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Article
Descriptive study of Extragastrointestinal Manifestations of Ulcerative Colitis and their relation to disease activity in 100 Iraqi patients

Author: Khalid A. Al-Khazraji خالد الخزرجي
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: PISSN: 00419419 / EISSN: 24108057 Year: 2011 Volume: 53 Issue: 1 Pages: 24-28
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Ulcerative colitis is a chronic inflammatory bowel disease (IBD); its extragastrointestinal manifestations vary from one country to another. This study identifies the prevalence of the extragastrointestinal manifestations in a sample of Iraqi patients with ulcerative colitis and their relation to disease activity.Patients and Methods: A descriptive study was conducted on 100 patients with established diagnosis of ulcerative colitis, who attended Baghdad Teaching hospital and Gastroenterology center in Baghdad during the period from May 2009 to January 2010. A direct interview and thorough clinical examination were done to determine the history of the disease, its severity and the presence or absence of the extraintestinal manifestations.Result: The Extragastrointestinal manifestations were observed in 17 patients (17%). The most common EGlMs were the peripheral arthritis and mouth ulcer. The EGlMs were more common in patients with severe disease.Conclusion: The EGlMs of ulcerative are less common in Iraqi patients than in patients from western countries, but their relation with disease activity was relatively similar.Keywords: ulcerative colitis. extragastrointestinal manifestatio


Article
Histochemical and immunohistochemical techniques in ulcerative colitis

Authors: Noel AI-Sakkal نوئيل سليمان الصقال --- Hatim Alnuaimy حاتم النعيمي
Journal: Annals of the College of Medicine Mosul مجلة طب الموصل ISSN: 00271446 23096217 Year: 2008 Volume: 34 Issue: 1 Pages: 28-34
Publisher: Mosul University جامعة الموصل

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Abstract

Objective: To demonstrate the mucin changes in Ulcerative Colitis, to evaluate the benefit of the staining method and to demonstrate the CEA staining pattern in dysplasia complicating ulcerative colitis (U.C).
Methods: Colorectal biopsies were examined for changes of U.C for which a combined PAS/Alcian blue stain was applied. CEA immunohistochemical stain was used for cases of dysplasia complicating ulcerative colitis.
Results: One hundred colorectal biopsies were examined, U.C. was diagnosed in (22%) of cases, the mean age was (36.68) years, (13) were males, and (9) were females. The prevalence of dysplastic changes complicating U.C were detected in (22.7%).The rectum was the most frequent site of dysplasia complicating, U.C.. Two of the cases showed mild dysplastic changes; two showed moderate dysplasia, and only one showed severe dysplasia. The secretory activity of mucin in colorectal mucosa was tow in surface epithelium and varied in the crypts from absent or weak to moderate reduction.
The site of CEA distribution seemed to be affected mainly by degree of dysplasia, it was predominantly along the apical surface of the cells and also in the cytoplasm in case of mild dysplasia, while in moderate dysplasia it was of cytoplasmic distribution, and in severe dysplasia there was intensive cytoplasmic distribution.
Conclusion: There was an increase in relative frequency of U.C.
Immunohistochemical study of CEA localization in dysplastic gland is helpful in detection of early malignant change in U.C.

