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Article
Seasonal Fluctuation in the Incidence of Duodenal Ulcer

Author: Karim Shalan Al-Araji
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2006 Volume: 5 Issue: 3 Pages: 308-311
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT :BACKGROUND :The aim of this study is to investigate and explain the distribution of patients with symptomatic duodenal ulcer " DU " along the months and seasons of the year and to show whether there is a seasonal fluctuation or not .PATIENTS AND METHOD :The reports of all endoscopically proved DU patients residing in Babylon , Iraq during five years period starting from January 1998 to December 2003. The results were plotted on curves month by month and season by season and then the data were analysed to show their distribution along the seasons of the year and whether there is fluctuation or not.RESULTS :Out of 4006 patients endoscoped , 1846 showed DU in a form of : ulcer , deformity , and stenosis . The highest incidence of DU was observed during winter 607 (32.88%) patients and spring 537 (29.08%) patients , progressively diminishing throughout summer 380 (20.58 ) patients and Autumn 322 ( 17.44% ) patients.CONCLUSION:There is a highly statistical significance " P <0.01 " of seasonal variation in the activity of duodenal ulcer with maximum incidence during Winter and Spring and lower during summer and Autumn .


Article
Factors Affecting Morbidity and Mortality Rates in the Management of Perforated Duodenal Ulcer
العوامل المؤثرة على معدل الاصابات والوفيات في علاج قرحة الاثنى عشري المنفجرة

Authors: Ahmed Abd Al-Raheem AL-Zubaydi احمد عبد الرحيم الزبيدي --- Nada M. Jawad ندى محمد جواد كاظم
Journal: IRAQI JOURNALOF COMMUNITY MEDICINE المجلة العراقية لطب المجتمع ISSN: 16845382 Year: 2006 Volume: 19 Issue: 1 Pages: 69-74
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Abstract: Objectives: To assess the surgical management of perforated duodenal ulcer with regards to certain factors and determined the association of these factors with morbidity, mortality& complication. Patients & Methods: A total number of 60 patients with duodenal perforations were included in this cross-sectional study. They were treated in Baghdad and Tikrit Teaching Hospitals during the period from July 2001 to Dec. 2002. Results: The patients with perforated DU were 55 males 91.7% & five females 8.3% with age ranging from 18-65 years and the mean age was 35 years. Only three died so the case fatality rate was 5%, complications developed in 14(23.3%) patients. Some factors play a role such as age, duration between perforation and treatment, Extent of peritonitis, shock, type of surgery, concurrent medical diseases and, history of DU.Conclusion: We can conclude that elderly shocked patients who presented late and gave at least one concomitant medical disease have significantly higher morbidity, mortality. Key words: Morbidity, Mortality, Perforated Duodenal Ulcer.

الملخص:التعرف على نوعية العملية الجرحية لمعالجة قرحة الاثنى عشري المنفجرة ومعرفة العوامل المؤثرةالتصميم: دراسة مقطعيةالمكان: مستشفى بغداد ومستشفى الكندي التعليمي الطريقة: جمعت المعلومات للمرضى المراجعين(60 مريض) وتم استجواب المرضى عن بعض العوامل المؤثرة ( العمر,تاريخ الاصابة بالقرحة, الصدمة, مدة انفجار القرحة,شدة ومدى التهاب غشاء البريتون, وجود الامراض الباطنية المرافقة ونوع العملية الجراحية التي اجريت)الدراسة بدات من تموز 1998 الى كانون الاول1999 جمعت المعلومات وتم تحليلها باستخدام التكرارات والنسبة المئوية ومربع كاي. النتائج:- كان عدد المرضى60(55 ذكور, 5 اناث) والاعمار بين(18-65 سنة) وعدد الوفيات ثلاثة(5%) والمضاعفات التي ظهرت لدى 14 مريض (23.3%) ودرست كافة العوامل المؤثرة وكان عامل العمر لا توجد علاقة احصائية معنوية بينما في حالة الفترة بين المعالجة وفترة حدوث انفجار القرحة ومدى انتشار التهاب البريتون ومرافقة امراض باطنية اخرى كانت هناك علاقة احصائية معنوية بينما لا توجد هذه العلاقة في حالة الصدمة وتاريخ سابق للقرحة ونوعية العملية الجراحية الاستنتاج:- ان المتقدمين بالعمر ولديهم صدمة قبل مراجعة المستشفى وتاخر حضورهم ولديهم احد الامراض الباطنية المرافقة للمريض كانت هناك علاقة كبيرة في حالة الاصابة والوفيات والمضاعفات.


