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Article
Chronic Idiopathic Thrombocytopenic Purpura Effects of Certain Variables on the Response to Treatment.

Author: Khudhayer A. Al-Khalissi
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2012 Volume: 11 Issue: 1 Pages: 45-49
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Idiopathic thrombocytopenic purpura is an acquired chronic autoimmune disease .Treatment whenindicated is usually by corticosteroids,then splenectomy if no acceptable response,with variableresponse rate to both types of treatment.OBJECTIVE:To look for the effects of certain variables on the type of response to steroid therapy in patients withadult idiopathic thrombocytopenic purpura, and to study the outcome of splenectomy in relation toprevious steroid therapy.METHOD:A prospective study on 80 patients, presented with bleeding and a platelet count of ≤ 30 X 109 / L.Initially treated with prednisolone and the response was studied in relation to gender , age , duration ofbleeding and platelet count on presentation. Patients who failed to maintain permanent completeremission were advised to have splenectomy.RESULTS:Of the 80 patients, 62 (77.5 %) were females and 18 (22.5%) were males. Mean age was 23 ± 10.1years. Ten (12.5%) patients only had permanent complete remission after steroid therapy. While 70(87.5%) patints failed. Response to steroid therapy was significantly related to duration of bleeding butnot to gender, age and platelet count. Thirty seven (46%) patients underwent splenectomy, permanentcomplete remission were achieved in 29 (78.2%).CONCLUSION:1. Duration of bleeding of ≤ 3 weeks is a good predictor of successful steroid therapy.2. Results after splenectomy is not related to previos steroid therapy


Article
Osteoporosis in steroid-dependent asthma patients in Mosul

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Abstract

ABSTRACTObjectives: To examine the prevalence of osteoporosis in steroid dependent asthma. To compare it with non-asthmatic patients who use steroid for different diseases and with a third group of patients who were referred for dual-energy X-ray absorptiometry (DXA) for various complaints and they never used steroid.Patients and methods: The study involved 70 asthma patients (12 males and 58 females) on oral corticosteroids and /or inhaled steroid, with their mean age of 48.94 with SD±13.49, 40 non asthmatic patients (3 males and 37 females) on oral steroid with their mean age of 53.93 with SD±13.02 and 47 patients as control one male and 46 females who are neither asthmatic nor using steroids, their mean age of 52.47 with SD±9.76. All patients and controls were studied in the outpatient department in Ibn Sena Teaching Hospital. All patients and controls had their bone mineral density (BMD) measurement done by using dual-energy x-ray absorptiometry (DXA).Results: The effects of weight on the development of osteopenia or osteoporosis indicate no statistically significant effects on the development of osteopenia or osteoporosis. The doses of steroids in osteoporotics showed no statistically significant difference between asthmatics and non-asthmatics. In osteopenia in both groups indicates statistically significant differences between them in favour of asthmatics over non-asthmatics. The duration of treatment with steroids for asthmatics and non-asthmatics indicates that, in osteoporotics asthmatics and non-asthmatics there were statistically significant difference between them, in favour of asthmatics over non-asthmatics, so as in osteopenics. Patients with asthma who take inhaled steroid only, indicates that the higher dose of inhaled steroids lead to osteoporosis with statistically significant difference between those who developed osteopenia or osteoporosis. We compared the DEXA scan score values (T-scores and Z-score values) of asthmatics and nonasthmatics in the entire sample in this study. There were statistically significant differences between asthmatics and non-asthmatics (including the controls) with p-value for the T-scores and Z-score of (0.000, 0.000) respectively.Conclusion: asthma should be regarded as independent risk factor for the development of osteopenia and osteoporosis. Steroid dose should be monitored. Adequate vitamin D supplement as preventive measures is well recognized factor in osteoporosis and osteopenia of all causes.

