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Article
Marsupialization after Undermining Excision and Flap-Like Margin Creation vs. (Marsupialization Only) or (Excision and Laying Open) Treatments for Pilonidal Sinus (PNS)

Author: Hadi Awad Hmoud
Journal: Karbala Journal of Medicine مجلة كربلاء الطبية ISSN: 19905483 Year: 2016 Volume: 9 Issue: 2 Pages: 2432-2335
Publisher: Kerbala University جامعة كربلاء

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Abstract

bAckground: Pilonidal disease treatment should be minimal, minimal pain, short hospitalization, low recurrence rate, minimal wound care, and allow rapid return to normal activity. Unfortunately, no treatment meets all these ideal goals.Aim: This study is conducted to find out a modality treatment for PNS that can achieve the above goals.Methodology: It is a retro and prospective study of 51 patients presented with PNS.All were divided randomly into 3 groups; First group treated by excision of the sinuses and laid the wound open. Second group treated by excision and marsupialization and third group treated by excision of skin containing sinuses’ openings only and further undermined (beneath the skin) resection of the infected tissues with flap forming with marsupialization of flap margins to the sacral fascia .Results: Healing time; Third group healed earlier.Post-operative painkillers; Third group needed less painkillers for shorter time.Return to daily activities; Third group return to their jobs and life activities earlier.Infection: Third group had only one case of cellulitis.Recurrent PNS; zero patient from third group had recurrent cellulitis.Discussion: Third group modality will reduce the tension on sutures and reduce the postoperative pain, and loosening sutures, also further reduces the recurrence rate.Conclusion: Third group modality yields a promising results in term of reducing the healing time, post-operative pain, recurrence of PNS and infection rates.It could be widely adopted, and would be largely cost-effective modality, as it will reduce the expenses of caring for wound, antibiotics use, painkiller use and the early return to the job.


Article
The Role of P53 nuclear Protein in Prediction of Progression and Recurrence of Superficial Tumor of the Bladder in Response to Intravesical Chemotherapy

Authors: Montadhar Hameed Nima --- Rasha Abbas Azeez
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2011 Volume: 10 Issue: 4 Pages: 531-535
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND :p53 gene is the most common mutation in human cancers.In bladder cancer, p53 mutations have beenassociated with high tumor grades and advanced stages.Moreover,p53 nuclear over expressionappears to be an independent predictor of disease progression and decreased survival aftercystectomy.OBJECTIVE:To identify the role of p53 nuclear protein in prediction the progression and recurrence of superficialtumor of the bladder in response to intravesical chemotherapyPATIENTS AND METHOD :The expression of p53 protien was studied by immunohistochemical analysis from 71 patients withsuperficial tumor bladder and all of them were treated by intravesical chemotherapy followedperiodically every three months by cystoscopyRESULT :P53 over expression was observed in 38out of 71(54%) patients with superficial tumor of the bladder.A statisticaly significant relation was noticed between P53 over expression and tumor grades ,however statistical significant relation between p53 negative expression and response to intravesicalmitomycin C chemotherapy was noticed , moreover , patients who received intravesical mitomycinC chemotherapy , 71% showed response with in 3 month , while 29% showed recurrence .Moreover, it seems that P53 status did predict response to intravesical mitomycin C chemotherapy.CONCLUSION :The response of intravesical chemotherapy in patients with superficial transitional cell carcinoma washigher in p53 negative expression.


Article
The Role of P53 nuclear Protein in Prediction of Progression and Recurrence of Superficial Tumor of the Bladder in Response to Intravesical Chemotherapy

