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اضطرابات الغدة الدرقية في مرضى الذئبة الحمامي المجموعي

اسم المؤلف: هند عدنان محمد
اسم المشرف: خضير زغير معيوف البدري
الموضوع العام: الطب
السنة: 2017
الموضوع الدقيق: الامراض - المفاصل
الدرجة: دبلوم عالي
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: Thyroid hormone abnormalities had been shown to be more frequent in patients with systemic lupus erythematosus (SLE), hence, performance of thyroid function tests in patients with SLE, as a part of the biochemical and immunological profiles, may help in early detection of associated thyroid disorders.Aim of the Study : To assess the thyroid hormone abnormalities in a group of systemic lupus erythematosus Iraqi patients.Patients and Methods : A case - control study was conducted at Baghdad Teaching hospital, Department of Rheumatology during the period from September 2016 to July 2017. Including 58 SLE patients and 60 controls who met the inclusion criteria. After ethical approval, data were collected using a preconstructed data collection sheet, questionnaire included demographic and clinical data of the patients and controls. Thyroid function tests, complete blood count, ESR, anti - double - strand DNA and complement C3 and C4 test were performed. Statistical analysis was done using the statistical package for social sciences (SPSS) v.24.Results : The mean age of the studied groups was 28.26 ± 7.1 years and 29.18 ± 6.3 years in SLE and control groups, respectively. No statistically significant differences between both groups had been found in age, BMI, or other demographic variables (P>0.05). Abnormal thyroid function was significantly more frequent in SLE patients (25.9%) than controls (5%), (P< 0.05). Primary hypothyroidism and Subclinical hypothyroidism were the more frequent disorder in SLE patients; 6/15 nd 5/15, respectively, each of subclinical hyperthyroidism and primary hyperthyroidism was reported in 2/15 SLE patients. Prednisolone and Hydroxychloroquine were the more frequently used medications among the SLE patients and were insignificantly associated with abnormal thyroid function in SLE patients, (P>0.05). High ESR was reported,, Leucopenia , high Anti dsDNA , low C3 and low C4 and Lymphopenia were reported in SLE patients. While all of SLE patients were ANA +ve and none of them had thrombocytopenia.Conclusions : Thyroid dysfunction was more frequent in SLE Iraqi patients compared to healthy population and the primary hypothyroidism and subclinical hypothyroidism were the more frequent types.

انتشار اضطراب الكئابه العظمى لدى المرضى العراقيين المصابين بالتصلب المجموعي Prevalence of Major Depressive Disorder in Iraqi Patients with Systemic Sclerosis

اسم المؤلف: رؤى ناجي سوادي
اسم المشرف: فائق ايشو كوريال مشتاق طاب هاشم
الموضوع العام: الطب
السنة: 2017
الموضوع الدقيق: الامراض - المفاصل
الدرجة: دبلوم عالي
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: Background : Systemic sclerosis (SSc) is a connective - tissue disease characterized by excessive collagen deposition in the dermis and internal organs, and by vascular hyper - reactivity and obliterative microvascular phenomena. Depression is a state of low mood and aversion to activity that can affect a person's thoughts, behavior, feelings, and sense of well - being.Objectives : The aim of this study was to evaluate the prevalence and predictors of major depressive disorder in Iraqi patients with SSc if present.Patients and methods : This case - control study involved 50 patients with SSc according to the criteria developed by the 2013 American College of Rheumatology/European League Against Rheumatism for the classification of systemic sclerosis ,and compared with another 51 healthy controls.Demographics and clinical data were collected including age, sex, BMI, smoking status, marital status, employment status, educational status, crowding index and disease duration. Disease activity for SSc was assessed with the SAQ. Medications used and autoantibody profile were collected.We applied DSM5 diagnostic criteria of all patients included .Results : The prevalence of major depressive disorder was (44% compared to control 2.0%), in which major depressive disorder 39.3 folds associated with SSc patients compared to control. A severe form of major depressive disorder was observed in (36.4 %) of SSc cases. Furthermore, cases with a severe form of disease evaluated by SAQ had an obviously higher rate of depression .Also the risk of having major depressive disorder was significantly correlated with smoking.Educational level had no statistically significant association with major depressive disorder, SSc cases with higher education(college) had the highest rate of major depressive disorder (36.4%) compared to a rate between 13.6% and 27.3% for lower level of educational attainment. The risk of having major depressive disorder was not different in the age, gender, marital status and employment status. The history of using each of prednisolone, DMARD and biological agents had statistically significant association with major depressive disorder. Also the presence of autoantibodies (anti centromer and anti Scl70 antibodies) had no statistically significant effect on the presence of major depressive disorder.Conclusions : The prevalence of major depressive disorder in systemic sclerosis patients was significantly higher in patients compared to controls.Severity of systemic sclerosis was increase the rate of major depressive disorder .