Article
The Effect of Ramadan Fasting on Duedenal Ulcer Perforation

Authors: Wissam Jaffar Altaee --- Safa M. Mahdi Alobaidi
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2011 Volume: 10 Issue: 3 Pages: 381-387
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Fasting during the month of Ramadan is one of the five holy pillars in the Islamic faith and is an important annual ritual practiced by all Muslims. This involves fasting from dawn to dusk, followed by a break of fast at designated times. The length of fasting varies from ten to 19 hours, depending on the season in which the fasting month of Ramadan falls and the geographical locations.OBJECTIVE:1st to evaluate the relation between Ramadan fasting & duodenal ulcer perforations & 2nd to asses the risk factors of this complications .PATIENTS & METHODS :This is a prospective study in Baghdad Teaching Hospital – Medical City . Data from 231 consecutive patients with perforated duodenal ulcer from the period of October 2007 to December 2010 were collected & analyzed & all the patients were managed surgically after resuscitation in emergency unit .RESULTS :(96/231, 41.6%) of patients with perforated duodenal ulcer during Ramadan vs. (135/231, 58.4%) during the rest of the years . (96/490, 19.5%) of patients with perforated duodenal ulcer from the total number of all patients with acute abdomeninal surgeries during Ramadan. 43 % of patients smoking & 47 % of patients had a previous history of acid peptic disease in Ramadan. 54 % of patients were in between (20 to 40) years age group and the male to female ratio was 6 :1 . 15% patients of perforated duodenal ulcer had history of regular use of non steroidal anti inflammatory drugs.. Erect chest x-ray demonstrated gas under the diaphragm in 86% . Only 2 patients had a previous surgery of duodenal ulcer perforation .CONCLUSION:This study suggests that the incidence of duodenal ulcer perforation is relatively high in Ramadan among the people, who are fasting & have predisposing factors ( smoking , history of acid peptic disease , non steroidal anti-inflammatory drugs ) and need special precaution during this month


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.


Article
ATTRIBUTES OF PATIENTS WITH PERFORATED DUODENAL ULCER IN DUHOK CITY
العوامل التي تؤثر على ثقب قرحة الاثني عشرفي مدينة دهوك

Authors: FERHAD MOHAMMED RASHEED AHMED فرهاد محمد رشيد احمد --- MOWAFAK M. BAHADDIN موفق بهاءالدين النقشبنيدي
Journal: Duhok Medical Journal مجلة دهوك الطبية ISSN: ISSN: 20717334 (online)/ ISSN: 20717326 (Print) Year: 2017 Volume: 11 Issue: 1 Pages: 8-17
Publisher: University of Dohuk جامعة دهوك

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Abstract

Background: Perforation of peptic ulcer is regarded as one of the common abdominal surgical emergencies. The objective of this study was to describe the clinical features and potential risk factors among patients with perforated duodenal ulcer in Duhok city.Subject and Methods: This is a prospective descriptive study done at the Emergency Teaching Hospital in Duhok city, over a period of one year (1st of January,2015- 31st of December,2015).The study included 35patients who were operated upon for perforated duodenal ulcer. The clinical findings and probable risk factors for perforation of the duodenal ulcer were studied.Results: Age of the patients ranged from 15-80 years; the commonest age group affected was the 20-39 years old (54.2%). Twenty-eight (80%) were males. Helicobacter pylori antibodies were positive of in 26 patients (74.2 %) while history of ingestion of non-steroidal anti-inflammatory drugs in 25 (71.4%). Twenty-one patients (60%) were smokers and 10 (28.5%) alcoholic. Past history of chronic peptic ulcer was present in 12 patients (34.2%), positive family history in 4 (11.4) and history of ingestion of steroid in 2 (5.7%). Duration of symptoms for more than 24 hours was present in 20 patients (57.1%), generalized abdominal pain in 19 (54.2%), epigastric pain in 16 (45.7%), nausea in 18 (51.4%), vomiting in 12 (34.2%) and rigid abdomen in 26 (74.2%).Conclusions: Young age, male gender Helicobacter pylori infection, ingestion of non-steroidal anti-inflammatory drugs and smoking, seemed probable risk factors for occurrence of duodenal ulcer perforation. Late presentation was not uncommon.