Authors: Montadhar Hameed Nima --- Rasha Abbas Azeez**
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2010 Volume: 9 Issue: 4 Pages: 531-535
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND :p53 gene is the most common mutation in human cancers.In bladder cancer, p53 mutations have beenassociated with high tumor grades and advanced stages.Moreover,p53 nuclear over expressionappears to be an independent predictor of disease progression and decreased survival aftercystectomy.OBJECTIVE:To identify the role of p53 nuclear protein in prediction the progression and recurrence of superficialtumor of the bladder in response to intravesical chemotherapyPATIENTS AND METHOD :The expression of p53 protien was studied by immunohistochemical analysis from 71 patients withsuperficial tumor bladder and all of them were treated by intravesical chemotherapy followedperiodically every three months by cystoscopyRESULT :P53 over expression was observed in 38out of 71(54%) patients with superficial tumor of the bladder.A statisticaly significant relation was noticed between P53 over expression and tumor grades ,however statistical significant relation between p53 negative expression and response to intravesicalmitomycin C chemotherapy was noticed , moreover , patients who received intravesical mitomycinC chemotherapy , 71% showed response with in 3 month , while 29% showed recurrence .Moreover, it seems that P53 status did predict response to intravesical mitomycin C chemotherapy.CONCLUSION :The response of intravesical chemotherapy in patients with superficial transitional cell carcinoma washigher in p53 negative expression.


Article
Recurrent Breast Cancer Following Modified Radical Mastectomy and Risk Factors
دراسة النكس لسرطان الثدي بعد استأصال الثدي

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Abstract

Background: - Recurrent breast cancer is cancer that comes back following initial treatment. Risk factors of recurrence are lymph node involvement, larger tumor size, positive or close tumor margins, and lack of radiation treatment following lumpectomy, younger age and inflammatory breast cancer.Objective: Asses the rate of recurrence for early breast cancer in Iraqi female patients, in relation to certain risk factors. Patients and methods: _ A prospective study was conducted on 100 consecutive female patients, with stage I and stage II breast cancer treated by mastectomy and axillary dissection by the same team. Patients were assessed postoperatively every three months and recurrences were detected by physical examination and ultrasound of the bed of mastectomy and axilla. Statistical correlation using univariant analysis between recurrence rate and certain associated variables was done. Results: - Recurrence rate was found to be 13%. It was more common among both young (20-29) years &the (40 – 49 ) years age groups which was 16.7%. Most of recurrences (61.6%) occurred (within 12_19 months) after surgical treatment. Statistically significant associations were found between recurrence and the latency period between first complaint and surgical management, the grade of the tumor, the size of primary tumor, and the number of lymph nodes involved. There was no statistically significant association between the type of adjuvant therapy and the incidence of local recurrence. Conclusions: the rate of recurrence after modified radical mastectomy is relatively high in our study. The same known risk factors related to the stage, grade and delay of treatment were detected, and close follow up especially at the first 20 months after surgery is recommended.Keywords: breast cancer, recurrence, risk factors, adjuvant therapy

المقدمة: هذه الدراسة قد أجريت لتقدير درجة النكس لسرطان الثدي بعد التداخل الجراحي لسرطان الثدي المبكر القابل للتداخل الجراحي ( سرطان الدرجة الاولى والثانية )في الوحدة الجراحية الأولى و مستشفى الرحمة الأهلي .عدد المرضى الكلي الذين ادخلوا في الدراسة كان مئة وسبعة عشر مريضا عراقيا جميعهم من الاناث وتمت متابعتهم من كانون الثاني 2007 ولغاية نهاية شهر كانون الاول 2010 باقل فترة متابعة وقدرها سنتين .حصل النكس للورم بعد اجراء عملية استئصال الثدي لثلاثة عشر مصابة بهذا المرض او ما يعادل (13%) من المريضات اللواتي ادخلن اصلا في الدراسة .حصل أغلب النكس (61,6%) ما بين الشهر الثاني عشر والتاسع عشر بعد التداخل الجراحي.جدار الصدر ومنطقة الابط كانا الموقعين الرئيسين لحصول النكس الموضعي بنسبة (7) مريضة أي( 53,8%) ،(4) مريضات أي (30%) على التوالي . اما النكس البعيد فحصل لمريضتين بنسبة(15,3 %). لقد وجدنا علاقة ترابطية ذات قيمة بين درجة النكس الموضعي و كل من :1-فترة التأخير بين شكوى المريضة الاولى واتخاذ الاجراء الجراحي .2-حجم الورم الاولي .3-عدد العقد اللمفاوية المتأثرة بالورم الاولي .4-مرحلة الورم الأولي عند إجراء الجراحة.5-درجة التمايز الخلوي للورم الأولي.فيما وجدنا الترابط غير ذي قيمة بين درجة النكس الموضعي و كل من :1-العمر .2-المستوى الثقافي .3-المستوى الاجتماعي المعاشي .4-مكان الورم الأولي.5-نوع العلاج المساعد .6-الحالة الزوجية .7-عدد الولادات والإرضاع .8-التاريخ العائلي بخصوص المرض .9-النوع النسيجي للورم.الاستنتاج:نستنتج أن هناك زيادة حادة في عدد اصابات سرطان الثدي عند النساء في السنوات الاخيرة وان درجة النكس لسرطان الثدي بعد اجراء التداخل الجراحي عاليا نسبيا للمريضات اللواتي ادخلن في هذة الدراسة مما يتطلب تكثيف المتابعة والفحص الدوري على المرضى لاستكشاف حصول النكس خصوصا خلال أول عشرين شهرما بعد التداخل الجراحي الأولي كما يتطلب تكثيف برامج الفحص الدوري لاستكشاف الورم في مراحله المبكرة لتقليل درجة النكس


