2013 Volume: 9 Issue: 16 Pages: 95-108
Publisher: Al-Qadisiyah University جامعة القادسية

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Systemic Methotrexate has been widely used to treat ectopic pregnancy.The aim of current study were to evaluate the safety and efficacy of single dose intramuscular methotrexate as a treatment option for early unruptured ectopic pregnancies. From 1st of January 2007 to 1st of January 2009 at Maternity teaching Hospital-Erbil, a case cohort prospective study was conducted on 60 patients with small unruptured ectopic pregnancies treated as in-patients with single dose of Methotrexate therapy.Ectopic pregnancy was diagnosed by both transvaginal ultrasound for the size and volume of the gestational mass and β-HCG measurement. Intramuscular methotrexate 50 mg/m2 was administered on days 1 and Serial ß-hcg was repeated on days 4 and 7, If the β-HCG on day 7was at least 15% lower than that on day 4, the patient was regarded as treatment success, and Follow-up serum ß-HCG was performed weekly until become negative ( value of <15 mIU/ml). while additional doses(second dose) of methotrexate were given on day 7 If the ß-HCG level on day 7 was the same or higher or less than 15% lower than that on day 4. The success rate of systemic methotrexate (single dose) was 75%(n-45), 25%(n=15) exposed to 2 or more doses of methotrexate ,16.6%(n=10) of patients exposed to multidose methotrexate respond to treatment, remain only 8.3%(n=5) not respond to multidose treatment they were treated surgically ,in which 2 cases of them operation done for them on their request after one dose of methotrexate, and other 3 cases were failed to respond to medical treatment after receiving 3 dose of methotrexate. The over all success rate of treatment in our study(medical treatment) was 91%(n=55).Success rate was higher in patients whom with β-HCG was ≤ 1500 mIU .Treatment was well-tolerated; most side effects were reported as mild and transient. All cases respond to methotrexate reported satisfaction with this regimen. Within two years follow up visit 38 cases become pregnant , 2 of them developed recurrent ectopic pregnancy.

عقار الميثوتريكست استخدم بصوره واسعه لعلاج حالات الحمل خارج الرحم تهدف الدراسة لتقييم مدى سلامة وفعالية استحدام عقار الميثوتريكسيت لعلاج حالات الحمل خارج الرحم المبكر وغير المنفجر. دراسه مستقبليه سريريه تضمنت ستون امرأه في مستشفى الولاده في اربيل للفتره من الاول من كانون الثاني 2007 ولغاية الاول من كانون الثاني 2009 وتم التشخيص باستخدام السونار المهبلي وقياس مستوى β-HCG في الدم . اعطي الميثوتريكسيت بالعضله 50 ملغم /متر مربع في اليوم الاول وتم قياس مستوى β-HCG في الدم في اليوم الرابع والسابع وتم اعتبار العلاج ناجح اذا قل المستوى بنسبة 15% وتم المتابعه اسبوعيا الى ان يصل مستوى سالب.تم اعطاء جرعه ثانيه من العقار في اليوم السابع اذا كان مستوى β-HCG اعلى او يساوي او لم يقل عن 15% عن مستوى اليوم الرابع. نسبة النجاح لجرعه واحده من الميثوتريكسيت كانت 75% و16.6% احتاجوا الى جرع متعدده و 8.3%لم يستجيبوا عولجوا جراحيا عقار الميثوتريكسيت بالعضله يعد سليم و فعال ويمثل بديل عن التداخل الجراحي لحالات الحمل الخارج الرحم المبكر

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