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Article
LAPAROSCOPIC VERSUS OPEN REPAIR OF PERFORATED PEPTIC ULCER

Authors: Abutalib B Alluaibi --- Ali Y Al-Wajeeh --- Mansour Amin Mohammed
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2017 Volume: 23 Issue: 2 Pages: 53-61
Publisher: Basrah University جامعة البصرة

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Abstract

LAPAROSCOPIC VERSUS OPEN REPAIR OF PERFORATED PEPTIC ULCERAbutalib B Alluaibi@, Ali Y Al-Wajeeh$ & Mansour Amin Mohammed* @MB,ChB, FIBMS, General Surgeon, Al-Mawanee General Hospital, Basrah. $MB,ChB, CABS, General Surgeon, Al-Mawanee General Hospital, Basrah. *MB,ChB, DS, CABS, MRCS, Lecturer, Dept. of Surgery, College of Medicine, Basrah, IRAQ.AbstractPeptic ulcer is the most common GIT disorder with a prevalence of 2%, peaking around the age of 70 years. Laparoscopic repair of perforated peptic ulcer began to evolve and replace the ordinary upper laparotomy. We studied 47 patients suffering from perforated duodenal or gastric ulcer in Al-Mawanee General Hospital in Basrah in the period 2014-2017, the patients were categorized into 2 groups: 1st group(24 patients) managed laparoscopically and the 2nd group (23 patients) managed by open approach. Perforation found to occur more with duodenal ulcer (29 pt. 61.70%) and more in male patients (26 pt. 55.33%). The peak perforation seen in age group >60 years and the commonest risk factors was the NSAIDs usage. Operative time was insignificantly longer in laparoscopic approach. However, the laparoscopic approach has less post operative pain and less overall complications (4 pt. 16.6% vs. 8 pt. 34.7%). In conclusion, laparoscopic repair of perforated peptic ulcer is a feasible operation andconsidered promising with less postoperative pain, less postoperative complications and better cosmetic results.


Article
Risk factors in perforated peptic ulcer disease: Incidence and relation to morbidity and mortality

Author: N S Jabbo
Journal: Mustansiriya Medical Journal مجلة المستنصرية الطبية ISSN: 20701128 22274081 Year: 2013 Volume: 12 Issue: 1 Pages: 35-44
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Background: Today, the hospital admission and surgical management for peptic ulcer disease is largely restricted to the treatment of its complications.Aims: To study the risk factors of perforated peptic ulcer.Patients and Methods: A prospective study of 118 patients presented with perforated peptic ulcers between January 2009 and December 2011 at Al- Yarmouk Teaching Hospital. A detailed history was documented including the proposed risk factors of age, gender, occupation, social habits and associated medical illnesses.Results: The total number of patients was 118 patients. Out of these, 101 were males (86%) and 17 were females (14%); with the male: female ratio being 6:1. Patients in the fourth decade constituted the highest proportion of cases (38%); 78% non-professional employers; 43.2% used ulcerogenic drugs; 72.9% were smokers and 14.4% consumed alcohol. Negative history of peptic ulcer diseases were documented in 64.4%; 19.5% had associated medical; 44% had blood group O and H. pylori infection was positive in 75% of cases. Regarding the risk factors, H. pylori and smoking were more related.Conclusions: Nonprofessional employer males in the fourth decade of life were the commonest in this collection. Combined risk factors of H. pylori and the use of NSAID formed the highest risk. Negative past history, those with group O and smoking were important risk factors in this study. Regarding the relation of risk factors to morbidity and mortality, medical co-morbidities & smoking had significant relation


Article
Assessment Of Dietary Pattern For Patients With Peptic Ulcer
معرفة النمط الغذائي للمرضى المصابین بقرحة المعدة

Author: Athra,a karim Hussein AL-Bahadli
Journal: kufa Journal for Nursing sciences مجلة الكوفة لعلوم التمريض ISSN: 22234055 Year: 2013 Volume: 3 Issue: 2 Pages: 214-221
Publisher: University of Kufa جامعة الكوفة