Article
Using mesh hernioplasty to patient with inguinal Hernia

Author: Fadhil A. Mohialdeen
Journal: Al-Qadisiyah Medical Journal مجلة القادسية الطبية ISSN: 18170153 Year: 2012 Volume: 8 Issue: 14 Pages: 32-43
Publisher: Al-Qadisiyah University جامعة القادسية

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Abstract

To clinically evaluate the outcome of Inguinal Hernioplasty in terms of haematoma, wound infection and recurrence, with special reference to surgery done by trainee surgeons. A total of 50 patients with inguinal hernia were operated during the study period. The result of the present study concluded that using mesh for surgical operation of hernia is much better than the ordinal operation of hernia because this technique reduces the recurrence of the disease, while the classical operation is related to recurrence of the disease. Also Mesh can reduce the appearing of hematomas, Wound infections after the operation, while the classical operation is related to appearing of the hematomas and Wound infections after the operation. Further more there is no significant difference between the two methods regarding appearing of seromas after the operation however, its appear among those patients which did a classical operation more than those which using mesh for operation. So In our set-up Mesh Hernioplasty has proven to be effective with low complication and recurrence rates.

يهتم البحث في تقييم النتائج السريرية لعمليات ترقيع الفتق الأربي من حيث التجمع الدموي ,خمج الجروح، وامكانية تكرارالفتق مجددا، مع إشارة خاصة إلى العمليات الجراحية التي يتم اجرائها من قبل الجراحين المتدربين. لقدتم اجراء ما مجموعه خمسون عملية للمرضى الذين كانو يعانون من فتق أربي خلال فترة الدراسة. واستخلص نتيجة لهذه الدراسة أن استخدام الشبكة(mesh) في عملية ترقيع الفتق هو أفضل بكثير من العملية التقليدية و يقلل من تكرار لهذا المرض، في حين ترتبط هذه العملية الكلاسيكية إلى تكرار لهذا المرض. أيضا يمكن أن تقلل من ظهور القيلة ،و خمج الجروح، في حين ترتبط العملية الكلاسيكية إلى ظهور التجمعات الدموية والتهابات الجروح ما بعد العملية. ليس هناك فرق كبير بين الطريقتين فيما يتعلق بظهور المصول seromas) ).


Article
Y Risk Factors of Recurrent Lumbar Disk Herniation

Author: Isam Ali Alsudany
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2015 Volume: 12 Issue: 4 Pages: 1168 -1172
Publisher: Babylon University جامعة بابل

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Abstract

Recurrent intervertebral disc prolapsed (RDP) is a major cause of poor result after lumbar discectomy surgery. The aim of current study is to assess risk factors of recurrent disc prolapse in Iraqian population in Hilla teaching hospital from 2002-2013. The study reviewed 40 patients with recurrent disc prolapsed and 100 patients without recurrence retrospectively. To evaluate possible risk factors for herniation recurrence A clinically significant recurrent herniation was defined as a disc herniation causing lower limb pain (sciatica) and (MRI) evidence of disc material at the same level of the previous surgery. Other 100 patients without recurrence were used just for compares to identify possible risk factors for recurrent RDP. There was important variation between groups with and without RDP in sex, smoking, height, weight and occupational characteristic. By putting these differences in logistic regression analysis, it showed that gender (male), height, heavy workers and heavy smoker could expected in lumbar disc prolapsed recurrence(RDP). Taking into consideration sex, heavy smoking and heavy workers as predictors of recurrent RPD, surgeons should advice their patients to limit hard work and put away smoking especially in tall and male ones to prevent RDP recurrence.


