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Article
Prognostic Significance Of Left Ventricular Diastolic Dysfunction With Preserved Systolic Function Following Acute Myocardial Infarction

Author: Mutaz F. Hussain, * CABM, FICMS معتز فوزي حسين
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 / 24108057 Year: 2006 Volume: 48 Issue: 3 Pages: 246-250
Publisher: Baghdad University جامعة بغداد

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Abstract

Background : The contribution of diastolic dysfunction in patients with preserved left ventricular (LV) systolic function to impaired functional status and cardiac mortality in myocardial infarction (MI) is unknown. Materials and Methods : Assessment of LV diastolic function was performed by Doppler analysis of the mitral and pulmonary venous flow and the propagation velocity of early mitral flow by color M-mode Doppler echocardiography in 150 consecutive patients at day 5-7 following their first acute MI.Results : Patients were classified into four groups: group A: preserved LV systolic and diastolic function (n=59); group B: LV systolic dysfunction with preserved diastolic function (n=8); group C: LV diastolic dysfunction with preserved systolic function (n=49); group D: combined LV systolic and diastolic dysfunction (n=33). The cardiac mortality rate at 6 months was significantly higher in groups C (12%) and D (36%) compared to A (2.5%) (p<0.01). Multivariate regression analysis identified LV diastolic dysfunction (p=0.001), killip class ≥II (p=0.005), and age (0.007) as predictors of cardiac death or readmission due to heart failure. Conclusion : The presence of LV diastolic dysfunction is associated with increased morbidity and mortality following acute MI. Key Words: Prognosis. Diastolic. Myocardial infarction__________________________________________________________________________________________


Article
Three months prognosis of transient ischemic attack (TIA) in Erbil Governorate
تخمين ثلاثة أشهر من نوبة نقص تروية عابرة في محافظة أربيل

Author: Abdullah Faqiyzadin Ahmed
Journal: Zanco Journal of Medical Sciences مجلة زانكو للعلوم الطبية ISSN: 19955588/19955596 Year: 2014 Volume: 18 Issue: 1 Pages: 632-637
Publisher: Hawler Medical Univeristy جامعة هولير الطبية

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Background and objective: A transient ischemic attack is a brief episode of neurological dysfunction resulting from focal cerebral ischemia not associated with permanent cerebral infarction. Transient ischemic attack carries a substantial short-term risk of stroke, hospitalization for cardiovascular events, and death. We aimed to evaluate prognosis of transient ischemic attack within three months follow up period, and identifying the predicting factors. Methods: Thirty patients with transient ischemic attack were evaluated and followed up for 3 months to identify their prognosis. ABCD2 score was used for risk stratification in index and follow up transient ischemic attack patients.Results: Within three months of follow up, 10% of patients developed transient ischemic attack and stroke each. There was an association between increasing age and increasing risk of index transient ischemic attack. Hypertension was the highest risk factors for index transient ischemic attack.Conclusion: Despite standard preventive medications, some patients will still have events later on.


Article
Central Nervous System Relapse in acute Lymphoblastic Leukemia: Prognostic Factors and the Outcome

Author: Tariq Abadi Al-Shujairi
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2008 Volume: 7 Issue: 4 Pages: 339-346
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:BACKGROUND:Despite the advances in treatment of acute lymphoblastic leukemia(ALL), CNS relapse remains an obstacle to successful treatment. This study was performed to determine the frequency of CNS relapse in ALL patients and to study risk factors and outcome after CNS relapse.PATIENTS AND METHODS:A retrospective study done on 364 patients diagnosed as ALL in Central Teaching Hospital for Children-Baghdad for the period from 1st Jan 2000 to 31st Mar 2005. ALL patients whom diagnosed after 1st Jan 2004 received CTHC 2004 protocol .The following parameters were studied: gender, age, hepatomegaly, splenomegaly, LAP, mediastinal mass, initial WBC count, platelets count, FAB morphology, initial CNS involvement and if the patient received radiotherapy.RESULTS:35 patients were excluded from the study. Out of 329 eligible patients, 76 patients (23.1%) had CNS relapse(isolated or combined), with mean duration before CNS relapse 12.30±8.28 months and median of 11 months. The following factors were significantly associated with development of CNS relapse: male gender, age <2 years, massive hepatomegaly, massive splenomegaly, lymphadenopathy, mediastinal mass, initial WBC count≥50000/mm, initial CNS involvement, and patients who did not receive prophylactic CNS radiation. The study shows that frequency of CNS relapse decreased significantly after addition of three intrathecal doses during induction). Shorter duration between diagnosis of ALL and CNS relapse was associated with higher mortality.CONCLUSION:Frequency of CNS relapse and mortality rate still higher than globally-accepted figures. Intensification of systemic and CNS-directed therapy, significantly decreased these figures in our patients.