الهدف: توضيح تغيرات المخاط في مرض التهاب القولون التقرحي وتقييم جدوى الطريقة لايضاح المظهر الصبغي لـ CEA في مصاعف الحثل لالتهاب القولون التقرحي.الطرائق: أجرى فحص لخزعات من القولون ومن المستقيم بصدد تغيرات التهاب القولون التقرحي بصبغة (PAS/Alcian) الزرقاء المزدوجة، واجرى صبغ مناعي-نسيجي كيماوي لـ CEA لحالات الحثل المضاعق لالتهاب القولون التقرحي.النتائج: أجري فحص مائة خزعة قولون او مستقيم، وشخص التهاب القولون التقرحي لدى 22% من الحالات معدل العمر كان 36.68 سنة ؛ 13 ذكر و 9 اناث. وجدت التغيرات الحثلية المضاعفة لالتهاب القولون التقرحي لدى 22.7 % وكان المستقيم الموقع الاكثر لحالات الحثل المضاعف لالتهاب القولون التقرحي. اظهرت حالتان تغيرات حثلية خفيفة واثنتان اخريان اظهرتا تغيرات حثلية متوسطة وواحدة فقط اظهر جرت تغيرات حثلية شديدة. كانت فعالية افراز المخاط من النسيج الطلائي للمستقيم والقولون واطئة، مابين معدومة الى واظئة او متوسطة في الخفايا (crypts).ويظهر ان موقع انتشار CEA يتأثر بدرجة الحثل، واكثر ما لوحظ في السطح القمي للخلايا وفي الهيولي في حالات الحثل الخفيف بينما كان منتشرا في الهيولي في الحالات المتوسطة وانتشارا شديدا لوطأة في الهيوليفي الحثل الشديد.الاستنتاج: يظهر وجود زيادة نسبية في تكرار التهاب القولون التقرحي ويستفاد من الدراسة موقع الـ (CEA) بالصبغة المناعية النسيجية الكيماوية للغدد التي فيها مضاف الحثل في كشف التغيرات السرطانية المبكرة في مرض التهاب القولون التقرحي.


Article
Humoral Immune Response and Luminal Microorganisms in Patients with Indeterminate Colitis
الاستجابة المناعية الخلطية والجراثيم الجوفية في المرضى المصابين بالتهاب القولون

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Abstract

Abstract:Background: Microorganisms that directly interact with the intestinal mucosa are obscured by fecal flora. Some members of the endogenous faecal microflora have a clear detrimental role in most animal models of colitis and enteritis. This is strongly suspected to be the cause of indeterminate colitis.Objective: Determination of humoral immune response and luminal microorganisms in patients with indeterminate colitis.Patients & Methods: The study consisted of two groups: 75 patients groups with indeterminate colitis and control group consisted of 30 healthy volunteers. Sigmoidoscope and colonoscope examination were done for the patients group and biopsy were also taken from ulcer lesion for histopathological examination for confirming the diagnosis. Blood samples were collected from them and serum were collected for immunoglobulins (IgG, IgM and IgA) levels and complement (C3 and C4) level by single radial immune diffusion method (Biomaghrib-Tunis). Fecal and rectal swabs were taken from those groups, cultured on different bacteriological media. Results: Males more than females are affected. The majority of them were complaining from rectal bleeding. Most of their diseased location was in rectum then sigmoid and ascending colon. Bacteriological results showed a significant decrease in the existence of Bacteroids fragilis (anaerobic bacteria) in patients group compared with control. Studying humoral immune response demonstrated a significant higher level in IgG, IgA, C3 and C4 in patients group and significant decrease in IgM level.Conclusions: Reduction in anaerobic bacteria might be a cause in initiation colitis with stimulation of immunoglobulins production and complement activation to overcome this inflammation.Key wards: colitis, Immunoglobulins, anaerobic bacteria.