عرض توزيع الخلايا الحمراء ومتوسط حجم الصفائح الدموية لدى عينه من المرضى العراقيين البالغين المصابين بمرض التهاب الفقار اللاصق Red cell Distribution Width and Mean Platelets Volume in sample of adult Iraqi patients with Ankylosing Spondylitis

اسم المؤلف: علي مكي حسن
اسم المشرف: فائق ايشو كوريال
الموضوع العام: الطب
السنة: 2017
الموضوع الدقيق: الامراض - المفاصل
الدرجة: دبلوم عالي
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: Ankylosing spondylitis (AS) is a chronic, progressive inflammatory rheumatic disease that affects the axial skeleton causing characteristic back pain, and lead to structural and functional impairment and decrease in the quality of life.Mean platelet volume (MPV) is a part of the complete blood count (CBC) test and correlates with the platelets function and activation. Red cell distribution width (RDW) is a part of the complete blood count (CBC) and estimates erythrocyte variability.Objective : To analyse RDW and MPV in patients with AS and to evaluate their relationships with acute phase reactants (APRs) and disease activity index.Patients and Methods : A total of 100 patients with AS (78 males : 22 females) diagnosed according to the modified New York classification criteria for AS and 146 (99male : 47female) healthy individuals matched in age and gender as controls enrolled in the study. Demographic data, disease activity scores using Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), medical history, Creactive protein (CRP), erythrocytes sedimentation rate (ESR), and complete blood count (CBC) were all measured.Results : The mean age for patients and control was 38.0 ± 9.0 and 35.8 ± 9.0 years respectively (p=0.057). Both MPV and RDW were significantly higher in patients with AS (9.215 ± 1.570 p < 0.001 and 14.133 ± 1.613 p < 0.001 respectively) compared with controls (7.753 ± 0.857 p < 0.001 and 12.299 ± 1.031 p < 0.001 respectively). There was a direct correlation of (RDW and MPV with both ESR and CRP (P < 0.001 for RDW and 0.01 for MPV), RDW had r=0.38 for C - reactive protein (CRP) and 0.413 for ESR, and MPV had r=0.23 for CRP and 0.232 for Abstract VIESR. Also BASDAI was directly correlated with RDW (r=0.326 p<0.001) and MPV (r=0.333, p<0.001).Conclusion : Both MPV and RDW were higher in AS patients than in controls and are directly correlated with ESR, CRP, and BASDAI.

العلاقة بين مستوى حامض البوليك في الدم وكثافة المعادن في العظام بين عينة من متوسطي وكبار السن العراقيين Association Between Level of Serum Uric Acid and Bone Mineral Density Among a Sample of Middle Aged and Elderly Iraqis

