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   Table of Contents - Current issue
July-September 2018
Volume 15 | Issue 3
Page Nos. 197-266

Online since Monday, September 24, 2018

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Analysis of ear foreign bodies in adult patients Highly accessed article p. 197
Abdulhusein Mizhir Almaamuri
Background: Foreign bodies (FBs) in the ear are frequently encountered by an otolaryngologist. Certain types of ear FBs in our adult patients may reflect negative phenomena in our community. Objectives: This study was carried out to analyze the main types of adult aural FBs and to highlight the increasing frequency of already known types and more interesting newly known type of FB. Materials and Methods: This is a prospective descriptive study of adult patients with aural FB seen in the ENT Department in Al-Mahawil Hospital for the 2 years – 2015 and 2016. The clinical presentation, type of FB, and management outcome were analyzed. Results: Two hundred and thirty-two patients aged 18–82 years were evaluated. Cotton wool (of the earbuds) was the most common FB with 93 (40%) patients (male: 54, female: 39) aged 21–82 years; the insect FB with 78 (33.7%) patients (male: 32, female: 46) aged 18–58 years; and garlic with 36 (15.5%) patients (male: 15, female: 21) aged 25–74 years; the newly known interesting FB put by the students into their ears during the examination was Bluetooth device in 15 (6.5%) patients (male only) aged 18–23 years; and miscellaneous FBs such as paper, broken matchstick and clinics were found in 10 (4.3%) patients (male: 7, female: 3) aged 35–60 years. All the FBs were unilateral and removed successfully without anesthesia, except four cases removed under general anesthesia. Complications did occur such as otitis externa: 8, bleeding and laceration: 6, and abrasion: 10. The complications were mainly due to previous unsuccessful trials and delayed referral. Conclusion: The increased abuse of earbuds causes more incidence of FB in the ears. We have seen more garlic in the ears because of misunderstanding of some traditional thoughts. Moreover, recently, we observed new FB, Bluetooth device objects in the ears of students. Health education of the general population is necessary for prevention.
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Prevalence, biochemical, and genetic analysis of mutated gene related to bitter taste perception for phenylthiocarbamide in Sulaymaniyah Province, Iraq p. 201
Harseen Mahmud Rahim, Rebin Kanabi Majeed, Nadia Ahmed Rostam
Background: Phenylthiocarbamide (PTC) taste or any organic bitter compound is widely studied between nations. Objectives: The aim of this study was to analyze the prevalence of PTC taste sensitivity and its mutated gene frequencies among people in Sulaymaniyah, Iraq. Materials and Methods: PTC, thiourea, and sodium benzoate paper were used on the participants. Each participant was required to taste each paper differently; then, the results were recorded whether they were tasters or nontasters. Results: Analysis of data from the current study revealed that 70.4% of the Kurdish population is PTC tasters. Of them, 25 (8.3%) of participants were normal tasters, 124 (41.1%) were standard supertasters, 36 (11.9%) were recessive supertasters, and 116 (38.5) of them were dominant supertasters. Smoking showed no effect on the taste perception in this study. However, the rate of female tasters was higher than male tasters. Conclusion: The analysis of data from the current study revealed that most of the Kurdish population is PTC tasters. However, the rate of female tasters was higher than male tasters. Further studies are needed to investigate genetic composition of the Kurdish population.