الملخص : خلفية : الكائنات الحية الدقيقة التي تتفاعل مباشرة مع الجدار المبطن للأمعاء والتي تحجب البكتريا التعايشية الموجودة في البرازمن اداء دورها . حيث وجد بعض الميكروفلورا البرازية الذاتية لها دور واضح في معظم النماذج الحيوانية في تسبب التهاب القولون والأمعاء و يشتبه بشدة أنها سبب في التهاب القولون غير المحدد الهدف :تحديد الاستجابة المناعية الخلطية والكائنات الحية الدقيقة الجوفية في المرضى الذين يعانون من التهاب القولون غير محدد. المرضى والأساليب :اشتملت الدراسة على مجموعتين : 75 مريضا مصاب بالتهاب القولون غير محدد ، و مجموعة مراقبة تتكون من 30 متطوع من الاصحاء تم فحص المرضى بناظور القولون واخذ خزعة نسيجية منهم ومسحة من المستقيم والبراز للمرضى ومجموعة الاصحاء . تم جمع عينات الدم منهم ، وجمعت ا لامصال للتحري عن مستويات الغلويبولينات المناعية المضادة (الاضداد) IgG,IgA,IgM والمتمم C3 و C4 بطريقة النشر المناعي الشعاعي Biomaghrib-تونس. اخذت مسحات البراز ومسحات المستقيم من هذه الجماعات ، وتربيتها على اوساط زرعية مختلفة وعزلت البكتريا باستخدام أساليب بكتريولوجية مختلفة لعزل البكتيريا المعوية وفقا لنوع البكتريا. النتائج : في هذه الدراسة كانت نسبة الذكور اعلى من الاناث وكان معظمهم يعانون من نزف دموي عن طريق المخرج. اظهرت الدراسة الجرثومية فرق مهم احصائيا في قلة الجراثيم اللاهوائية في مجموعة المرضى وكذلك اظهرت الاستجابة المناعية الخلطية فرق مهم احصائيا في زيادة الاضداد IgG وIgA والمتمم C3, C4.الاستنتاجات: يمكن أن نستنتج من هذه الدراسة ان قلة الجراثيم اللاهوائية من الممكن ان تؤدي الى التهاب القولون ومن ثم تحفيز انتاج الاضداد والمتمم.


Article
Colonoscopic findings in patients referred to Erbil public endoscopy units

Authors: Karzan Hikmet Abdullah --- Shahryar Mamand Tahir
Journal: Zanco Journal of Medical Sciences مجلة زانكو للعلوم الطبية ISSN: 19955588/19955596 Year: 2019 Volume: 23 Issue: 3 Pages: 439-445
Publisher: Hawler Medical Univeristy جامعة هولير الطبية

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Abstract

Background and objective: Colonoscopy, which is the visual examination of the large bowel and distal part of the small bowel, is an important diagnostic and therapeutic procedure. This study aimed to find out diagnostic findings of endoscopies in Erbil endoscopy unit and relation to important personal data including age and gender.Methods: An observational study was carried out from July 2017 to October 2017. Colonoscopies were done for 125 patients who met the inclusion criteria.Results: The findings of 125 colonoscopies were classified into gross and pathological findings. Colitis was found in 17 patients (13.6%), of which 10 patients (58.4%) had inflammatory bowel disease with higher incidence in females (60%). Polyps were found in 20 patients (16%) with adenomatous type being the most common pathological type (12 patients, 60%). Grossly sessile types were found in 13 patients (60%).Malignant tumors were found in eight cases (6.4%) with male predominance (62.5%). Ulcers were found in six cases (4.8%), and diverticula in five cases (4%). Normal colonoscopy was found in 46 cases (36.8%), with majority of these cases (37 cases) aged 21-41 years. Hemorrhoids were found in 23 patients (18.4%).Conclusion: Polyps were the most common colonic mucosal pathology with male predominance and older ages, followed by colitis with a higher incidence in females. Malignancies had lesser frequencies, the majority being in male and old age people. Normal colonoscopies and hemorrhoids were the largest groups, and diverticula with ulcers were the least findings.