Article
The Outcomoe Of Suture Versus Mesh Repair Of Primary Small Umbilical Hernias In Adults

Author: Saad Ramadhan Jawad سعد رمضان جواد
Journal: Mustansiriya Medical Journal مجلة المستنصرية الطبية ISSN: 20701128 22274081 Year: 2017 Volume: 16 Issue: 1 Pages: 45-48
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Background: There are a different methods of umbilical hernia repair and there is controversy about which repair is better for small umbilical hernias. Aim : Is to compare which method is superior the mesh or suture repair for small umbilical hernias in terms of clinical outcome and recurrence rate. Methods: In this study , 120 patients were treated surgically using either suture or mesh repair for their umblical hernias from march 2013 to march 2015 at Al Imam Ali hospital.In 67 patients, the hernia was repaired by prolene suture and 53 patients their hernias were repaired by mesh. Both groups were followed for complications and recurence rate. The data was analysed statistically for significance using Fishers exact test. Results: 89 patients (74.16%) were females,31 (25.84%) were males . ages of the patients were ranged between 21 to 67 years, mean age was (36.17).There was no significant difference statistically between two groups regading recurrence after one year follow up, 467 (6%)in suture repair and 153(1.9%)in the mesh repair.5patients(7.46%) got seroma in the suture repair group while 4 patients (7.54%) in the mesh repair.Hematoma developed in 2patients( 3%) in the suture repair group and nil in the mesh repair group.Regarding infection 3 (4.5%)in suture repair and 2patients (3.7%) in the mesh repair group .3patients (4.5%) treated by suture repair complained of chronic pain while only 2 (3.7%)in the mesh repair group.Conclusion: This study showed no significant difference between two methods of repair regarding short term complications and recurrence rates.

Keywords

umbilical hernia --- repair --- suture --- mesh --- recurrence


Article
The outcome of stroke: A six month follow-up study
نتائج السكتة الدماغية: دراسة متابعة لمدة ستة أشهر

Author: Kameran Hassan Ismail
Journal: Zanco Journal of Medical Sciences مجلة زانكو للعلوم الطبية ISSN: 19955588/19955596 Year: 2018 Volume: 22 Issue: 1 Pages: 82-88
Publisher: Hawler Medical Univeristy جامعة هولير الطبية

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Abstract

Background and objective: Stroke is an increasing problem in developing countries and is the principal cause of disability and dependency in the western world. This study aimed to find out the one- and six-month case fatality, dependency and recurrence rates of stroke in Erbil teaching hospitals. Methods: This hospital-based prospective study included 293 stroke patients hospitalized in Erbil teaching hospitals from January 1st, 2015 through December 31st, 2015. Stroke was diagnosed by a consultant internist or neurologist and confirmed by brain CT-scan and/or MRI. Patients were followed-up for six months, then one- and six-month outcomes were measured including case-fatality, dependency and recurrences rates.Results: The one and six month case fatality rates were 28.3% and 37.5%, respectively. The rates in females (33.3%, 42.6%, respectively) were higher than that in males (23.7%, 32.9%, respectively), but there was no significant association between case-fatality rate and gender. A total of 74.3% and 45.4% of patients at one- and six-month were functionally dependent. The majority (88.9%) of diabetic patients were functionally dependent. Also, the one and six month recurrence rates of stroke patients were 15.7% and 23.2%, respectively. For both one and six month post stroke more recurrence occurred from ischemic (16.2%, 14.3%, respectively) than from hemorrhagic (24.5%, 19.5%, respectively) strokes, but there was no significant association between the recurrence and stroke subtype (P = 0.691, P = 0.367, respectively).Conclusion: The reported outcomes are relatively comparable to that reported in other developing countries, although it is still more than the rates of developed countries. Outcome measures can help to give information and develop guidelines for clinical practice and research.