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Transthoracic fine-needle aspiration versus tru-cut biopsy under computed tomography-scan guide in diagnosis of peripheral lung lesions p. 205
Maitham Fuad Abdal-Hussain
Background: Lung cancer is the number one cause of cancer-related death in the Western world. Intrapulmonary nodules are presenting either solitary or multiples. Primary bronchogenic carcinoma is the most common malignant tumor that presents as a solitary pulmonary nodule. Fine-needle aspiration (FNA) and Tru-cut biopsy are parts from several interventional procedures that need to reach to the final diagnosis. Aim: This study aims to assess the comparison between transthoracic FNA results and Tru-cut biopsy results in the diagnosis of peripheral pulmonary lesions and the possibility of depending on one of them in the diagnosis of these lesions. Materials and Methods: FNA and true cut biopsy under computed tomography scan guided were performed to patients had peripheral pulmonary lesion and sent to the cytological and histopathological laboratory for analysis. Results: All patients (20) that had pulmonary lesion were evaluated. Results of FNA were; 15/20 of them were adequate samples for diagnosis while 5/20 were inadequate. Results of Tru-cut biopsies were – 17/20 were adequate for histopathological assessment while 3/20 were inadequate. Thirteen out of 20 patients had malignancy, five patients diagnosed by both Tru-cut biopsy and FNA, other five diagnosed by Tru-cut biopsy only and three patients diagnosed by FNA only. One patient had benign lesion and diagnosed by both procedures. Six out of 20 patients had other results that diagnosed by both procedures. Squamous cells carcinoma was 5/13 patients (38.46%) and adenocarcinoma was the same percentage. The concordance of FNA results with Tru-cut biopsy results was 60%. Conclusion: The study demonstrated that Tru-cut biopsy is moderately superior to FNA in the evaluation of peripheral malignant lung lesions. Therefore, we advise not using the FNA alone in the evaluation of peripheral chest lesions that suspected of malignancy (except if large bullae or severe emphysema present) and Tru-cut biopsy is often required together to reach the diagnosis.
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Comparison between modified alvarado score and Tzanakis score in diagnosing acute appendicitis in Erbil City p. 210
Faris Muhammed Mahmood, Sirwan Ahmed Garota
Background: The problem of negative appendectomies is an obstacle in medicine because the physicians face difficulties in diagnosing this disease. Therefore, the inclusion of ultrasonography which is a cheap diagnostic tool may enhance the diagnostic dexterity of physicians in acute appendicitis (AA). Objective: This study evaluates and compares the Modified Alvarado Score (MAS) with Tzanakis Score (TZS) in diagnosing AA. Materials and Methods: A prospective study involved 100 patients who were admitted to Rozhhalat hospital in Erbil, following a diagnosis of AA, they had undergone appendectomy during the period from May 2017 to February 2018. All the patients were inquired, examined, and investigated according to MAS and TZS at the same time preoperatively, while the final decision was confirmed by the result of histopathology. Results: Retrocecal appendix was found in 73.15% of patients. Males were 66 cases, while females had 34 cases in a ratio (Male:Female = 1.9:1). The patient's mean of age was 22.667 years (standard deviation of ± 8.03 years). Histological result of 86% of cases was proven to be AA. The accuracy of MAS in diagnosing acute appendicitis was calculated by its sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) which were 0.941, 0.928, 0.987, and 0.723 respectively. While the results of the TZS found that the sensitivity: 0.977, the specificity: 0.928, the PPV: 0.988, and the NPV: 0.867. Results also found that the overall negative appendectomies were 14%. Conclusion: TZS is a cheap, easy, and more practical tool for detecting AA in comparison to MAS.
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The utility of apparent diffusion coefficient in diagnosis of acute cholecystitis p. 214
Musafir Atea Hashim
Background: Acute cholecystitis (AC) is a very common gastrointestinal pathology. Patient's history, physical examination, and laboratory investigations are usually not sufficient for accurate diagnosis. Moreover, imaging findings can overlap with that of many other gallbladder pathology especially chronic cholecystitis (CC). Therefore, there is a reasonable necessity for new diagnostic tools for AC. Objective: This study aimed to evaluate the efficiency of the apparent diffusion coefficient (ADC) as a diagnostic tool for AC and differentiating it from CC. Materials and Methods: During the period from April 2017 to March 2018, a total of 62 patients with suspected cholecystitis were enrolled in this prospective cross-sectional study. Patients were subjected to diffusion-weighted imaging, from which the ADC values were calculated. All patients were then undergone laparoscopic or open cholecystectomy, and the diagnosis of AC or CC was proven through histopathological examination. Receiver operating characteristic analysis was used to find out the area under the curve (AUC), sensitivity, and specificity of ADC in the diagnosis of AC. Results: The average value of ADC from three regions of interests from patients with AC was 1.434 ± 0.31 × 10−3 mm2/s. On the other hand, the average ADC from CC was 2.032 ± 0.31 × 10-3 mm2/s with significant difference (P = 0.013). The AUC was 0.803, 95% confidence interval = 0.702–0.905, P < 0.001, with a sensitivity and a specificity of the test at 1.94 × 10−3 mm2/s cutoff value were 0.70 and 0.73, respectively. Conclusions: These results indicate a good diagnostic value of ADC in discrimination between acute and CC. Further studies using contrast media are required for more accurate evaluation of ADC as a diagnostic tool for AC.