الخلاصةالأهداف: دراسة نسبة حدوث هشاشة وتنخر العظام عند مرضى الربو القصبي المعتمدين في علاجهم على الكورتيزون ومقارنتهم بمرضى يستخدمون الكورتيزون ولكنهم لايعانون من الربو القصبي بالاضافة الى مقارنتهم بمجموعة ضابطة لا تستخدم الكورتيزون.طرائق البحث: تمت الدراسة في العيادة الاستشارية لمستشفى ابن سينا التعليمي بالموصل. أجري الفحص على 157 مريضا (70 مريضا ربو قصبي يستخدمون الكورتيزون، 47 مريضا يستخدمون الكورتيزون ولايعانون من الربو القصبي بالاضافة الى40 مريضا كمجموعة ضابطة). أجري لجميع العينة فحص هشاشة العظام (DXA).النتائج: وزن المرضى لم يكن له تأثير معنوي يفرق بين مرضى الربو القصبي والمرضى الآخرين. جرعة مادة الكورتيزون للمرضى بينت ما يلي:-المرضى المصابين بتنخر العظام وإمكانية كسر العظام لمجموعة الربو والمجموعة الأخرى اللذين يأخذون الكورتزون لم تسجل فروقات معنوية بينهم.-المرضى المصابين بهشاشة العظام لمجموعة الربو والمجموعة الأخرى اللذين يأخذون الكورتيزون كان هنالك فرق معنوي مع أرجحية مرضى الربو على الآخرين. فترة المعالجة بالكرتيزون كان تأثيرها واضحا على مرضى الربو أكبر من المرضى الآخرين وخصوصا عند الإصابة بتنخر العظام وإمكانية كسر العظام. وكان هذا الفرق أكثر وضوحا عند مرضى الربو المصابين بهشاشة العظام. اما مرضى الربو اللذين يعالجون بأجهزة استنشاق الكورتيزون تبين أنهم يتعرضون للإصابة بتنخر وهشاشة العظام كلما زادت جرعة العلاج او الفترة الزمنية. عند دراسة قيمة (T-score & Z-score ) لمرضى الربو القصبي والمرضى الآخرين ظهر ان هنالك فرق معنوي كبير يرجح مضى الربو عن بقية العينة المفحوصة.الاستنتاج: مما تقدم نستطيع القول بان الربو القصبي بحد ذاته مسبب رئيسي للإصابة بنخر ولهشاشة العظام. ويجب إعطاء المرضى فيتامين D3 والكالسيوم كعلاج وقائي.

Keywords

Asthma --- osteoporosis --- steroids --- DXA


Article
Effects of Abuse of Anabolic Androgenic Steroids on Iraqi Athletes

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Abstract

Anabolic androgenic steroids (AAS) are man-made derivatives of the male sex hormone testosterone, originally designed for therapeutic uses to provide higher anabolic potency with lower androgenic effects. Increasing numbers of young athletes are using these agents illicitly to enhance physical fitness, appearance, and performance despite their numerous side effects and worldwide banning. Today, their use remains one of the main health problems in sports because of their availability and low price. The present study focuses on investigating the adverse effects of anabolic androgenic steroid abuse on sex hormones, liver and renal function tests, fasting glucose levels and lipid metabolism in Iraqi male recreational bodybuilders. We have recruited fifteen male bodybuilders (age 19-32 years) and an equal number of healthy non-obese, non-AAS-using sedentary controls. Serum hormones (luteinizing hormone (LH), follicle stimulating hormone (FSH), total testosterone, and prolactin), liver function indices (serum alanine aminotransferase (ALT), aspartate aminotransferase(AST), alkaline phosphatase(ALP), total and direct bilirubin), renal function parameters (serum creatinine and urea), lipid profile and serum glucose levels were measured. Abuse of AAS was associated with significant decreases (p< 0.005) in serum levels of LH (66.9%), FSH (49.8 %) and testosterone (63.7%) together with significant increases (p< 0.05) in prolactin concentrations (49.8%) in AAS-using bodybuilders compared to sedentary controls. Anabolic androgenic steroids-using athletes had significantly higher (p< 0.05) circulating levels of total bilirubin (116.3%), direct bilirubin (127.6%), aspartate (1752.9%) and alanine (263.1 %) transaminases than those of sedentary control subjects. Serum alkaline phosphatase levels were not significantly different (p> 0.05) between the two groups. Concerning renal function, AAS-using athletes had significantly higher serum concentrations of creatinine (28.6%) and urea (21.3%) than sedentary controls. Meanwhile, AAS abuse was accompanied by atherogenic lipid profile. Anabolic androgenic steroids -using athletes had significantly higher (p< 0.05) serum levels of triglycerides (TG) (45.6%), low density lipoprotein-cholesterol (LDL-C) (26.0%) and very low density lipoprotein-cholesterol(VLDL-C) (45.6%) together with significantly lower serum concentrations of high density lipoprotein-cholesterol (HDL-C) (31.3%) than sedentary controls. Serum total cholesterol (TC) and fasting glucose concentrations were not significantly different (p> 0.05) between the two groups. The results presented in the study confirm that abuse of AAS induces unfavorable body functions and undesirable side effects. Therefore, efforts should be sought against use of these compounds outside the therapeutic frame.