Keywords

CNS relapse --- leukemia --- children --- prognosis.


Article
Prognostic Significance of Serum Albumin Levels in Patients with Systolic Heart Failure

Author: Muataz Fawzi Hussein
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2012 Volume: 11 Issue: 3 Pages: 411-417
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:BACKGROUND:Hypoalbuminemia is considered as poor prognostic factor in patients with certain chronic diseases, such as cancer and end-stage renal failure. Low serum albumin is common in patients with heart failure; nevertheless, the relationship between serum albumin and heart failure prognosis has not been well verified.OBJECTIVE:To elucidate the effect of serum albumin level on prognosis of patients with systolic heart failure.METHODS:This study included 250 patients with systolic heart failure who were admitted to Baghdad teaching hospital between February 2008 and April 2010. Patients were divided into groups based on presence of hypoalbuminemia (≤3.4 g/dL).RESULTS:The mean age of patients was 55 ± 14 years and the mean left ventricular ejection fraction [LVEF] was 28 ± 11 %). The mean serum albumin was 3.9 ± 0.7 g/dL; 27.2 % of patients had hypoalbuminemia. Patients with and without low serum albumin levels were similar in age, cause of heart failure, and ejection fraction. Patients with hypoalbuminemia had higher New York Heart Association (NYHA) class, higher serum urea, creatinine and C-reactive protein levels but lower levels of sodium, hemoglobin, and cholesterol. In patients with body mass index (BMI) < 25 kg/m2, 26% had hypoalbuminemia compared to 20% in those with BMI ≥25 kg/m2 (P ≤ 0.01). One-year survival was 64.71% in patients with and 85.72% in those without hypoalbuminemia (P < 0.001). Risk-adjusted hazard ratio for 1-year mortality was 1.9 (1.5-2.4).CONCLUSION:Hypoalbuminemia is common in patients with heart failure and is independently associated with increased mortality.


Article
Estrogen and Progesterone Receptors (ER and PR) Status of Breast Cancer Cases in Kurdistan and Their Correlation with Pathologic Prognostic Variables

Author: Mayada I. Yalda
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2013 Volume: 10 Issue: 1 Pages: 75-84
Publisher: Babylon University جامعة بابل

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Abstract

Background: breast cancer shows different clinico-pathological features according to geographic and ethnic groups' variation. The ER and PR positive status is an indication that the patient is a good candidate for hormone therapy. Furthermore, the high percentage and intensity of ER and PR positive cells are important predictive markers for this cancer.Aim To assess breast cancer-specific features for patients diagnosed in the north of Iraq and to assess the hormone receptors status and their relation to other pathological prognostic factors.Patients and Methods: This study included 324 breast cancer cases diagnosed and reviewed by histopathology in the central lab of Duhok/ Iraq, from May 2007 to March 2012. Immunohistochemical markers were used to identify the ER and PR status and scoring according to Allred scoring guideline. Results: About 68.2% of the patients included in this study were younger than 50 years. Most of them presented at stage II and III. Negative stain for ER was seen in more than half of the patients. The score proportion was decreasing with the increase in the stage, but the correlation was statistically insignificant; on contrary the correlation of ER and PR scoring with lymph node involvement was statistically highly significantConclusion: The young onset of breast cancer among Kurdish patients, the high stage at first presentation and the relatively high percentages of hormone insensitive cancers in both young and old patients could be attributed to the genetic predisposition modified by the revolution in life style and required additional study and analysis.