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Acute toxicity study of indomethacin and oxytetracycline in rabbits p. 218
Rebin Kanabi Majeed, Hawraz Farhad Muhammed, Harseen Mahmud Rahim
Background: The toxic effect of nonsteroidal anti-inflammatory drugs (NASIDs) and broad-spectrum antibiotics in human and animal science has been studied widely. The advantages and the adverse impact of these medications could be determined by measuring some biochemical parameters such as the level of alkaline phosphatase (ALP), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and blood urea nitrogen (BUN). In addition, the changes in some hematoimmunological parameters could also be measured; for instance, red blood cell (RBC) count, hemoglobin level, white blood cell (WBC) count, and differential WBC count. Objectives: The aim of this study is to evaluate the effect of both indomethacin, as a NSAID example, and oxytetracycline, as a broad-spectrum antibiotic separately and together, on some biochemical and hematological parameters. Materials and Methods: Sixteen male albino rabbits were used, with age about 1 year and body weight about 1.5 kg. They were divided into four groups and each group contains four rabbits. The first group served as a control group, which receives only food and water. One of the groups were administered with oxytetracycline at a dose of 50 mg/kg. The second was administered with indomethacin at a dose of 5 mg/kg, and the final group was administered with both oxytetracycline and indomethacin with the same previous dose. All the drugs were dissolved in the distilled water before administration of dose to each animal in the group orally using a stomach cannula for 14 days. The rabbits were kept for 14 days under the room temperature with free access to food and water. Serum was separated from the clotted blood obtained by ear vein. Total RBC and WBC counts were made by the hemocytometer method. The differential WBC counts were made by finding the percentage average of the different types of cells counted in ten fields from Giemsa-stained slides. Serum enzymes such as ALP, AST, and ALT were determined by procedures of Sigma Diagnostics, BUN by method of Crocker. Results: The level of ALP has shown great increase in all groups, while the level of AST and ALT was increased only in the group that administered with indomethacin. However, both parameters showed a significant decrease in the other groups. Regarding hematological changes, WBC increased in all groups, while RBC and Hb level showed sharp decrease. Lymphocytopenia occurred in only the group that administered with oxytetracycline. Conclusion: The results showed toxic effect of these two most popular using drugs in animals specifically when it is used chronically. In addition, there is no great difference when it is used separate or together. Further study is required to investigate the level of damage that happens in the organs.
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Left ventricular echocardiographic abnormalities by conventional echocardiography and tissue doppler image in chronic obstructive pulmonary diseases patients p. 222
Batool Sahib Jbarah, Safaa Jawad Kadhem, Basim Muhammad Madloom
Objective: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. It leads to deleterious effects on heart, cor pulmonale, and congestive heart failure that are a major cause of morbidity and mortality. Early diagnosis and treatment can mitigate the ill effects of COPD and lead to better patient management and improve the morbidity data. Echocardiography provides a rapid, noninvasive, portable, accurate method to evaluate cardiac functions, early diagnoses, and intervention for cardiac comorbidities can reduce mortalities in COPD patients. The aim of this study is to find echocardiographic changes in COPD patients and correlated with disease severity. Materials and Methods: Eighty-two patients of COPD fulfilling the inclusion criteria coming to outpatients of Margan medical city were recruited. They were staged by pulmonary function test and evaluated by echocardiography. Statistical analysis of correlation was done with Chi-square test and ANOVA test and the statistical significance was taken P< 0.05. Results: The most common echocardiographic finding was left ventricular diastolic dysfunction (LVDD), which was present in 64.6% of cases, the prevalence increase with increase the severity of disease; other echocardiographic findings were pulmonary hypertension, the total prevalence was 53.7% and also the prevalence increase by increase severity. LV diastolic function affected significantly with severity of COPD. Conclusions: Echocardiography should be considered in the assessment of patients with clinically significant COPD.