الستيرويدات البنائية هي مشتقات الهرمون الذكري المعروف بـ (Testosterone) صُنعت خصيصاً للتغلب على عيوب و مساوئ الـ (Testosterone) كمستحضر دوائي. تذكر الدراسات أنَّ أعداد الرياضيين الذين يقبلون على تعاطي مثل هذه المركبات بدون تصريح طبي في تزايد ملحوظ بمرور السنين على الرغم من التحذيرات المتكررة حول أعراضها الجانبية و على الرغم من وضع المنظمات الاولمبية و الجهات الحكومية عقوبات صارمة على من يتعاطى هذه المواد أو يتاجر بها. يعتبر الاستخدام الخاطئ لهذه المركبات من قبل الرياضيين من أهم مشاكل الرياضة في العصر الحديث. اُجريت هذه الدراسة و صممت لتقييم تأثيرات تعاطي هذه الستيرويدات البنائية على مستوى الهرمونات في مصل الدم و وظائف الكبد و الكلى و مستوى توزيع الشحوم و مستوى السكر في مصل الدم لمجموعة من ممارسي رياضة كمال الأجسام. اشتملت هذه الدراسة على (15) رياضياً يتعاطون الستيرويدات البنائية و (15) متطوعاً لا يمارسون رياضة كمال الأجسام و لا يتعاطون الستيرويدات البنائية. إعتمدت طرق التقييم على قياس مستوى الهرمونات في مصل الدم (LH, FSH, Testosterone, and prolactin) و وظائف الكبد (Total and direct bilirubin, SAST, SALT, and alkaline phosphatase) و وظائف الكلى (S creatinine and S urea) و مستوى توزيع الشحوم في مصل الدم (TC, TG, HDL-C, LDL-C, and VLDL-C) بالإضافة إلى تركيز السكر في الدم. أظهر تحليل البيانات تأثيراً ذو قيمة معنوية واضحة لتعاطي الستيرويدات البنائية على تركيز الهرمونات في مصل الدم .


Article
Evaluation of the Effectiveness of Two Methods Using Methylprednisolone on Post Operative Sequelae Following Lower Third Molar Surgery

Author: *Ibrahim S. Gataa, BDS , FICMS
Journal: KUFA MEDICAL JOURNAL مجلة الكوفة الطبية ISSN: 1993517X Year: 2009 Volume: 12 Issue: 2 Pages: 257-266
Publisher: University of Kufa جامعة الكوفة

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Abstract

The surgical extraction of lower wisdom tooth like any surgical procedure is usually associated with postoperative sequelae (pain, swelling and trismus).Different drugs and surgical techniques were used to decrease these inflammatory responses. Steroids have been used commonly for this purposes particularly methylprednisolone (MP). The aim of this study was evaluating the efficacy of preoperative systemic and local administration of MP (10 mg) on the post operative sequelae following surgical removal of lower third molar. Patients included in the study were (60) divided into 3 groups each group consist from (20) persons. The first group was the control one while the second group received (10mg) of MP orally and the third group injected with (10mg) of MP locally around the site of surgery one hour preoperatively. The postoperative sequelae were assessed on the 2nd,5th, and 7th days following the operation. The result showed significant reduction in pain and oedema with the use of systemic MP and there was no effect on trismus. The local injection of (10mg) of MP was significantly affecting the oedema formation on the 5th, and 7th days. The administration of oral methylprednisolone (10mg) played a good role in reducing pain and oedema following lower third molar surgery. The method used was simple, applicable and easily accepted by the patients.