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Abstract

Objective: To assess dietary pattern that may contribute to the occurrence of peptic ulcer as risk factors and find out the relationships between dietary pattern indicators and some demographic characteristics (age groups& gender) of the patients with peptic ulcer.Methodology: A descriptive study was carried out in liver and digestive disease hospital and Al-Kadhmiya Teaching Hospital in Baghdad city during the period from March/13/2012 to June/10/2012. A purposive( non- probability) sample was selected that consisted of(100) patients with peptic ulcer their age between(20-60) years old. A questionnaire format and observational checklist were used which consist of three parts the first part includes demographic information of the sample, the second part includes risk factors information and the third part includes dietary pattern indicators distributed to(18) items. The data were collected through the utilization of questionnaire and the structure interview technique with peptic ulcer patients, the interview with each patient took approximately( 12-15) minutes. The data were analyzed by using descriptive statistical measures which included frequencies& percentage, as well as the use of inferential statistical measures which include Chi- Square(X2) and p- value.Results: The results of the study sample have revealed that more than one third of patients with peptic ulcer were with the age group(20-29) years, mostly females, college graduate, married and government employee( officer). However, the greater number of these patients were non smoker and not drinking alcohol. Most patients with peptic ulcer were(63%) always eat hot foods.Conclusions; The study concluded that there was a significant differences between dietary pattern indicators with age and gender. Recommendations: The study recommended that:1-Educational program should be designed to increase people information toward the disease and to reduce the risk of peptic ulcer.2-A booklet should be prepared and presented to patients with peptic ulcer as guide for the management of the disease.

الهدف: تقييم النمط الغذائي للمرضى المصابين بقرحة المعدة وإيجاد العلاقة بين النمط الغذائي وبعض الصفات الديموغرافية بين الفئات العمرية والجنس. المنهجية: دراسة وصفية أجريت في مستشفى أمراض الكبد والجهاز الهضمي ومستشفى الكاظمية التعليمي في مدينة بغداد خلال فترة الثالث عشر من آذار ولغاية العاشر من حزيران 2012حيث تم اختيار عينة غرضيه( غير احتمالية) مكونة من (100) مريض مصاب بقرحة المعدة تراوحت أعمارهم ما بين(20-60) سنة وتم استعمال استبانه مصممة من ثلاثة أجزاء تضمن الجزء الأول المعلومات الديموغرافية للعينة والجزء الثاني يتضمن عوامل الخطورة والجزء الثالث يتضمن مؤشرات النمط الغذائي موزعة على(18) فقرة تم جمع المعلومات من خلال استمارة الاستبانة وبطريقة المقابلة الشخصية للمرضى, واستغرقت المقابلة مع كل مريض مابين (12-15) دقيقة وتم تحليل بيانات الدراسة من خلال استعمال الإحصاء الوصفي الذي تضمن التكرارات والنسب المئوية, علاوة على استعمال الإحصاء ألاستنتاجي الذي شمل مربع كاي والقيمة الاحتمالية. النتائج: أظهرت نتائج الدراسة إن أكثر من ثلث المرضى المصابين بقرحة المعدة ضمن الفئة العمرية (20-29) سنة واغلبهم من الإناث, ومن خريجي الجامعات, متزوجون وموظفين حكوميين وان معظم هؤلاء المرضى لا يدخنون ولا يتناولون الكحول وأكثر المصابين بقرحة المعدة دائما يتناولون الأطعمة الحارة الاستنتاجات: استنتجت الدراسة ان هناك دلالة احصائية ذات مستوى معنوي بين النمط الغذائي والعمر والجنس.التوصيات: اوصت الدراسة بالاتي: 1- برنامج تثقيفي يجب أن يصمم لزيادة معلومات الناس حول المرض وللتقليل من خطر الإصابة بالمرض.2- اصدار كتيب يجب أن يهيئ ويقدم للمرضى المصابين بقرحة المعدة كدليل للتكيف مع المرض


Article
Evaluation The Protective Effect of Catharanthusroseus Extract on Induced Peptic Ulcer in Male Rabbits

Author: Rusul Ali kadhem
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2016 Volume: 13 Issue: 4 Pages: 762 -771
Publisher: Babylon University جامعة بابل

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Abstract

The goal of this study is to evaluate the role of Catharanthusroseus alcoholic extraction for treatment of induced peptic ulcer in male rabbits in which there was thirty male , the animals was divided in five groups normal control given only distal water, active control given 500 mg/kg acetyl salsylic acid orally, standard group received single dose 20mg/kg IP of omeprazole follow by 500mg/kg acetyl salsylic acid, the fourth and fifth group received 20, 30mg/kg subsequently ofC. roseusextract orally by stomach tube one hour before acetyl salsylic acid 500mg/kg orally, macroscopically significant protective effect of C.roseus extract show in dose of 30mg/kg about 61.97%, microscopically in both 20,30mg/kg the sign of healing process were detected which was approximately same as that appear in the standard group, measuring serum level of pro-inflammatory cytokines (IL-4and IL-8),showed there was significant reduction in there level at same level in both doses ,so as conclusion the alcoholic extraction of C.roseus had an antiulcerognic effect with significant reduction in the both IL-4 and IL-8.