اسم المؤلف: سندس عدنان جوامير
اسم المشرف: محمد هادي العصامي
الموضوع العام: الطب
السنة: 2017
الموضوع الدقيق: الامراض - المفاصل
الدرجة: دبلوم عالي
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: خلفية البحث : حامض البوليك هو حامض ضعيف وناتج نهائي من تحلل وايض البيورينات ويتواجد تحت الظروف الفسلجية على شكل ملح الصوديوم الاحادي , بداية اعتبر حامض البوليك كناتج خامل يتبلور في التراكيز العالية مكونا حصاة الكلية والتهاب المفاصل النقرسي , بالتالي ادرك انه من مضادات الاكسدة القوية يمسح الاوكسجين الدري , مختبريا وحسب الدراسات الخلوية اعتبر حامض البوليك ايضا كمؤيد للاكسدة حسب الكيميائية المكروية. كثافة العظام المعدنية هي مقياس المحتوى المعدني للعظام بوحدة الغرام والمساحة المتوقعة ذات البعدين بوحدة السنتيمتر المربع والوسيلة المستخدمة هي مقياس امتصاصية الطاقة المزدوجة للاشعة السينية.الهدف : تقييم العلاقة بين مستوى حامض البوليك في مصل الدم ومقياس كثافة المعادن للعظام ان وجد.المرضى والطرائق : شملت الدراسة (60) رجلا وامراة منهم (35)امراة والباقي رجال (25) اعمارهم تتراوح من 40الى 70سنة .تم جمع بيانات المرضى الديموغرافية والسريرية بما في ذلك العمر والجنس والطول والوزن ومعيار كتلة الجسم وحالة التدخين والحالة الوظيفية والدورة الشهرية والحالة المرضية ومستوى النشاط والتحصيل الدراسي . تم قياس نسبة الحامض بوحدة ملغرام لكل ديسيلتر مربع لكل وكدلك كثافة المعادن للعظام للفقرات القطنية من الواحد الى الاربعة وعنق عظم الفخذ الايمن لكل شخص مع حساب مقياس تي ومقياس زت عن طريق مقياس الامتصاص للطاقة المزدوجة للاشعة السينية النتائج : هناك علاقة احصائية مباشرة ضعيفة بين مستوى حامض البوليك وكثافة العظم للفقرات القطنية في جميع الاشخاص القيمة الاحتمالية (0,176). العلاقة بين مستوى الحامض وكثافة العظام للذكور مباشرة في عنق الفخذ الايمن ومعتدة احصائيا القيمة الاحتمالية (0,040) . توجد علاقة مباشرة ضعيفة بين مستوى حامض البوليك وكثافة عظام الفقرات القطنية في الاناث في سن الياس (0,225) .الاستنتاجات : هناك اثار وقائية منطقية لحامض البوليك للعظام في الذكور | Background : Uric acid is the final breakdown product of purine metabolism in humans, it is a weak organic acid that under physiologic condition exists mainly as a monosodium urate salt , initially, uric acid was considered an inert waste product that crystallizes at high concentrations to form renal stones and provoke gouty arthritis , subsequently, uric acid was recognized to be a powerful antioxidant that scavenges oxygen radicals. Cellular studies have nevertheless demonstrated that depending on its chemical microenvironment, uric acid may also be pro - oxidant. Bone mineral density measurements are widely used to diagnose osteoporosis and measurement in bone mass are commonly used as a surrogate for fracture risk . Bone mineral density is the measured parameter, and allows the calculation of the bone mineral content in grams and the two - dimensional projected area in square centimeter of the bone being measured; thus the units of is gram per square centimeter. Objectives : The aim of this study was to evaluate the relationship between the serum uric acid and bone mineral density in a sample of middle and elderly Iraqis Patients and methods : This cross - sectional study involved sixty participants , thirty five were female and twenty five were male, based on exclusion (systemic rheumatic diseases , malignancy , gout , chronic kidney and liver diseases, diabetes mellitus , thyroid disease, pregnancy, medications : thiazide , calcium , vitamin D, steroid , bisphosphonate) and inclusion (Iraqi consenting men and women , aged from forty to seventy years) criteria. Demographics and clinical data were collected including age, sex, body mass index, smoking status, employment, educational status, menstrual history, level of physical activity, comorbidities .Serum uric acid was measured and bone mineral density was calculated for each individual by dual energy x ray absorptiometry scan , Z - score and T - score at first lumbar - forth lumbar spine and right femoral neck were measured . Results : There is weak direct relationship between bone mineral density, T and Z score with uric acid (stronger in bone mineral density than the others probability value ( 0.176) in lumber spine bones for all patients , but no relationship was found between bone mineral density , with uric for right femoral neck in all participants probability values (0.346) , while in females, there was no relationship between uric acid and bone mineral density , T and Z score of the lumbar vertebral spine , while; there was weak inverse relationship between bone mineral density , T and Z score with uric acid in right femoral bone . In postmenopausal female; in lumbar vertebral spine bone there was weak direct relationship between uric acid with bone mineral , Z and T score, while; in right femoral bone there was no relationship between uric acid with bone mineral density , Z and T score. In males for right femoral bone; there was significant direct relationship between bone mineral density with uric acid probability value (0.04), while the relationship between uric acid with T and Z score was non - significant (however it is direct and weak correlation),while ; no relationship was observed between uric acid with bone mineral density, T and Z score for lumbar vertebral spine bones.Conclusion : Significant direct relationship was found between bone mineral with uric acid , so uric acid is protective against bone loss in male