يشكل سرطان الثدي مشكلة كبيرة للنساء ويظهر تتغيرا في صفاته بحسب التغير الجغرافي والعرقي , وللمُستقبِلات الهرمونيه للاستروجين و البروجسترون و لشدة ايجابيتها دور ليس في التنبئ بتطورالمرض فقط بل في التنبئ باستجابة المريض للهرمونات العلاجيهتهدف الدراسة الحالية الى التعرف على مميزات حالات سرطان الثدي عند المرضى المصابين في شمال العراق مع دراسه مناعيه للمُستقبِلات الهرمونيه للاستروجين و البروجسترون و علاقتهم بالمميزات الأخرى في سرطان الثدي.تم جمع 324 عينه من مرضى مصابين بسرطان الثدي من المختبر المركزي في مدينة دهوك و مستشفيات أربيل و السليمانيه منذ مايس 2007و حتى آذار 2012. لقد تم تحليل صفات السرطان من نواحي مختلفه مع التركيز على درجة تميزه , مرحلة الورم , انتشاره في العقد اللمفاويه. وتم استخدام النسيج المُضَمَّن في البرافين لقياس المُستقبِلات الهرمونيه للاستروجين , البروجسترون وشدة ايجابيتهاالنتائج: أضهرت الدراسه أن حوالي 68.2% من المرضى في هذا البحث كانوا بعمر يقل عن الخمسين , كما أن معظمهم كانوا في مرحله متطوره نسبيا (المرحله 2 و 3) و بدرجة تمييز قليله .كانت المُستقبِلات الهرمونيه ذات نتائج سلبيه في اكثر من نصف الحالات, ولوحظ أن شدة الصبغ المناعي كانت تتناقص مع تقدم مرحلة الورم . لقد ارتبطت بعلاقه ذات مغزى احصائي مع الانتشار في العقد اللمفاويه, وكانت عاليه في درجة التمييز العاليه نستنتج من هذه الدراسه أن سرطان الثدي سجل بأعمار صغيره مقارنة بالدراسات من بعض مناطق العالم العربي, وأصغر بكثير من الدراسات من العالم الغربي. ان الاعمار الصغيره نسبيا بالاضافه الى النسبه العاليه من التشخيص الأولي بدرجة تميز قليله و في مرحله متطوره و نسبه متدنيه من المُستقبِلات الهرمونيه للاستروجين و البروجسترون قد يعزى الى تأثيرات جينيه معدله بتأثيرات انماط الحياة المعاصره وتحتاج الى المزيد من التحليل و الدراسه.

Keywords

Immunohistochemistry --- ER --- PR --- Breast --- Cancer --- Prognosis


Article
The Rate and Prognosis of Ventricular Fibrillation Complicating Acute Myocardial Infarction

Author: H. A. Nasrallah حسن علي نصرالله
Journal: Karbala Journal of Medicine مجلة كربلاء الطبية ISSN: 19905483 Year: 2006 Volume: 1 no. 1 Pages: 1-7
Publisher: Kerbala University جامعة كربلاء

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Abstract

Objective: To determine the rate of ventricular fibrillation according to thetime of onset of ischemic chest pain of patients with acute myocardialinfarction.Design: Prospective observational study.Setting: The only general hospital in Karballa city.Patients: 146 consecutive patients admitted to the coronary care unit withacute myocardial infarction.Main outcome measures: Time of onset of chest pain and ventricularfibrillation and survival of patient admitted with myocardial infarction. duringhospitalization.Results: The rate of ventricular fibrillation in these patients was high in thefirst 4 hours from onset of pain (14 patients 77.8%) and decline afterward,11.1% of patients with V.F. died during hospitalization compared with 7.8%of those without.Conclusion: Early admission to hospital of patient with acute myocardialinfarction will reduce the early mortality due to ventricular fibrillation. Fasteraccess to facilities for resuscitation must be achieved if major improvement inthe persistently high mortality of patient with acute myocardial infarction. is tobe made.