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Interventricular mechanical dyssynchrony in dilated cardiomyopathy and its relation with left ventricular systolic dysfunction p. 227
Ahlam Kadhim Abbood, Haider Jabar Al-Ghizzi, Wissam S Tajuldin
Background: Heart failure (HF) is a major problem worldwide, and despite the optimal medical treatment, still it carries high mortality. Ventricular dyssynchrony among patient with HF portends poor prognosis. Aim of the Study: The aim is to evaluate the prevalence of interventricular dyssynchrony in patients with dilated cardiomyopathy (DCM) patients and its relation to underlying etiology and the severity of systolic dysfunction. Materials and Methods: Fifty-eight patients with ischemic and nonischemic cardiomyopathy (ICM and NCM) were included in this study. Inclusion criteria include Type II–IV New York Heart Association patients with ejection fraction (EF) <35%. Mechanical dyssynchrony (interventricular dyssynchrony) was assessed by pulsed Doppler. Assessment of left ventricular (LV) systolic function was by EF and stroke volume. Evaluation of the prevalence of mechanical indices in DCM and their relation to underlying etiology and severity of LV systolic dysfunction was done. Results: The prevalence of interventricular dyssynchrony was more in NCM than ICM. There was a nonsignificant negative correlation between this dyssynchrony and LV systolic parameters. Conclusion: Mechanical dyssynchrony indices were affected by the underlying etiology and severity of LV systolic dysfunction associated with the existence of the mechanical dyssynchrony.
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Subendocardial left ventricular dysfunction by speckle-tracking strain image in asymptomatic patients with chronic aortic regurgitation and normal ejection fraction p. 231
Ghufran Jawad Obada, Haider Jabar Al-Ghizzi, Ali Jaber Aboob, Ameer Ahmad Aljubawii
Background: Aortic regurgitation (AR) is the most common valvular heart disease. During asymptomatic phase, many changes in the left ventricle (LV) geometry, volume, wall stress, and LV wall thickness eventually ends up with LV myocardium dysfunction. The traditional echocardiographic parameters utilized for the detection of myocardial dysfunction and the subsequent timing of surgery are not sensitive enough to detect these changes in their early stage before an irreversible myocardial damage occurs. Objective: the objective of this study to demonstrate the presence of global longitudinal strain (GLS) abnormality in patient with chronic asymptomatic AR reflecting a subclinical left ventricular dysfunction. Materials and Methods: A total of 35 asymptomatic patients with chronic AR of different severity and preserved ejection fraction (EF) were compared with 35 age-matched control healthy subjects. Results: There was a statistically significant reduction in the GLS values in patient with AR regardless its severity compared with control (P < 0.00), despite the preserved EF. Also decreased GLS index to LV end diastolic volume in patients with chronic AR (P < 0.00). Furthermore, they exhibited significant increase (P < 0.00) in wall thickness, end-systolic volume, and LV mass in patients compared to the control group. Conclusion: GLS measured by speckle tracking for chronic asymptomatic AR was significantly lower than normal participants and may have potential role in timing of surgery and postoperative prognosis.
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The incidence of dermatophytosis in Babylon Province, Iraq p. 234
Oday Hussein Kadhim
Background: Dermatophytosis is caused by dermatophytes, which attack and grow on dead animal keratin. Dermatophytes belong to three genera, namely, Epidermophyton, Microsporum, and Trichophyton. Objective: The objective of this study is to detect the types and the frequencies of the dermatophytes infections in Babylon Province. Materials and Methods: In this study, 200 specimens of dermatophytic patients are collected in Babylon Province. Collection of Specimens includes skin scrapings, hair fragments, and nail clippings. The specimens were diagnosed by direct microscopic examination and culture. Results: One hundred and sixty-four (83%) specimens of dermatophyte infection were positive in culture and used in phenotypic diagnosis. Tinea corporis was the predominant infection in 83 (41.5%) patients, Trichophyton rubrum showed the highest frequency of dermatophytes isolates 29 (17.68%), Trichophyton mentagrophytes 26 (15.85%), and Microsporum canis 24 (14.63%). Fifty-six cases were positive in direct microscopic examination, and the invasion of hair was ectothrix type, forming masses of arthroconidia on the outside of the hair shaft in 44 (78.57%) specimens, while the invasion of hair was endothrix type, and abundant sporulation inside the hair shaft causes breakage of the hair near the surface of the scalp in 12 (22.43%) specimens (P < 0.05). The age group of 21–30 years revealed tendency for dermatophytosis of tinea corporis while the age group of 1–10 years showed tendency for dermatophytosis of tinea capitis. Conclusion: Tinea corporis was the predominant infection. T. rubrum, T. mentagrophytes, and M. canis showed the highest frequency of dermatophyte isolates. Positive direct microscopic examination and culture isolates (phenotypic diagnosis) could be used in the diagnosis of dermatophytosis.