متوسط حجم الصفائح الدموية وعرض توزيع الخلايا الحمراء في المرضى العراقيين المصابين بالتهاب المفاصل الروماتويدي Mean Platelet Volume and Red Cell Distribution Width in Iraqi Patients with Rheumatoid Arthritis

اسم المؤلف: انمار عبد الوهاب البياتي
اسم المشرف: زياد شفيق الراوي
الموضوع العام: الطب
السنة: 2017
الموضوع الدقيق: الامراض - المفاصل
الدرجة: دبلوم عالي
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: خلفية البحث : التهاب المفاصل الروماتويدي هو التهاب مناعي ذاتي جهازي مزمن يصيب المفاصل واجهزة الجسم الاخرى. متوسط حجم الصفائح الدموية هو جزء من اختبار العد الكامل للدم ويرتبط مع وظيفة الصفائح الدموية وفاعليتها. عرض توزيع الخلايا الحمراء هو جزء من اختبار العد الكامل للدم ويقدر تغيرات كريات الدم الحمراء.الهدف : لتقييم عرض توزيع الخلايا الحمراء ومتوسط حجم الصفائح الدموية في مصل المرضى الذين يعانون من التهاب المفاصل الروماتويدي وتقييم علاقاتهما مع الخصائص الديموغرافية والسريرية الاساسية للمرضى.المرضى والطرائق : شملت دراسة تضبيط الحالة هذه تشخيص ما مجموعه 111 مريضا مصابا بمرض التهاب المفاصل الروماتويدي (98 انثى : 13 ذكرا) وفقا لمعايير التصنيف الامريكية لامراض الروماتيزم / الرابطة الاوروبية لمكافحة الروماتيزم لالتهاب المفاصل الروماتويدي، متوافقين بالعمر والجنس مع 97 شخصا من الاصحاء كمجموعة ضبط (سيطرة) (76 انثى : 21 ذكر). وتم قياس كل من البيانات الديموغرافية، ودرجات نشاط المرض، والتاريخ الطبي، والادوية المستعملة، والعامل الروماتويدي، ومضاد سيترولينيتد الببتايد الضد ، ومعدل ترسيب كريات الدم الحمراء ، واختبار العد الكامل للدم.النتائج : كان متوسط العمر للمرضى والسيطرة 46.53 ± 11.89 و48.19 ± 12.06 سنة على التوالي (p=0,321). لم تكن فروقات متوسط حجم الصفائح لمرضى التهاب المفاصل الروماتويدي (8.0 ± 1.4) والسيطرة (7.7 ± 1.2) معتد احصائيا(P=0.4)، بينما وجد ان عرض توزيع الخلايا الحمراء اعلى بكثير في المرضى (14.5 ± 2.8) مقارنة مع مجموعة الضبط (12.4 ± 1.1) (p => 0.001). لم يكن هناك ارتباط معنوي بين عرض توزيع الخلايا الحمراء ومتغيرات مختلفة كـ(العمر، مؤشر كتلة الجسم ، مدة المرض، درجة فاعلية المرض 28، ومؤشر نشاط المرض السريري، معدل ترسيب كريات الدم الحمراء، الجنس، العامل الروماتويدي ومضاد سيترولينيتد الببتايد الضد). ان لعرض توزيع الخلايا الحمراء قدرة جيدة على التفريق بين مرضى التهاب المفاصل الروماتويدي ومجموعة الضبط،وكذلك فان لمعدل ترسيب كريات الدم الحمراء قدرة ممتازة على التفريق بين مرضى التهاب المفاصل الروماتويدي ومجموعة الضبط.الاستنتاجات : كان عرض توزيع الخلايا الحمراء اعلى بكثير في مرضى التهاب المفاصل الروماتويدي من مجموعة الضبط، في حين كان متوسط حجم الصفائح الدموية اعلى في مرضى التهاب المفاصل الروماتويدي مقارنة مع مجموعة الضبط غير ان الفروقات لم تكن معتدة احصائيا. لم يكن هناك ارتباط كبير في مرضى التهاب المفاصل الروماتويدي بين عرض توزيع الخلايا الحمراء ومتغيرات مختلفة كـ(العمر، مؤشر كتلة الجسم، مدة المرض، ، درجة فعالية المرض 28 ، ومؤشر نشاط المرض السريري ، معدل ترسيب كريات الدم