Article
PILONIDAL SINUS: COMPARATIVE STUDY - OPEN OR CLOSE PROCEDURE
الناصور العصعصي : دراسة مقارنة بين الطريقة المغلقة

Author: HAYDER H. IBRAHIM حير جسين ابراهيم
Journal: Duhok Medical Journal مجلة دهوك الطبية ISSN: ISSN: 20717334 (online)/ ISSN: 20717326 (Print) Year: 2009 Volume: 3 Issue: 1 Pages: 45-50
Publisher: University of Dohuk جامعة دهوك

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ABSTRACTBackground Pilonidal disease is a disabling nuisance in young adults, yet its management remains controversial. Ambulatory treatment with minimal morbidity and a rapid return to normal activity is desirable. Objective Many techniques have been described for the treatment of patients with pilonidal sinus. The aim of this study is to compare two methods of surgical treatment of pilonidal sinus with regard to cure and recurrence rates. Methods A case series study. All patients were treated as a day case surgery from January 1992- December 2001; divided in two groups: Group A ( excision as lay open method) includes 100 patients and group B ( excision and primary closure) includes 90 patients. Results: One hundred ninety patients, 165 males, 25 females were treated for pilonidal sinus over a period of 10 years. 100 patients were managed by excision only and 90 patients were managed by excision and primary closure. Operation for recurrent sinus was performed on 16 patients by open method. All cases treated as day case .The average time for healing following laying open was 45 days while in closed method was 14 days. 15 cases developed recurrence following surgery, 6 in group A (6%), including those already recurrent 16 patients, in whom one patient developed recurrence again and 9 in group B (10%). P<0.001. The mean follow up peroid was 1.5 year. Conclusion The open method has less recurrence rate than closed procedure but the later one has many advantages and more acceptable by the patients.

الاهداف: مقارنة مجموعتين من المرضى المصابين بناسور العصعص , قسم إلى مجموعتين وعولجوا جراحيا , المجموعة الأولى بالطريقة المفتوحة والمجموعة الثانية بالطريقة المغلقة وقورنتا من ناحية الشفاء ونسبة رجوع الحالة المرضية.المرضى و طريقة البحث: دراسة سلسلة حالات . أجريت الدراسة على مائتي وتسعين مريضا كحالة جراحية يومية للفترة من كانون الثاني 1992- ولغاية كانون الاول2001 . المجموعة ( أ ) مكونة من مائة مريض عولجت بالطريقة المفتوحة والمجموعة الثانية ( ب ) مكونة من تسعين مريض عولجت بالطريقة المغلقة.النتائج: مائة وتسعون مريض , (165 ) من الذكور و( 25 ) من الإناث و عولجوا بالعملية الجراحية لناسور العصعص خلال مدة عشر سنوات . مائة مريض كانت معالجتهم بالطريقة المفتوحة وتسعون مريض بالطريقة المفلقة . معدل مدة التئام الجرح في المجموعة ( أ) هي 45 يوم بينما في المجموعة ( ب )كانت 14 يوم . عدد حالات رجوع المرض في المجموع ( أ ) كانت 6% وفي المجموعة (ب) .1 % , فقيمة ب اقل من 0.001 . معدل مدة المتابعة للمرضى في كلا المجموعتين كانت سنة ونصف. الاستنتاجات: نسبة رجوع الحالة المرضية في الطريقة المفتوحة اقل ولكن الطريقة المغلقة لها فوائد كثيرة كمدة التئام الجرح اقل والرجوع للعمل أسرع ومحبذة لدى الكثير من المرضى.