Article
The Role of Some Medicinal Plants in the Management of Peptic Ulcer

Author: Faruk H. Al-Jawad فاروق الجواد
Journal: Al-Kindy College Medical Journal مجلة كلية الطب الكندي ISSN: 18109543 Year: 2011 Volume: 7 Issue: 2 Pages: 51-58
Publisher: Baghdad University جامعة بغداد

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Background: Plants used in folk medicine for the treatment of peptic ulcer diseases is a very promising approach to overcome the limitations of classical medicines. Aim: To explore the efficacy of medicinal plants, namely turmeric, garlic and marshmallow, in eradication of H. pylori. Methods: This prospective study was carried out on 225 of well-known dyspeptic patients who were divided into four groups; a control group (received classical medical therapy) and three other groups that received one of the three medicinal plants, plus the same therapy used in the control group. The follow up was done by using a questionnaire form, endoscopic examination, and determination of serum levels of anti H.pylori antibodies & gastrin by using ELISA test. In addition, liver enzymes were monitored by using spectro-photometer to prove the safety of medicinal plants. Results: The rate of recurrence of peptic ulcer disease was decreased in patients who received the combined therapy when compared to the patients in control group. Medicinal plants were effective in decreasing the recurrence of H. pylori infection when each one of them was used in combination with the medical therapy without causing harmful effects on the liver. Conclusion: Turmeric, garlic & marshmallow are effective in management of peptic ulcer with low cost.


Article
Peptic Ulcer in a Group of Iraqi Diabetic Patients
القرح الهضميه لدى مجموعه من المرضى العراقيين المصابين بداء السكري

Authors: Sarab K. AL-Rawy د.سراب خاشع الراوي --- Sabeha Al-Bayati د.صبيحه البياتي
Journal: IRAQI JOURNALOF COMMUNITY MEDICINE المجلة العراقية لطب المجتمع ISSN: 16845382 Year: 2010 Volume: 23 Issue: 3 Pages: 190-195
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Background: Both acute and chronic hyperglycemia can lead to specific gastrointestinal (GI) complication.H.pylori infection is well established cause of dyspepsia, although all the three factors; lifestyle, digestive fluids, and H.pylori infections may play a role in ulcer development.Objective:-This study attempts to determine the role of some factors like lifestyle, duration of dyspeptic symptoms, state of diabetic control and H.pylori infection in diabetic patients.Methods:-The study was carried in the endoscopy unit of Al-Yarmook Teaching hospital. The total blood samples of 178 subjects with 80 antral biopsies obtained from four groups; 30 diabetic with peptic ulcer (P.U) as patients group and control groups involving 54 non diabetic with no peptic ulcer, 50 non diabetic with peptic ulcer and 44 diabetic with no peptic ulcer. All participants answered a special questionnaire, and every gastric biopsy specimen was subjected to cultural, histology, rapid urease test for H.pylori diagnosis in addition to blood samples for enzyme- linked immunesorbent assay ( ELISA) as a serologic study and to estimate plasma glucose level.Results: Some dietary factors such as spicy foods 60% and smoking 54% had more influence on the incidence of H.pylori infection with peptic ulcer disease (PUD). Some dyspeptic symptoms (nausea/ vomiting 93.3%, loss of weight 80%, hematemesis /N-melaena 67%) are seen more in diabetic with P.U.D(patients group) when compared with the other control groups. ELISA test for diagnosis of H.pylori infection revealed that there is no significant difference (P>0.05) to the incidence of H.pylori infection in diabetes either with PU 40% or with no PU 59%. The H.pylori infection was positive in diabetic with P.U (patients group) 73.3% who have dyspeptic symptoms <1year, when compared with (control group) non diabetic with P.U 34% (P<0.01).Conclusion: Some dietary factors and smoking increased the incidence of P.U.D. Poor glycemic control was not associated with significant increase in the incidence of P.U.D. Duration of dyspeptic symptoms < 1 years with positive result for H.pylori infection was higher in diabetic patients with P.U.DKeyword: H.pylori, peptic ulcer, diabetes mellitus.