Keywords

Colonoscopy --- Colitis --- Polyps --- Malignancy


Article
Role of Loop Ileostomy in the Management of Ulcerative Colitis Patients

Authors: Ahmed N. Hussein --- Maytham H Shahid
Journal: Al-Kindy College Medical Journal مجلة كلية الطب الكندي ISSN: 18109543 Year: 2019 Volume: 15 Issue: 2 Pages: 62-68
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Ulcerative colitis is a chronic inflammatory condition characterized by relapsing and remitting episodes of inflammation limited to the mucosal layer of the colon.Loop ileostomy might be helpful in the management of the disease.Objective: To evaluate the role of loop ileostomy in the management of ulcerative colitis. Methods: Between Januarys 2008 and January 2018, patients with fulminant ulcerative colitis resistant to medical therapy had been referred to our surgical unit and were included in our study. Assessment of the patients’ medical status (serum electrolytes, total serum protein, complete blood count, erythrocyte sedimentation rate, general stool exam,and abdominal ultrasound and x-rays) and psychological statuswere done and then preoperative status correction followed by defunctioning loop ileostomy operated upon them and followed postoperatively in hospital for the response fortwo weeks of hospitalization.Results: Twenty patients were included in the study, two patients died postoperatively due to comorbidities and pulmonary embolism. Eighteen of twenty patients had a gradual improvement clinically (mucus diarrhea with/without blood, weight gain, fever, psychological and edema) and in hematological and biochemicalvalues (complete blood count, serum albumin protein, erythrocyte sedimentation rate and electrolytes) within two weeks.Conclusion: Defunctioning loop ileostomy is a simple,less morbidprocedure if compared to other medical treatments which can change the complication features of fulminant ulcerative colitis towards either continue in medical therapy or towards definitive curative surgery and cost effective as it decrease the need for expensive medications.


Article
Prevalence of autoimmune hemolytic anemia in ulcerative colitis

Author: Khalid A. Al-Khazraji
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: PISSN: 00419419 / EISSN: 24108057 Year: 2008 Volume: 50 Issue: 3 Pages: 273-281
Publisher: Baghdad University جامعة بغداد

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Abstract

Summary
Background: Ulcerative colitis is a chronic idiopathic inflammatory disorder that affects the
rectum & extends proximally to affect variable extent of the colon. Autoimmune hemolytic
anemia had reported in few cases.
Objective: to determine the prevalence of autoimmune hemolytic anemia in Ulcerative
colitis.
Patient & Methods: Fifty Iraqi patients having Ulcerative colitis attending the GIT Center in
Baghdad during the period from March to August 2004 were interviewed, examined and
diagnosed according to pathological study done for colonic biopsies by the same centre.
Blood was drown for the assessment of complete picture with blood film, reticulocyte
percent, erythrocyte sedimentation rate, Coombs test (direct, indirect), antinuclear antibody,
immunoglobulin assay, serum iron and TIBC in the same laboratory unit.
Results: In our study, 18(36%) patients were anemic, fifteen of them had normal or low
reticulocyte percent with normochromic normocytic RBC in blood film, probable causes of
anemia was either iron deficiency proved by low serum iron and high total iron binding
capacity (TIBC), or anemia of chronic illness. The remaining three of eighteen patients with
reticulocytosis, two of them Coombs test were negative and normal film, but they were
having acute bloody diarrhea which probably was the cause of reticulocytosis.
The third patient was Coombs positive with features of hemolytic anemia in the blood film
(polychromic with spherocytosis), this patient had also a high titer of IGg, LDH, so that this
female had all the evidence of autoimmune hemolytic anemia which is a rare complication of
Ulcerative colitis.
Salfasalazine as a treatment of Ulcerative colitis can cause autoimmune haemolysis, but in
this case the drug had stopped for one month before the development of autoimmune
haemolysis.
In our sample we had five patients with reticuloytosis but normal haemoglobin level and
normal blood film with cooms negative (direct and indirect) those five patients might had
nonimmune causes of hemolytic like G6PD deficiency which need further investigations, or
might had bloody diarrhea which cause elevated reticulocyte as areaction to blood loss, or it
may be due to salazopyrine effect which may lead to increase level of reticulocyte.
Conclusion:Most studies giving range of autoimmune haemolytic anaemia with Ulcerative
colitis between 1%-2%, all these studies showed direct coomb's test positive, and our study
showed 2% incidence. So it is one of the rare manifestations of Ulcerative colitis. It does not
depend much on severity, duration and degree of colonic involvement.