Article
IS IT ESSENTIAL TO USE SCOLICIDAL AGENT IN OPEN SURGERY FOR HEPATIC HYDATID CYST?
هل من الضروري استخدام المبيدات لرؤس طفلي الاكياس المائية اثناء اجراء العملية الجراحة ثلاكياس في الكبد

Author: Haydar Hussain Ibrahim حيدر حسين ابراهيم
Journal: Duhok Medical Journal مجلة دهوك الطبية ISSN: ISSN: 20717334 (online)/ ISSN: 20717326 (Print) Year: 2015 Volume: 9 Issue: 1 Pages: 37-45
Publisher: University of Dohuk جامعة دهوك

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Abstract

ABSTRACTBackground and objective: Hydatid disease of the liver is endemic in Iraq and is a commonhealth problem. Although various treatment options have been described with injection ofscolicidal agent into cyst cavity to reduce the recurrence but with risk of complication of suchagents.The aim was to assess the open surgical procedure in treatment of hepatic hydatid cystwithout injection of scolicidal agents in terms of complication and recurrence rate.Patients and methods: A prospective study of 103 patients with hepatic hydatid cystoperated upon by one consultant surgeon using open surgical approach during the period of15 years (Feb 2000- March 2014) without intraoperative injection of scolicidal agent into thecyst cavity .Results: The mean age was 33.1.(4–70 years). Sex 35 males, 68 females. M/F 1/1.9. The sizeof the cyst was variable from 5-17cm in diameter. Number of the cyst per patient was from1-12 cysts. Location of the cyst was 81 in the right lobe and 12 patients in the left lobe R/L6.7/1. Both lobes were involved in 10 patients. Uncomplicated cyst in 67 patients andcomplicated in 36 patients.Frank rupture into biliary system presented as cholangitis with jaundice was detected in 5patients and intraperitoneal rupture was seen in one patient presented as acute abdomen withurticaria following blunt trauma .Post operative morbidity was observed in 58 patients (56.3%) which include chest infectionin 10 patients, wound infection in 10 patients, bile leak in 25 patients, hepatic abscess in 3patients and recurrence rate detected in 10 patients (9.7%)Conclusion: As scolicidal agents are not free from complications (both local and systemic),dealing with hepatic hydatid cysts surgically without using scolicidal agents does not affectthe recurrence rate.

الخلفية والاهداف: الاكياس المائية في الكبد من الام ا رض الشائعة في الع ا رق وهناك عدة طرق للعلاج الج ا رحي هدف هذه الد ا رسة لتقييم فيما اذا كان من الضروري استخدام المضادات للطفيلي اثناء العملية الج ا رحية للاكياس المائية في الكبد لتجنب مضاعفات تلك المواد.طرائق البحث: المرضى المصابون باكياس الكبد المائية وعددهم مائة وثلاثة مرضى في مستشفيات الموصل ودهوكخلال خمسة عشر سنة للفترة من شباط 2000 -اذار 2014 من قبل استشاري واحد وبدون استخدام المواد القاتلة لرؤؤس الطفيلي والتي شملت 35 من الذكور و 68 من النساء.70 سنة (المعدل 33.1 سنة). عدد الاكياس المائية – النتائج: أظهرت الد ا رسة ان العمر في كلا الجنسين يت ا روح بين 4 17 سم باستخدام الامواج الصوتية. 81 مريض لديهم – 12 كيس. حجم الكيس يت ا روح بين 5 - للمريض الواحد يت ا روح مابين 1 اكياس في الفص الايمن للكبد و 12 مريض في الفص الايسر و 10 مرضى لديهم اكياس في الفصين.الاكياس الغير معقدة 73 والاكياس المعقدة 30 والتي تشمل انفجار الكيس الداخلي وانفجار الكيس داخل قناة الصف ا رء وانفجار الكيس داخل البريتون والتهاب الكيس التقيحي.58 مريض) والتي تشمل حالات التهاب الجرح، التهاب ) % المضاعفات التي حدثت بعد العملية كانت بنسبة 56.3.(% الرئتين وظهور ناسور الصف ا رء وحالات رجوع الاكياس المائية ظهرت في 10 مرضى ( 9.7 الاستنتاج: بما ان معظم المواد المستخدمة لقتل الطفيلي اثناء العملية الج ا رحية لا تخلو من مضاعفات (الموضعيةوالعامة) فعليه من المستحسن تجنب هكذا مواد وفي نفس الوقت بدون زيادة في نسبة رجوع الاكياس المائية.

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