الخلفيه:يؤدي ارتفاع نسبه السكر بالدم سواء الحاد منه او المزمن الى حصول اختلاطات معدّيه معويه ،حيث ثبت ان الاصابه بجرثومه الملويه البوابيه يسبب عسر الهضم ،على الرغم من ان العوامل الثلاثه وهي :طريقه المعيشه ،السوائل الهاضمه والاصابه بجرثومه الملويه البوابيه بمجموعها تلعب دورافي تطور القرح الهضميه.الهدف:تهدف الدراسه لتحديد دور عده عوامل منها :طريقه المعيشه ،ارتفاع نسبه السكر بالدم، المده الزمنيه اللازمه لظهوراعراض عسر الهضم وغيرها والتي تعد كعوامل مؤثره في امكانيه حدوث امراض القرح الهضميه وبالتالي تشخيص الاصابه بجرثومه الملويه البوابيه لدى المرضى المصابين بداء السكري.طريقه البحث:اجريت الدراسه بوحده الناظور/مستشفى اليرموك التعليمي،و تضمنت الدراسه 178 عينه دم و80 خزعه نسيجيه والتي اخذت من الغار المعدّي ،حيث شملت الدراسه 30 من المرضى المصابين بداء السكري والقرح الهضميه ومجاميع السيطره المتضمنه 54 غير مصابين بداء السكري ولا القرح الهضميه و50 مصابين بالقرح الهضميه فقط و44 مصابين بداء السكري فقط. لقد اجاب المشاركين علىالاسئله الخاصه بنموذج الاستطلاع ،كما واخضعت عينات الخزع النسيجيه التي اخذت من الغار المعدّي لكل مريض يعاني من القرح الهضميه سواء أكان مصابا او غير مصابا بداء السكري الى الزرع البكتريولوجي ،الفحص النسيجي وتحليل اليوريز السريع لتشخيص جرثومه الملويه البوابيه كما وشخصت باستخدام طريقه مقايسه الممتز المناعي المرتبط بالانزيم والتي اجريت على مصول كل من مجاميع المرضى والسيطره والذين تم فحص مستوى السكر بالدم لديهم. النتائج:اوضحت النتائج ان هناك بعض العوامل المرتبطه بعادات الغذاء كالتوابل وبنسبه60% والتدخين وبنسبه54% تكون ذات تاثير اكبر على المرضى المصابين بالقرح الهضميه. لوحظ ان بعض اعراض عسر الهضم ( كالغثيان والتقيء 93.3 % ، وفقدان الوزن 80% ،وقيئ الدم 67%) كانت بنسبه اعلى عند المرضى المصابين بداء السكري والقرح الهضميه (مجموعه المرضى) مقارنه بمجاميع السيطره،وان 59% من مرضى السكري والمصابين بالقرح الهضميه( مجموعه المرضى) و40% من المصابين بالسكري فقط( مجموعه السيطره)قد اعطوا نتائج ايجابيه لجرثومه الملويه البوابيه باستخدام طريقه مقايسه الممتز المناعي المرتبط بالانزيم والتي اجريت على مصولهم حيث لم تكن النتائج ذات تاثير مقبول معنويا،كما واعطت التنائج الخاصه بتشخيص جرثومه الملويه البوابيه نسبه 73.3% لدى المرضى المصابين بداء السكري والقرح الهضميه( مجموعه المرضى) واللذين يعانون من ظهور اعراض عسرالهضم(<1سنه) مقارنه بالمرضى المصابين بالقرح الهضميه فقط (مجموعه السيطره)34% حيث كانت النتائج مقبوله احصائياP<0.05.الاستنتاجات: ان لبعض العادات الغذائيه والتدخين تاثير في زياده نسبه الاصابه بالقرح الهضميه لدى المرضى المصابين بداء السكري كما وان عدم او ضعف السيطره على نسبه السكر بالدم لا يعد من العوامل التي تزيد من نسبه الاصابه بالقرح الهضميه وان وجود اعراض عسر الهضم لمده تقل عن السنه واللذين اعطوا نتائج ايجابيه لجرثومه الملويه البوابيه كانت بنسبه اعلى لدى المرضى المصابين بداء السكري والقرح الهضميه.