Article
clinical prognostic factors after the first attack of early onset multiple sclerosis in iraq
العلامات السريرية التنبأية بعد الانتكاسة الاولى لمرض تصلب الاعصاب المنتشر المبكر الحدوث في العراق

Author: Hasan A.Al hamadani حسن عزيز الحمداني
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 / 24108057 Year: 2011 Volume: 53 Issue: 4 Pages: 358-362
Publisher: Baghdad University جامعة بغداد

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Article
The Impact of Long Term Prognosis of Troponine in High Risk Unstable Angina

Author: Haitham Noaman Al-Koubaisy
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2014 Volume: 13 Issue: 3 Pages: 306-309
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:BACKGROUND : To evaluate the long term prognosis (6 months of follow up) regarding mortality , acute myocardial infarction and coronary angiography results in patients with troponin positive or negative in high risk unstable angina pectoris .METHODS : All patients included in this study were adults, 73 patients, 52(71.24%) male versus 21(28.76%) female of different ages . All had clinical features of ischemic chest pain of high risk unstable angina. They attended private clinic in HIT city, Anbar Governorate ( West of Iraq ) during the period January 2010 – December 2012. All had planner ST-segment depression in electrocardiography (ECG) according to concordant ECG leads other ECG findings of T- wave inversion or ST- elevation myocardial infarction were excluded, measurement of serum troponin test was done for all patients. All patients included in the study were admitted to coronary care unit (CCU) and received full treatment including heparin and discharged from hospital when they were clinically stable. Coronary angiography was done for all patients and followed up for 6 months.RESULTS : From all patients included in this study 27(36.98 % ) were troponin positive unstable angina, 3 (11.12%) patients of them were died and 24 (88.88 % ) patients of them survived. Their coronary angiography were sever type in 11(40.74 %) patients and they did coronary artery bypass surgery(CABG) and 13(48.14 % ) patients had multiple lesions in more than one vessels and need more than one balloon and stent(Percutaneous trans luminal coronary angioplasty PTCA) .While those whom troponin negative unstable angina were 46( 63.02 %) patients all were survived, only 5 (10.86 %) of them need coronary artery bypass surgery, 27 (58.69 %) patients need single or multiple stents , 4(11.5 %) patients had non critical coronary artery lesion only for medical treatment and the remaining 11 ( 41.81 %) patients were had normal coronary angiography .CONCLUSION : Troponin positive high risk unstable angina carry poor prognosis where has 3 times more mortality risk and more likely to be in need for surgery and difficult stenting and may not be able to be treated surgically or by stenting but medically without intervention than negative troponin high risk unstable angina .


Article
Prognosis of Stroke Patients Requiring Mechanical Ventilation in a Neurological Critical Care Unit

Author: Rasha Al-Aubaidi
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2017 Volume: 16 Issue: 3 Pages: 274-284
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:BACKGROUND: Intubation and mechanical ventilation are sometimes necessary during treatment of acute stroke. Indications include neurological deterioration, pulmonary complications, and elective intubation for procedures and surgery.OBJECTIVE: This study was performed at neurosciences hospital for the period 2013 - 2014 to prospectively assess the prognosis of stroke patients who require ventilation in a neurological intensive care unit and to determine factors that may influence outcome. METHODS: Analysis was made of 124 consecutive stroke patients,who required mechanical ventilation over a 2-year period. We determined the survival rate at 1 year after admission.RESULTS: The 1-year survival rate was 33.1%. Sixty-five patients (52%) died in the neurological intensive care unit. Among 17 variables analyzed, seven were found to significantly influence 2-month fatality in the univariate analysis: age greater than 65 years, atrial fibrillation, bilateral absence of pupillary light reflex, bilateral absence of corneal reflex, bilateral Babinski’s sign, infratentorial stroke, and Glasgow Coma Scale (GCS) score less than 10. Independent predictors of death at 2 months were age greater than 65 years, GCS score less than 10, and intubation performed because of coma or acute respiratory failure.CONCLUSION:Intubation and mechanical ventilation of severe stroke patients should be performed in a timely manner.older patients comatose on admission requiring mechanical ventilation have very poor prognosis. Fatality rate in our patients was high, but one third were still alive at 1 year after admission. Patients electively intubated in our study had a better prognosis independent from other factors, including age and GCS score.The probability of death at 2 months was more than 2.5 times greater in patients who were intubated because of neurological or respiratory deterioration than in those electively intubated for angiography or surgical intervention.