الحمراء، الجنس، العامل الروماتويدي ومضاد سيترولينيتد الببتايد الضد). | Background : Rheumatoid arthritis is a chronic systemic autoimmune inflammatory disease, which affects the joints and other body systems. Mean platelet volume is part of the complete blood count test and correlates with the platelet function and activation. Red cell distribution width is part of the complete blood count test and estimates erythrocyte variability in volume.Objective : To evaluate red cell distribution and mean platelet volume in patients with rheumatoid arthritis and to assess their relationships with baseline demographic and clinical characteristics of rheumatoid arthritis .Patients and Methods : A total of 111 patients (98 female : 13 male) with rheumatoid arthritis diagnosed according to the American College of Rheumatology/European League Against Rheumatism classification criteria for Rheumatoid arthritis 2010 and age sex matched 97 control healthy individuals (76 female : 21 male) were involved in this case - control study. Demographic data, disease activity scores, medical history, current medications were reported. Rheumatoid Factor, Anti Citrullinated Peptide Anti body, complete blood count erythrocyte Sedimentation Rate, and were all measured.Results : The red cell distribution width was significantly higher in patients (14.5 ± 2.8) compared to controls (12.4 ± 1.1) (p=>0.001). While Mean platelet volume in rheumatoid arthritis patients was (8.0 ± 1.4) and that for controls (7.7 ± 1.2), the differences were insignificant (P=0.4). Mean age for patients and controls were 46.53 ± 11.89 and 48.19 ± 12.06 years respectively (p=0.321). There were no significant correlation between red cell distribution width and various variables (Age, Body Mass Index, disease duration, Disease Activity Score28, Clinical Disease Activity Index, ESR, Sex, Rheumatoid factor, and Anti Citrullinated Peptide Anti body).The red cell distribution width had good validity to differentiate rheumatoid arthritis patients from controls, while erythrocyte sedimentation rate had excellent validity to differentiate between rheumatoid arthritis patients and controls.Conclusions : Red cell distribution was significantly higher in rheumatoid arthritis patients than in controls, While mean platelet volume was higher in rheumatoid arthritis patients compared to controls, but not reach statistically significant. In rheumatoid arthritis patients there were no significant correlation between red cell distribution and various variables (Age, Body mass index, Disease duration, Disease activity score 28, Clinical disease activity index , Erythrocyte sedimentation rate, Sex, Rheumatoid factor, and Anti Citrullinated Peptide Anti body).