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Role of diffusion-weighted image in differentiation between epidermoid cyst and other cerebellopontine angle masses p. 238
Dhemyaa Ali Farhan, Osamah Ayad Abdulsttar
Background: Many masses can present in the cerebellopontine angle (CPA), and the magnetic resonance imaging (MRI) is essential in the diagnosis and differential diagnosis of these masses, and a complimentary advanced MRI technique such as diffusion-weighted image (DWI) is needed as to differentiate between epidermoid and arachnoid cyst. Objective: This study aimed to find out the role of DWI in differentiate between epidermoid cyst and other CPA masses. Materials and Methods: By using data collection form electronic medical record, we collect demographics; choosing 40 patients; 23 of them are male and 17 are female. They were complaining of signs and symptoms of neurological disorders. By subjecting the patients to MRI sequences including T1; T2; DW; apparent diffusion coefficient (ADC); and postcontrast imaging to find out the role of DWI in differentiate between epidermoid cyst and other CPA masses. The study carried on from September 2017 to July 2018 in the institution Al-Hilla general teaching hospital in the diagnostic radiology department at MRI unit. Results: The resultant patient sample regarding final diagnosis; and regarding signal intensity (SI) of each particular mass; constricting on DW and ADC value; and then comparison has been done between SI of epidermoid cyst and each particular lesion to define the role of DWI in differential diagnosis between epidermoid cyst in one hand and other CPA masses. Conclusion: MRI can be considered the most useful method to improve the sensitivity of CPA lesion detection and a complimentary advanced MRI technique such as DWI is needed as to differentiate between epidermoid and arachnoid cysts.
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Prevalence of normal anatomical variations in the region of paranasal sinuses in patients with chronic rhinosinusitis p. 243
Hasanein Hamid Hadi, Hasanein Ahmed Al-Bayati, Safaa Sahib Naji Al-Gazali
Background: Knowledge of the anatomical relationships and the anatomical variations in paranasal sinus region is critical for surgeons performing endoscopic sinus surgery. It helps surgeons to avoid the potential complications of sinus surgery and to improve success of management strategies. Objective: The objective of this study was to show how prevalent are the anatomic variations in the region of the paranasal sinuses and nasal cavity in patients with chronic rhinosinusitis. Materials and Methods: A cross-sectional study was conducted from January 2018 to July 2018 at Al-Hilla general teaching hospital. We collected data of 75 patients (who have met the clinical criteria of chronic rhinosinusitis) subjected to computed tomography (CT) of the paranasal sinuses. CT was performed using SIEMENS SOMATOM Definition AS and Philips machines. Direct coronal scans (1 mm in thickness) were made, from the anterior wall of the frontal sinus to the posterior wall of the sphenoid sinus with axial and sagittal reconstruction images. Results: Anatomical variations found in 69 patients of a total 75 patients with age range from 18 to 60 years with 92%. Among these, nasal septal deviation was the most common (seen in 54/75 patients = 72%) followed by the Agger nasi cells in 52 patients (69%), concha bullosa in 31 patients (41.3%), Haller cells in 28 patients (37%), and Onodi cells in 18 patients (24%). Conclusion: Sinonasal anatomical variations are common findings in patients with chronic rhinosinusitis. Providing information on these anatomical variations will improve the success of endoscopic sinus surgery.