Article
The role of Laminin111 and Matrix metalloproteinase-2 Immunohistochemistry Expression in Prediction of Laryngeal Squamous Cell Carcinoma Prognosis
دور Laminin111 و Matrix metalloproteinase-2 التعبير المناعي في التنبؤ بتشخيص سرطان الحنجرة الحرشفية

Authors: Aws Rassul Hussain Al-Salih اوس رسول حسين --- Thair Wali Ali ثائر والي علي --- Ali Hassan Ali Murad علي حسن مراد
Journal: Al-Qadisiyah Medical Journal مجلة القادسية الطبية ISSN: 18170153 Year: 2017 Volume: 13 Issue: 23 Pages: 141-149
Publisher: Al-Qadisiyah University جامعة القادسية

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Objective: To investigate the role of laminin111 (LAM111) and matrix metalloproteinase-2 (MMP2) as a prognostic predictors in laryngeal squamous cell carcinoma (LSCC). Materials and Methods: The study was carried out on 30 patients with LSCC treated at the ENT Department, Al-Diwaniya Hospital in Al-Qadisiya province- Iraq. The clinical and histological data consisted of sex, age, site, clinical presentation, stage of the tumor, lymph node (LN) metastasis, and immunohistochemical studies (IHC). The IHC study was performed using anti LAM111and anti MMP2 monoclonal antibodies. Results: The majority of patients were above 50 years (73.33%), male affected more than the female with male to female ratio 2.8:1, 50% of tumors were located in glottic region, (86.67%) presented as mass. Most of the tumors were classified as well differentiated LSCC (53.33%), (76.67%) were recorded as negative LN metastasis, and 14 (46.67%) patients were in disease stage II. LAM111showed significant positive correlation with LN metastasis (P=0.027) and tumor stage (P=0.018), while MMP2 revealed significant positive correlation only with LN metastasis (P=0.029). There was a significant positive correlation between LAM111and MMP2 (P=0.014). Conclusion: Both LAM111 and MMP2 are poor prognostic markers for LSCC and predict LN metastasis.

الهدف: التحقيق في دور laminin111 (LAM111) والمصفوفة metalloproteinase-2 (MMP2) بمثابة تنبؤات النذير في سرطان الخلايا الحرشفية الحنجرة (LSCC). المواد والطرق: أجريت هذه الدراسة على 30 مريضاً مصابين بـ LSCC عولجوا في قسم الأنف والأذن والحنجرة ، مستشفى الديوانية في محافظة القادسية - العراق. تتألف البيانات السريرية والنسيجية من الجنس والعمر والموقع ، والعرض السريري ، مرحلة الورم ، ورم العقدة الليمفاوية (LN) ، والدراسات الكيميائية المناعية (IHC). تم إجراء دراسة IHC باستخدام الأجسام المضادة أحادية النسيلة المضادة لـ LAM111 و MMP2. النتائج: كانت غالبية المرضى فوق 50 عامًا (73.33٪) ، وكان الذكور يتأثرون أكثر من الإناث مع نسبة الذكور إلى الإناث 2.8: 1 ، وكانت 50٪ من الأورام موجودة في المنطقة الخلوية ، (86.67٪) تم تقديمها ككتلة. تم تصنيف معظم الأورام كما LSCC متباينة بشكل جيد (53.33 ٪) ، (76.67 ٪) تم تسجيلها كما ورم خبيث سلبي LN ، و 14 (46.67 ٪) من المرضى كانوا في المرحلة الثانية من المرض. أظهر LAM111 علاقة إيجابية كبيرة مع ورم خبيث LN (P = 0.027) ومرحلة الورم (P = 0.018) ، في حين كشف MMP2 عن وجود علاقة إيجابية مهمة فقط مع ورم خبيث LN (P = 0.029). كان هناك ارتباط إيجابي كبير بين LAM111 و MMP2 (P = 0.014). الخلاصة: كلا LAM111 و MMP2 هما علامات نذير ضعيفة لـ LSCC ويتوقعان ورم خبيث LN.

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