Article
Androgenic –Anabolic Steroids Abusing Effect on Liver Enzymes and Lipid Profile in Male and Female Rats

Author: Nehaya M. Al-Aubody & Mohammad A. AL-Diwan
Journal: Journal of Education for Pure Science مجلة التربية للعلوم الصرفة ISSN: 20736592 Year: 2014 Volume: 4 Issue: 2 Pages: 191-204
Publisher: Thi-Qar University جامعة ذي قار

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Abstract

The present study was conducted at Veterinary Medicine College–University of Basrha /Iraq to investigate the effect of testosterone( Sustanon ® 250) abusing on some physiological and biochemical parameters. Sixty four male and female rats were divided into four groups(each group consisted of 8 males and 8 females). The first group served as control group in which the rats dosed by intramuscular injection with 10 μ l olive oil weekly for 12 weeks, the rest 3 treated groups (G1 . G2 and G3) in which the rats dosed by intramuscular injection with 50 . 100 and 150 mg Sustanon ® 250 / kg B.W. respectively weekly for 12 weeks , then all rats were terminated for the physiological and biochemical tests . The Sustanon ® 250 through its effect on liver caused increasing both ALT and AST and decreasing the ALP in treated rats compared with control group . The lipid profile was significantly affected by Sustanon ® 250 injection through elevation of TG and VLDL , but lowering the HDL ,LDL and AI.

أجريت الدراسة الحالية في كلية الطب البيطري / جامعة البصرة لدراسة تأثير فرط استخدام (sustanon®250) على مستوى بعض انزيمات الكبد ومستوى الدهون في ذكور و اناث الجرذان المختبرية. قسمت الجرذان المختبرية إلى أربعة مجاميع , المجموعة الأولى اعتبرت مجموعة سيطرة حقنت عضليا ب 10 مايكرولتر من زيت الزيتون أسبوعيا لمدة ثلاثة شهور . أما المجاميع الثلاثة الباقية فهي مجاميع معاملة بال sustanon®250 إذ حقنت المجموعة الأولى ب50ملغم / كغم من وزن الجسم والثانية 100 ملغم / كغم من وزن الجسم والثالثة ب 150 ملغم / كغم من وزن الجسم أسبوعيا لمدة ثلاثة شهور ، ثم بعد انتهاء فترة الحقن ضحي بالجرذان لدراسة المعايير الفسلجية والكيموحيوية. أظهرت النتائج زيادة معنوية في إنزيمي ALT و AST ونقصان معنوي لإنزيم ALP في الجرذان المعاملة بمادة ال sustanon®25 مقارنة مع مجموعة السيطرة. كما تأثر مستوى الدهون معنويا بسبب حقن ال sustanon®250إذ أظهر زيادة في مستوى الدهون الثلاثية والدهون واطئة الكثافة جدا ونقصان الدهون عالية الكثافة والدهون واطئة الكثافة والدليل التعضدي


Article
Pathological Effects of Anabolic Steroid (Sustanon®) on the prostate gland of adult Male Rats
التأثيرات المرضية للستيرويد البنائي (السستانون )على غدة البروستات في ذكور الجرذان البالغة

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Abstract

This study is designed to investigate the pathological effects of sustanon which is a type of anabolic androgens in different concentration on prostate gland of male rats. The experiment include 100 male rats randomly divided into five groups 20 rats each group. The first group is considered as a negative control treated with diet and water only. The second group is considered a positive control treated weekly for 60 days with sesame oil intramuscularly. While groups III, IV and V treated with diluted sustanon in 5, 10 and 20 mg/kg body weight intramuscularly weekly for 60 days respectively. Fifth biopsies were taken each group at 15,30 and 60 days after treatment . Also 5 rats from each group has given water and diet after stopping of treatment ,then 30 days later biopsy was taken for macroscopical and pathological examination. Pathologically all treated groups showed gross and histopathological changes. The prostate grossly revealed enlargement of gland associated with histopathological changes represented by hyperplasia of glandular epithelium in all treated groups. After stopping treatment for thirty days there was grossly atrophy of gland, histopathologicaly there was odema and depletion of colloidal substance, congestion of blood vessels and atrophy in some acini was also, recorded .In conclusion from the present study that sustanon at the doses 5, 10 and 20 mg/kg of body weight in a period 15, 30 and 60 days had side effects on prostate and these effects were progressive notice after30 days of stopping the drug administration.