الخلفية والأهداف: انثقاب قرحة الهضمية تعتبر حالة شائعة بين حالات البطن الطارئة جراحيا. الأسباب الشائعة هي الملوية البوابية ، الأدوية غير الستيرويدية المضادة للالتهابات ، التدخين ، مسبقا مصاب بقرحة الاثني عشر ، الكحول ،التاريخ العائليلانثقاب قرحة الهضمية والادوية الستيرويدية . هذه الدراسة هدّفت لتمييز و وصف عوامل الخطر المحتملة لقرحة الإثني عشري في محافظة دهوك. طرق البحث: الدراسة المتوقّعة ’فيه شملت 35 مريض بقرحة الإثني عشري المنفجره تحضر مستشفى دهوك الطوارئ التعليمي على مدى سنة واحدة( 1 من كانون الثاني 2015- 31 من كانون الاول2015). تمت دراسة عدد من عوامل الخطر المحتملة لانفجار القرحة الاثني عشر .النتائج: خمسة وثلاثين مريضا مصابا بانفجارالقرحة الاثني عشردرست . اعمارهم تتراوح بين 15-80 عاما. أعلى نسبة في الفئة العمرية 20-39 سنة . 28( 80 ٪ )كانواذكورا و 7(20 ٪ )كانوااناث وكانت نسبة الذكور إلى الإناث 4:1. الملوية البوابية كانت إيجابيةفي 26 ( 74.2 ٪ ) مريضا ، 25( 71.4 ٪ ) مرضا كانوا قد استعملوا الادوية غير الستيرويدية المضادة للالتهابات ، و 21( 60 ٪ ) مدخّنو 10 ( 28.5 ٪ ) من المرضى شارب كحول ، والتاريخ الماضي من مرض القرحة الهضمية المزمنة في 12 ( ( 34.2 ٪ ) مريضا ، و 4 مرضى ( 11.4٪ ) لديهم تاريخ عائلي ايجابي و فقط 2 ( 5.7 ٪)مرضا كانوا قد استعملوا الادوية الستيرويدية . مدة العرض أقل من 24 ساعة كانت ( 57.2 ٪ ) و لأكثر من 24 ساعة كانت ( 42.8 ٪ )، وكانت الأعراض المرتبطة آلام في البطن المعمم 19 حالة ( 54.2 ٪ ) ، ألم شرسوفي في 16 حالة ( 45.7 ٪ )، والغثيان في18 (51.4 ٪ ) حالة ، والتقيؤ في 12 ( 34.2 ٪ ) حالة والبطن جامدة في 26 ( 74.2 ٪ ) حالة.الاستنتاجات: الملوية البوابية و تناول العقاقير غير الستيرويدية المضادة للالتهابات تلعب دورا رئيسيا كعوامل خطر في حدوث انثقاب القرحة الاثني عشر . العمر والجنس يعتبران أيضا من عوامل الخطر لانثقاب قرحة الاثني عشر والصدمة ومدة عرض التأخير من العوامل الهامة لنتائج ما بعد العمليات الجراحية . من المستحسن القيام بدراسة أكبر لأن دراستنا هي من الحجم الصغير ( 35 مريضا ) ، لتكون قادرة على جمع المزيد من المعلومات عن مسببات قرحة الاثني عشر المثقبة في دهوك ، وكذلك تفتقر إلى دراسة متابعة طويلة المدى. وضع بروتوكولات لفحص المرضى المحتمل اصابتهم بالقرحة الاثني عشر بواسطة تنظيرالمرئ- المعدي -الإثناعشري ، مثل المدخنين ، شاربي الكحول ومستخدمي العقاقير غير الستيرويدية المضادة للالتهابات المزمنة.


Article
Time effects on accuracy of homemade urease test in diagnosis of H. Pylori

Author: Bashar Ali Saeed
Journal: Muthanna Medical Journal مجلة المثنى الطبية ISSN: 2226146x Year: 2015 Volume: 2 Issue: 2 Pages: 70-75
Publisher: Al-Muthanna University جامعة المثنى