Article
THE PREVALENCE AND CLINICAL SIGNIFICANCE OF PERINUCLEAR ANTINEUTROPHIL CYTOPLASMIC ANTIBODY IN PATIENTS WITH INDETERMINATE COLITIS

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Abstract

Background: Indeterminate colitis (IC), a term originated by pathologists to characterize confounding histopathlogic appearance of resected mucosa, has become catch phrase for cases in which diagnostic criteria at all levels elude classification as Crohn's disease (CD) or ulcerative colitis (UC).OBJECTIVES: evaluate the prevalence of pANCA expression in the sera and its isotypes. Patients and methods: PATIENTS GROUP consisted of 60 patients (40 males and 20 females) with indeterminate colitis and their age range was (19-84 years). CONTROL GROUP consisted of 30 (15 males and 15 females) healthy volunteers and their age range was (20- 66 years). Antineutrophil cytoplasmic ( pANCA and cANCA) testing was performed by an IIF technique on ethanol fixed human EOH granulocytes as substrate (EUROIMMUNE- Germany). Sigmoidoscope and colonoscope examination were done for the patients group and biopsies were taken from the patients for histopathological examination.Results:Serological results of ANCA showed a significant increased frequency of pANCA (63.3%) in indeterminate colitis patients as compared to controls (p=0.000). The highest percentage of this pANCA titer was 1:10 (p=0.000) then 1:100 (p=0.008) and most of them was IgG (53.3%) (p=0.000). Sensitivity of pANCA was 60%, specificity of pANCA was 40%, positive predictive value of pANCA was 61.1% and negative predictive value of pANCA was 66.6%. cANCA did not demonstrated in both groups. Conclusions : pANCA was more prevalent in indeterminate colitis and could be used as a predictive serological marker for the outcome of disease.


Article
ULCERATIVE COLITIS IN YOUNG CHILDREN, A CASE REPORT
التهاب القولون التقرحي في الاطفال الصغار (تقرير حالة)

Authors: Abdul-Kareem M. Ali عبد الكريم محمد علي --- Ahmed H. Alanee احمد هاشم العاني
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2008 Volume: 6 Issue: 2 Pages: 121-123
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

Ulcerative Colitis is one type of the inflammatory bowel diseases that affect the rectum and the colon. The usual age of presentation is at adolescence and adulthood. It is rarely seen during infancy and in young children. Our case, Mohammed, was presented at the age of 18 months with persistent bloody diarrhea that did not respond to the usual antibiotic and anti-parasitic drugs. All the investigations that were done during the period of the illness (more than 9 months) were non conclusive. Then colonoscopy were done which revealed the picture of ulcerative colitis. The patient then was put on oral steroid and salazopyrine with dramatic improvement in the general condition and disappearance of bloody diarrhea. Now the patient is on salazopyrine orally with steroid only in exacerbations.

التهاب القولون التقرحي هو واحد من امراض الامعاء الالتهابية التي تؤثر على المستقيم والقولون يظهر المرض غالبا في سن المراهقة والبلوغ ، ومن النادر اني يظهر المرض عند الرضع وصغار الاطفال حالتنا المرضية (محمد) ظهرت علمات المرض عنده بعمر( 18 شهر) باسهال دموي مستمر لايستجيب للمضادات الحيوية الاعتيادية والادوية المخصصة ضد الطفيليات .كل التحاليل المختبرية التي اجريت خلال فترة المرض المستمرة لاكثر من تسعة شهورغير محددة اومشخصة لمرض معين . وبعد ذلك نواظير القولون اظهرت صورة التهاب القولون التقرحي . ثم وضع المريض على العلاج المخصص لهذا المرض (Oral steroid and salazopyrine) مع حدوث تحسن ملحوظ وكبير في الحالة العامة للمرض واختفاء الاسهال الدموي .وعند حدوث نوبات جديدة للمرض يعطى المريض العلاج ذاته المستعمل عند التشخيص الابتدائي .