Article
Study of Helicobacter pylori among a sample of Iraqi diabetic patients with peptic ulcer disease
دراسه لجرثومه الملويه البوابيه المعزوله من المرضى العراقيين المصابين بداء السكري والقرحه الهضميه

Authors: Amria H. Shubber د.اميره حسين شبّر --- Dhuha S. Saleh د.ضحى سعد صالح --- Sarab K. Al-Rawy د.سراب خاشع الراوي
Journal: IRAQI JOURNALOF COMMUNITY MEDICINE المجلة العراقية لطب المجتمع ISSN: 16845382 Year: 2010 Volume: 23 Issue: 2 Pages: 114-120
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Abstract:Background: - Whilst upper gastrointestinal disturbances are frequently observed in patients with diabetes mellitus. We want to know the prevalence of Helicobacter pylori infection and peptic ulcer disease in Iraqi diabetic patients.Objective: - The present study is an attempt to determine the prevalence of Helicobacter pylori in a sample of Iraqi diabetic patients with peptic ulcer disease by applying different diagnostic criteria.Methods:-This case-control study was carried at the gastrointestinal unit of Al-Yarmouk Teaching Hospital. The total of 80 samples (blood & antral biopsies) from patients and control groups with an age range of 20-80 years including 30 diabetics with peptic ulcer, and a control group of 50 non diabetic with peptic ulcer. Every gastric biopsy specimen was subjected to cultural, histological and rapid urease test and blood samples to measure the value of glucose level in all study groups. Results: - Of the total studied patients 30 diabetics have peptic ulcer (P.U) H. pylori was present in 60% of patients as evaluated by culture and rapid urease test, compared to the non diabetic with peptic ulcer (control group) as evaluated by culture (48%) and in rapid urease test (52%).Histological method revealed 76.66% of patients showed positive H. pylori infection while the control group showed 48% only.Conclusion:-The prevalence of H. pylori infection was found to be significantly higher in patients group of diabetic with peptic ulcer and dyspepsia than in control group (P<0.05). In patients group histological method showed high percentage and more accurate results for diagnosing the positive H. pylori infection when compared to the culture and RUT. Keyword:-H. pylori, peptic ulcer disease and diabetes mellitus.

الملخص:الخلفيه:يتعرض المرضى المصابين بداء السكري وبنسبه عاليه الى الاضطرابات المعدّيه/المعويه.وعليه كان لا بد من ان نتعرف علىنسبه انتشارجرثومه الملويه البوابيه كمسبب للقرح الهضميه في المرضى العراقيين المصابين بداء السكري.الهدف:تضمنت هذه الدراسه تحديد نسبه انتشار جرثومه الملويه البوابيه كمسبب ايجابي للقرحه الهضميه لدى المرضى العراقيين المصابين بداء السكري وذلك بتطبيق عده طرق تشخيصيه.طريقه البحث:تناولت هذه الدراسه مجاميع المرضى الوافدين الى وحده الناظور/قسم الباطنيه التابع لمستشفى اليرموك التعليمي. وتضمنت الدراسه 80 عينه دم وخزعه نسيجيه جمعت للفئات العمريه (20-80) سنه حيث شملت 30 من المرضى المصابين بداء السكري والقرحه الهضميه و50 من المرضى المصابين بالقرحه فقط كمجموعه سيطره,حيث اخضعت الخزع النسيجيه التي اخذت من الغار المعّدي سواء اكان مصابا او غير مصاب بالسكري الى الزرع الجرثومي على الوسط الانتقائي لعزل الجرثومه،تحليل اليوريز السريع والفحص النسيجي،اضافه لفحص مستوى السكر بالدم والذي اجري على مصول كل من مجاميع المرضى والسيطره. النتائج: من مجموع30 مريضا مصابا بالسكري والقرحه المعّديه كان وجود الجرثومه وبطريقتي الزرع واليوريز بنسبه 60% في حين كانت النسبه 76.66% بطريقه الفحص النسيجي ،مقارنه بمجموعه السيطره وهم المرضى المصابين بالقرحه فقط حيث كانت نتيجه الزرع بنسبه 48% واليوريز بنسبه 52% والفحص النسيجي بنسبه 48% . والاستنتاجات: لوحظت زياده واضحه احصائيا لأنتشارالخمج بالملويه البوابيه عند مجموعه المرضى المصابين بالسكري والقرحه المعّديه ويعانون من اعراض عسر الهضم مقارنه بمجموعه السيطره((P<0.05.كما ولوحظ ان طريقه الفحص النسيجي لدى مجموعه المرضى كانت ذات كفاءه و نسبه عاليتين في اعطاء نتائج ايجابيه لتشخيص جرثومه الملويه البوابيه مقارنه بالطرق التشخيصيه الاخرى.