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Abstract

o evaluate the effect of test duration on the sensitivity and specificity of positive urease test for the detection of Helicobacter pylori in patient with duodenal ulcer and gastropathy, and to evaluate the difference of the results of rapid urease test in patients with duodenal ulcer compared to patients with gastropathy. 117 patient "75 patient with duodenal ulcer group (A) and 42 patient with gastropathy group (B)" were included in the study, two sets of gastric biopsies "each contain one antral and one corpus biopsy" were obtained from each patient, one set used to obtain urease test which was read at 30 minutes, 2, 10 and 24 hour after biopsy insertion into the reagent, and the other set used for histopathological examination. 68/75 (90%) patients were tested positive for Helicobacter Pylori by histopathological examination in group (A), in comparison to 35/42 (83%) patient in group (B). The sensitivities of the urease test at 30 min, 2, 10 and 24 hours in group (A) were 45%, 62%, 73% and 99% respectively, corresponding figures for the specificity were 92%, 83%, 80% and 80% respectively. While in group (B) the sensitivities were 42%, 59%, 69%, and 95% respectively, and the specificity was 96%, 88%, 83%, and 81% respectively. The optimum duration of incubation of urease test for a good sensitivity was 24 hours; rapid urease test does not correlate to disease severity.


Article
Incidence, Types and Complications of Chronic Gastric Ulcer (A Change in the Indications of Surgery)

Author: Zuhair Raof Al-Bahrani
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2008 Volume: 7 Issue: 4 Pages: 277-284
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:BACKGROUND:Peptic ulcers are defects in the gastrointestinal mucosa that extend through the muscularis mucosae. They persist as a function of the acid or peptic activity in gastric juice. The natural history of peptic ulcer ranges from resolution without intervention to the development of complications with the potential for significant morbidity and mortality, such as bleeding and perforation.OBJECTIVE:Reviewing the incidence, types, complications and surgical indications for chronic gastric ulcer in Iraq and comparing it with other world reports.METHODS:Retrospective study of the data base for 5166 patients with chronic peptic ulcer disease operated upon between 1965-2000. The incidence of chronic gastric ulcer, their age, sex, race, clinical presentation, diagnosis, types, size of ulcers and the indications of surgery during the period 1965-1980 (Group A) and 1981-2000 (Group B) were reviewed.RESULTS:Among the 5166 patients with peptic ulcer disease,111(2.15%) had chronic gastric ulcer.86 (77.5%) were male and 25 (22.5%) were females. 97 (87%) were Arabs and 14 (12.6%) were Kurds, a ratio: 8.1/1. Age ranges (mean) 19-79 (53.9) years. Duration of illness ranges (mean) 6 months to 9 years ( 4.2 years). 68.5% of patients were among the low socioeconomic classes. 77.9% of males were smokers. Barium study showed the ulcer in the 89 patients examined. Malignancy was excluded by endoscopy and biopsy in 91 and frozen section biopsy during surgery in 49 patients. Types of ulcer were; Type I: 47 (42.3%), Type II: 44 (39.6%), Type III: 14 (12.6%) and Type IV 6 (5.4%) patients. The Size of ulcers was; < 2 cm 23 (20.7%), 2-4 cm 57 (51.4%) and > 4 cm 31 (27.9%) patients. Indications for surgery in Group A (67 patients) versus Group B (44 patients) were; dyspepsia 51 (67.1%) v 11 (25%), gastric outlet obstruction 9 (13.4%) v 18 (40.9%), bleeding 6 (9%) v 13 (29.5%) and perforation one (1.5%) v 2 (4.5%) patients. Surgical procedures were; vagotomy and drainage in 77 (69.4%) and B-I partial gastrectomy in 34 (30.6%) patients. 2 (1.8%) died post-operatively, 11 lost to follow after 6-9 months and 98 patients were followed for 5-32 years. Evidence of recurrent stomal ulcer in one patient.CONCLUSION:The incidence of chronic gastric ulcer in Iraq is low compared to chronic DU a ratio 1/45.5. Mean age 53.9 years. Male/female: 3.4/1 .Arabs/Kurds: 6.9/1 . Coexistence of chronic duodenal ulcer with chronic gastric ulcer was 39.6%. The indications for surgery during the period 1965-1980 versus the period 1981-2000 were; elective in 51 (76%) v 11 (25%) and urgent or emergency in 16 (24%) v 33 (75%) patients. Operations were; vagotomy and drainage in 69.4% and resection in 30.6% of patients.