صممت هذه الدراسة لمعرفة التأثيرات المرضية لأحد أنواع مركبات الاندروجين البنائية المتمثلة بالسستانونSustanon بتراكيز مختلفة في ذكور الجرذان.ضمت التجربة 100جرذاً قسمت عشوائياً إلى خمس مجاميع بواقع20 جرذاً لكل مجموعة.المجموعة الأولى عدت مجموعة سيطرة سالبة تم معاملتها بالماء والعلف وأما المجموعة الثانية فقد عُدّتْ مجموعة سيطرة موجبة تم حقنها بزيت السمسم أسبوعياً لمدة 60 يوما عن طريق الحقن داخل العضلة، أما المجاميع الثالثة والرابعة والخامسة فقد تم معاملتها بمركب السستانون المخفف وبالجرع 5 و10 و20 ملغم/ كغم من وزن الجسم على التوالي أسبوعياً ولمدة 60 يوما عن طريق الحقن داخل العضلي. تم تشريح الحيوانات واخذ نماذج من البروستات وبواقع خمسة عينات من كل مجموعة لدراسة الافات العيانية والنسجية وعند الفترات 15 و30 و60 يوماً بعد المعاملة ثم تركت 5 جرذان من كل مجموعة على الماء والعلف لمدة 30 يوماً بعد أخر معاملة تم بعدها اجراء Euthanesia) ) للحيوانات واخذ نماذج البروستات لملاحظة وجود الافات العيانية والنسجية تقدمية ام عكسية.ومن الناحية المرضية أظهرت كافة المجاميع المعاملة بالسستانون تغيرات مرضية عيانية ونسجية حيث أظهرت غدة البروستات تغيرات مرضية عيانية تمثلت بتضخم غدة البروستات في بداية المعاملات وعند كافة الجرع صاحبها تغيرات نسجية تمثلت بفرط تنسج ظهارة العنبات الغدية وبروزها بهيئة أصابع تمتد إلى التجويف لجميع الجرع مع نفاد المادة الغروانية الحمضية في تجويف البعض الاخر، اما في الحيوانات التي تركت دون معاملة لمدة 30 يوما فلقد لوحظ ضمور واختفاء في ظهارة العنبات مع تفجي شديد للمادة الحمضية الموجودة في تجويف عنبات اخرى فضلاً عن الوذمة والتليف واحتقان الاوعية الدموية مابين العنبات وتكاثر في الارومات الليفية بين العنبات الغدية.تستنتج الدراسة بان جرع السستانون 5 ،10 و20 ملغم/ كغم من وزن الجسم وخلال الفترات 15 ،30 و60 يوماً كانت لها تاثير مباشر على غدة البروستات لذكور الجرذان واستمرت حتى بعد انقطاع المعاملات لمدة 30يوما وتغذيتها على الماء والعلف فقط وكانت هذه التغيرات تقدمية.


Article
Clinical Improvement of osteoarthritic knee pain by adding intra-articular steroid Injection to viscosupplementation

Author: Ahmed Latteef Al-Shamari
Journal: Mustansiriya Medical Journal مجلة المستنصرية الطبية ISSN: 20701128 22274081 Year: 2015 Volume: 14 Issue: 1 Pages: 51-57
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Background: Intra-articular injections have been used for many years to treat painful joint disorders, especially by means of injecting crystalline suspensions of long-duration corticosteroids. Viscosupplementation, which is a relatively new intervention, consists of injection of exogenous hyaluronic acid into joints in order to treat osteoarthritis of knee joint. Patients and Methods: A prospective cohort study was conducted in a private orthopedic clinic in Baghdad from March 2013 to the end of September 2014, where it enrolled a total of fifty six (56) patients of middle ages, ranging from 39 to 64 years, classified as either grade II or III according to Kellgren and Lawrence radiographic criteria. Intra-articular injection of two drugs (a long acting steroid drug, then hyaluronic acid) were given locally in one or both knee joints with one week apart. To evaluate the effect of therapy, current study group patients were assessed by Visual Analogue Scale (VAS) after 1 week, and after 4-8 weeks from the beginning of the therapeutic trial. Results: more than two-third of cases were women (a ratio of 2.1:1), with age group of 50- 59 years old. No statistical correlation was found between Visual analogue scale (VAS) and radiographic grading (i.e. Kellgren and Lawrence radiographic criteria). Significant statistical difference (P<0.05) was shown in patients receiving intra-articular corticosteroids after week "1" of therapy, and a slightly better effect after adding hyaluronic acid on week "4" regarding the VAS scale of pain for radiographic grade II patients. Radiographic grade III patients showed a significant statistical correlation in VAS after week (4) of therapy for both moderate and severe classes. Conclusion: Intra-articular injections of both corticosteroids and hyaluronic acid with one week apart appear to give clinical improvement better than using Intra-articular injection of hyaluronic acid alone.

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