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Efficacy and safety of vaginal CO2Laser treatment in female stress urinary incontinence p. 251
Saja Mohammed Jasim, Raed Younis Khalil Al-Rawi
Background: Urinary incontinence (UI) is a common disorder that affects women of various ages and impacts all aspects of life. Objective: Our objective was to assess the efficacy and safety of vaginal Fractional CO2laser treatment for mild-to-severe stages of female stress UI (SUI).Materials and Methods: A total of 60 women with a mean age of 47.6 ± 8 years suffering from SUI were included in this prospective, single-center, nonrandomized, pilot study. Patients were clinically examined and assessed before treatment and at each follow-up visit at 1, 3, and 6 months postvaginal fractional CO2laser treatment by International Consultation on Incontinence Questionnaire-UI Short Form (ICIQ-UI SF) questionnaire for assessing the degree of incontinence and its impact on the quality of life, Pelvic Organ Prolapse/UI Sexual Questionnaire (PISQ-12) for assessing the quality of life in the area of sexuality, digital assessment of muscle strength, and Q-tip test for evaluating the mobility of the urethra and bladder neck. Two or three sessions of vaginal fractional CO2laser treatment were performed for each woman using SmartXide2 with V2LR laser. Pain during the treatment was measured at every session with a visual analog scale (VAS), any other possible adverse effect observed. Results: Significant improvement (P < 0.001) was found in ICIQ-UI scores, PISQ-12 scores, muscle strength, and Q-tip angle, at all follow-ups after treatment compared to baseline values. ICIQ-UI scores decreased at 1, 3, and 6 months follow-ups by 6.5, 7.17, and 7.30 points, respectively (P < 0.001). PISQ-12 scores increased at 1, 3, and 6 months follow-ups by 6.2, 7.8, and 9.1 points, respectively (P < 0.001). Muscle strength increased at 1, 3, and 6 months follow-ups by 1, 1.5, and 2 points, respectively (P < 0.001). Q-tip angle decreased at 1, 3, and 6 months follow-ups by 11.7°, 18.5°, and 24.2°, respectively (P < 0.001). No adverse events were reported by any patients during the procedure. Conclusion: This study demonstrated that vaginal Fractional CO2laser treatment using SmartXide2 with V2LR configuration laser system is an effective and safe treatment option for patients with mild-severe SUI.
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A comparison between low dose and standard dose computed tomography scan in detection of urolithiasis p. 258
Ahmed Danoon Marsoul, Huda Ali Rasool, Muhammed Ridha Judi
Background: Computed tomography (CT) (standard and low-dose CT [LDCT] scan) has become the reference technique in medical imaging for urinary calculi, to diagnose, plan treatment, and explore differential diagnosis of renal colic. Objective: This study was done to compare the low-dose nonenhanced CT scan with standard dose CT scan in the detection of urolithiasis. Materials and Methods: Cross-sectional study conducted from 2017 to 2018 in Al-Hilla teaching general hospital on 60 patients undergone unenhanced (native) spectral detector CT (SDCT) and LDCT, the patients were scanned by Siemens CT system, 64 slice using automated tube current modulation, all CT scan were performed without oral or intravenous contrast. Results: This study showed that 93 stones detected by SDCT scan and 89 stones detected by LDCT scan, mean age of patients 44.2 ± 7.3 and mean of body mass index 26.3 ± 3.1, male constitute 56.6% (34) and female 43.4% (26). In 46.6% of patients had stone in the left side and 53.4% show stone in right side, most of patients presented solitary stone which appear 73.4%, 11.6% of patients had double stone, 5% had triple stone, 6.6% had four stones, and 3.45% had 5 or more stone at investigation, 10.8% of stones lie in ureter, 7.6% of stones in renal pelvis, 13.9% in upper calyx, 28% in lower calyx, and 39.7% lie in middle calyx, according to size of stones 11.9% of stones had size <3 mm, 35.4% of stones range 3–5 mm, 34.5% size range 6–10 mm, 12.9% 11–15 mm in size, 3.25 of stones had size range 16–20 mm and only 2.1% of stone had size >20 mm. In standard CT scan, the current mean was 283.2 while in LDCT scan the mean was 126.1 mA, sensitivity is (93%) and specificity (100%) of LDCT in reference SDCT. Conclusion: LDCT scans provide effective methods of identifying and evaluating urinary tract stones, high diagnostic accuracy, sensitivity, and specificity are maintained despite significant radiation dose reduction compared to standard dose CT.
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Safeguarding the health and wellbeing of migrant women workers worldwide p. 263
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
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Coumarin is most medical and therapeutic component of Iraqi medicinal plant Atriplex nummularia p. 264
Yamama Khalid Abdulmueed, Enas Jwad Kadium
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