Article
Surgically Treated Duodenal Ulcer Complications
المعالجة جراحيا مضاعفات قرحة الاثنى عشر

Author: Loay. S. Alnoaimi لؤي سعد النعماني
Journal: The Medical Journal of Tikrit مجلة تكريت الطبية ISSN: 16831813 Year: 2006 Volume: 2 Issue: 122 Pages: 1-7
Publisher: Tikrit University جامعة تكريت

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Abstract

A cross sectional study, based on collection of 159 patients (150 male, 9 female) age range
between 10-90 years with median age of32 years, admitted to tikrit teaching hospital and underwent
emergency surgery for d.u complication over the last 10 years (oct.1993 to oct.2002). In this study
each complication was analyzed according its frequency, its relation to the timing of the
management, and its relation to the progress in medical management .The study showed that there is
declining in the occurrence of d.u disease complications, [at 1993 they received 29 cases (18.2%)
VS 2002 in which (8) case only 5%]. Regarding history of du; 99 patient (62%) gave positive
history of d.u. disease, while the rest of patients 60 (38%)denied any previous disease . Incidence of
complication after emergency surgery was 25 case (15.7%); this is in form of simple wound
infection, abdominal abscess, and respiratory c.v. complications. These operations followed by death
5 cases (31%) and the cause of this mortality were mainly septicemia and respiratory &c. v.
complications, renal failure. Medical treatment does not prevent complication also we found that
there is no special seasonal variation in spite of Perforation which occur more in winter months. 31-
40years-age group, male patients are more susceptible for complications, morbidity and mortality
increased by age and delay in the management

دراسة مقطعية، استنادا إلى مجموعة من 159 مريضا (150 من الذكور و 9 إناث) عمر
نطاق بين 10-90 عاما مع متوسط ​​عمر of32 سنوات، واعترف الى تكريت المستشفى التعليمي وخضع لعملية جراحية طارئة
لدو مضاعفات على مدى السنوات ال 10 الماضية (oct.1993 إلى oct.2002). في هذه الدراسة
تم تحليل كل المضاعفات وفقا تردد، وعلاقتها إلى توقيت إدارة /> في تراجع حدوث مضاعفات مرض دو، [في عام 1993 حصلوا على 29 حالة (18.2٪)
VS 2002 الذي (8) حالة فقط 5٪]. وقدم 99 مريض (62٪) إيجابي تاريخ />

عدوى، خراج في البطن، والسيرة الذاتية في الجهاز التنفسي مضاعفات. وكانت هذه العمليات تليها
5 حالات وفاة (31٪)، وسبب هذه الوفيات تسمم الدم بشكل رئيسي وأمراض الجهاز التنفسي و ج. خامسا
والمضاعفات، والفشل الكلوي. العلاج الطبي لا يمنع المضاعفات كما وجدت أننا
وليس هناك اختلاف موسمي خاص على الرغم من ثقب الذي يحدث أكثر في أشهر الشتاء. 31 -
40years، الفئة العمرية، والمرضى الذكور أكثر عرضة للأمراض، والمضاعفات والوفيات
زاد العمر وتأخير في إدارة


Article
Risk factors for perforated duodenal ulcer in sulaemania city
عوامل خطر الإصابة بقرحة الاثني عشر المثقبة في مدينة السليمانية

Authors: Muhammed Abulrahman Mahmood --- Zanko Sherko Fathalah --- Taher Abdullah Hawrame
Journal: Zanco Journal of Medical Sciences مجلة زانكو للعلوم الطبية ISSN: 19955588/19955596 Year: 2010 Volume: 14 Issue: 3 Pages: 61-66
Publisher: Hawler Medical Univeristy جامعة هولير الطبية

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Abstract

Background and Objective: This prospective study was to evaluate the probable risk factors for perforation of duodenal ulcer, highlighting any prevalent one in the occurrence of perforation in Sulaemania city. The study was designed to be performed on patients with perforated duodenal ulcer attending the emergency department in Sulaemania teaching hospital over the period of this study.Method: This study was conducted between 1st of March 2009 till the 1st of October 2009 involving 50 patients with perforated duodenal ulcer attended the emergency department in Sulaemania teaching hospital. A number of probable risk factors for the patients were studied.Results: Out of 50 patients, 41(82%) were males, 9(18%) were females and the male to female ratio was (4.5:1), about 32% of the patients were more than 60 years old. Patients described themselves as having a nervous personality were 31(62%) and the number of patients lived in city center were 28(56%). Smoker patients were 36(72%) and 33 patients (66%) had a history of NSAIDs ingestion.Conclusion: Smoking, NSAIDs ingestion, sex, age and stress played a major role as risk factors in the occurrence in duodenal ulcer perforation. There is a seasonal variation in incidence of perforation including high incidence during spring and autumn.

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