Article
Characterization of lymphocyte subsets as a tool of assessment of histological disease activity pattern in ulcerative colitis

Author: Hayder F. Ghazi
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: PISSN: 00419419 / EISSN: 24108057 Year: 2010 Volume: 52 Issue: 3 Pages: 304-308
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: In Ulcerative colitis (UC), the presence of a persistently elevated number of T cells in the inflamed area with respect to the activity of the disease suggesting bad prognosis. This study was done to evaluate cellular immune response in different disease activity patterns and its possible implication in evaluation of disease activity.Materials and methods: This study included Forty seven archived paraffin-embedded samples of ulcerative colitis; these samples diagnosed and graded for disease activity. Then dual immunofluorescence staining was used for phenotyping of lymphocytic infiltrate (CD3- CD19) and (CD4-CD8). A total and differential T cell as well as plasma cell count was recorded in these UC tissue samples. Non parametric Kruskal-Wallis test was used to compare the median cell counts among different study groups.Results: There is higher lymphocytic infiltrate for all types of cells when UC samples compared with control samples with highly statistical significant difference, T cells represents the major constituents of colonic mucosal infiltrate (86.89%) and about 75.79% were CD4 positive T cells. T-cell subsets and plasma cell have high statistical significant difference (p≤0.001) according to histological grade. Furthermore, with the histological grade the highest association found with T lymphocytes (r=0.944) followed by T helper (r=0.821), T cytotoxic (r=0.653) and B lymphocyte (r=0.237).Conclusions: Qualitative and semi quantitative characterization of lymphocytes subsets was useful in the assessment of different histological grades of UC disease activity.


Article
Development of Modified Release Nicotine Tablet Formulation for Treatment of Ulcerative Colitis

Author: Marwan Y. Al-hurr مروان يحيى الحر
Journal: Iraqi Journal of Pharmaceutical Sciences المجلة العراقية للعلوم الصيدلانية ISSN: 16833597 Year: 2010 Volume: 19 Issue: 2 Pages: 75-81
Publisher: Baghdad University جامعة بغداد

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Abstract

One of the therapeutic effects of nicotine is used as a protective against developing ulcerative colitis . ulcerative colitis is an inflammatory disease of the bowel affecting the superficial lining mucosa in the rectum and large intestine. In this study nicotine tablets were formulated as modified release tablets targeted to the colon. All formulas were studied for drug release , effect of diluent, retardant concentration, avicel grade,and compression force, the selected formula was then further studied for drug release in 3 different pH ( coated tablets) .The kinetic study revealed acceptable shelf life . Finally the selected formula was given to 6 patients in a pre-liminary clinical study which showed that nicotine can stabilize mild to moderate ulcerative colitis attacks.

التهاب القولون التقرحي احد التهابات الجهاز الهضمي التي تصيب الطبقة المخاطية السطحية للمستقيم و الامعاء الغليظه ويعتبر النيكوتين عامل حماية ضد تطور هذا المرض. في هذا البحث تم تحضير مضغوطات النيكوتين محورة التحرر موجه الى القولون. وتم دراسة تحررالدواء و تأثير نوع المواد المضافة غير الفعالة و تركيز المواد المثبطه للتحرر للصيغ المحضرة, وتأثير قوة الكبس على تحرر النكوتين. وتم أجراء دراسة اوسع للصيغه المختارة من حيث تحرر النيكوتين في اوساط مختلفة الاس الهيدروجيني و من حيث ثباتها في درجات حرارة مختلفة. وتم ايضا اجراء دراسة سريريه اولية على 6 مرضى للصيغة المختارة حيث أظهرت الدراسة ان النيكوتين يمنع تطور المرض و يزيد من استقرارية هذا المرض في الراحل البسيطة و المعتدلة الشدة.

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