Article
CLINICO-EPIDEMIOLOGICAL STUDY OF PEPTIC ULCER DISEASE AMONG CHILDREN IN THREE TERTIARY HEALTH CARE CENTRES IN BAGHDAD

Authors: Wafaa F. Tawfeeq وفاء فائق توفيق --- Mohammad F. Ibraheem محمد فاضل ابراهيم --- Zainab G. Kadhem زينب غان كاظم
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2013 Volume: 11 Issue: 4 Pages: 381-387
Publisher: Al-Nahrain University جامعة النهرين

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Background:Peptic ulcer is diagnosed at endoscopy where there is a mucosal break of 5mm or larger covered with fibrin. Mucosal breaks smaller than 5 mm are called erosions that do not penetrate the muscularis mucosa whereas an ulcer extends through the muscularis mucosa in the sub-mucosa.Objective:To determine the clinical picture, epidemiological aspectof peptic ulcer in children from birth to sixteen years of age and determine the relationship of the clinico-epidemiological aspect of the disease and the socio-demographic features.Methods:Fifty-three patients with an age ranged from birth to 16 years presented with gastrointestinal tract complaint and diagnosed to have peptic ulcer by endoscopic findings. The data was collected by viewing the case sheet of every child included in the study using special questionnaire to obtain socio-demographic information.Results:The mean age was (10.73±5.2) and the majority of the patients (54.72%) were in the age range (11-16) years old, with a male to female ratio of 2.5:1. Duodenal ulcer (66.04%) is more common than gastric ulcer (33.96%). There is significant association between age groups and type of peptic ulcer. Negative family history was found in (71.7%) of patients. Hematemesis is the most common clinical feature present in (69.81%).Conclusions:It is important to investigate children with recurrent abdominal pain, nocturnal pain and positive family history of the disease. Further studies for longer duration are required to follow up complications and healing or chronicity to the adult life.Key words:Peptic ulcer, children, clinico-epidemiological view.


Article
The incidence of Non Steroidal Anti-Inflammatory drugs as a causative agent of peptic ulcer diseases

Author: Hassan KH Rajab
Journal: The Medical Journal of Tikrit مجلة تكريت الطبية ISSN: 16831813 Year: 2016 Volume: 2 Issue: 2 Pages: 154-162
Publisher: Tikrit University جامعة تكريت

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Article
Risk Factors for Acute Perforated Duodenal Ulcers in Erbil Governorate-Kurdistan, Iraq
عوامل الخطر لقرحة الاثني عشر الحادة في محافظة أربيل - كوردستان، العراق

Authors: Sherwan Ahmed Garota --- Abdulqadir Maghded Zangana
Journal: Zanco Journal of Medical Sciences مجلة زانكو للعلوم الطبية ISSN: 19955588/19955596 Year: 2009 Volume: 13 Issue: 1 Pages: 1-5
Publisher: Hawler Medical Univeristy جامعة هولير الطبية

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Abstract

Background and objectives: Acute perforations of duodenal ulcers continue as one of the real emergencies of surgery which require immediate attention and prompt operation. The aim of this study was to evaluate the probable risk factors for perforation of duodenal ulcer, highlighting any prevalent one in the occurrence of perforation in Erbil governorate. Design: Retrospective study. The cases were selected on the basis of structured protocol. Setting: The study was performed on 124 patients with perforated duodenal ulcer attending the emergency departments of the three major hospitals in Erbil city (Erbil emergency hospital, Hawler teaching hospital and Hawler private hospital) Erbil governorate located in Iraqi Kurdistan over a period of 4 years.Methods: The study was performed on 124 patients with perforated duodenal ulcer over a four year period (Jun. 2000- Jun. 2004). A number of probable risk factors for perforation of the duodenal ulcer were studied. Asymptomatic patients who perforated were studied as a separate group.Results: one hundred twenty four patients with duodenal ulcer perforation were studied, 111 male and 13 female (male to female ratio 8.5:1) about 60% of patients were within their 4th and 5th decade of age. Patients residing in the rural areas had a lower incidence of perforation (39%) than that living in the urban areas (61%). seventy four patients (59.6%) were asymptomatic before they developed the perforation. Sixty six patients (53.2% of the total number) developed the perforation during Ramadan fasting months (four out of the total 48 months), sixty five percent of the cases were smokers. Stress and smoking played a significant rule in the occurrence of perforation in 83% of cases.Conclusions: Stress, smoking and fasting played a major rule as a risk factor in the occurrence of duodenal ulcer perforation. A high incidence of perforation occurs during the months of Ramadan fasting, especially those without or on irregular treatment. The incidence of asymptomatic patients who were fasting and under stress, who then perforated was high.

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