ارتفاع المؤشرات الالتهابية كمتنبئ للاستجابة للادوية المضادة لعامل تنخر الورم (الايتانرسبت والانفلكسماب) في عينة من المرضى العراقيين المصابين بتشمع الصلب Raised Inflammatory Markers as Predictors of Response to Anti - Tumor Necrosis Factor Drugs (Etanercept and Infliximab) in a Sample of Iraqi Patients with Ankylosing Spondyl

اسم المؤلف: سيف عبد الكريم رؤوف
اسم المشرف: نزار عبد اللطيف جاسم
الموضوع العام: الطب
السنة: 2017
الموضوع الدقيق: الامراض - المفاصل
الدرجة: دبلوم عالي
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: الخلفية : تشمع الصلب هو مرض التهابي جهازي مزمن يؤثر بشكل اساسي على الهيكل العظمي المحوري، على الرغم من ذلك فان المفاصل الطرفية وانسجة الارتكاز والانسجة خارج المفصل قد تتاثر ايضا بالمرض مثل العيون والقلب والرئتين. يرتبط ارتفاع المؤشرات الالتهابية ( بروتين سي التفاعلي او معدل ترسيب كريات الدم الحمراء) في المرضى المصابين بتشمع الصلب في بداية اعطاء الادوية المضادة لعامل تنخر الورم مع استجابة سريرية افضل. الهدف من الدراسة : تقييم دور ارتفاع المؤشرات الالتهابية ( بروتين سي التفاعلي او معدل ترسيب كريات الدم الحمراء) في تنبؤ الاستجابة للادوية المضادة لعامل تنخر الورم في المرضى المصابين بتشمع الصلب.المرضى والطرائق : ادخل في الدراسة الاترابية 71 مريضا من المصابين بتشمع الصلب كعدد كلي، كلهم كانوا مطابقين لمعايير نيويورك المعدلة لتشخيص تشمع الصلب ومعايير تصنيف الجمعية الدولية لتقييم التهاب المفاصل الصلبي لغرض تشخيص التهاب المفاصل الصلبي. تم استثناء 19 مريضا من الدراسة نتيجة انقطاعهم عن استخدام الادوية المضادة لعامل تنخر الورم واستمر 52 مريضا بالدراسة وتمت متابعتهم لمدة ثلاثة اشهر . تم جمع البيانات الديموغرافية ، مدة المرض ، نوع العلاج ، مؤشر نشاط مرض التشمع الصلب والمؤشر الوظيفي لمرض تشمع الصلب من المرضى. وتم ايضا فحصهم مختبريا لبروتين سي التفاعلي، معدل ترسيب كريات الدم الحمراء ، كريات الدم البيضاء ، الهيموغلوبين وعدد الصفائح الدموية.النتائج : كان متوسط عمر المرضى 35.2 ± 9.6 سنوات ، شكل الذكور 84.6% منهم وكان متوسط مدة المرض 5 (3 - 10) سنوات. اظهر التحليل احادي المتغير بان المتنبئات للاستجابة للادوية المضادة لعامل تنخر الورم شملت الارتفاع الاساسي لبروتين سي التفاعلي ، معدل ترسيب كريات الدم الحمراء ، مؤشر نشاط مرض التشمع الصلب والمؤشر الوظيفي لمرض تشمع الصلب. اظهر التحليل متعدد المتغير بان المتنبئ المستقل الوحيد للاستجابة للادوية المضادة لعامل تنخر الورم هو الارتفاع الاساسي لبروتين سي التفاعلي. كانت نقطة القطع المثلى لبروتين سي للاستجابة للادوية المضادة لعامل تنخر الورم اكثر من 7.5 ملغم/ لتر بحساسية 94.29% ونوعية 88.24%, بينما لمعدل ترسيب كريات الدم الحمراء كانت اكثر من 32 ملم/ ساعة بحساسية 74.29% ونوعية 94.12%. كان هنالك نزول واضح في مؤشر نشاط مرض التشمع الصلب والمؤشر الوظيفي لمرض تشمع الصلب بعد ثلاثة اشهر من العلاج (لكلا العلاجين ايتانرسيبت وانفلكسماب). لم تتنبا المتغيرات الاخرى التي تم دراستها والتي تشمل البيانات الديموغرافية، مدة المرض، الهيموغلوبين، كريات الدم البيضاء، الصفائح الدموية، نوع العلاج، وجود التهاب المفاصل الطرفية، التهاب انسجة الارتكاز او التهاب القزحية بالاستجابة.الاستنتاجات : يتنبا الارتفاع الاساسي للمؤشرات الالتهابية ( بروتين سي التفاعلي او معدل ترسيب كريات الدم الحمراء) باستجابة افضل للادوية المضادة لعامل تنخر الورم في المرضى المصابين بتشمع الصلب. بروتين سي التفاعلي لديه تنبؤ افضل للاستجابة للادوية المضادة لعامل تنخر الورم من معدل ترسيب كريات الدم الحمراء | Background : Ankylosing spondylitis is a chronic systemic inflammatory disorder mainly affecting the axial skeleton, although peripheral joints, entheses and extra - articular tissues may also be involved such as eyes, heart and lungs. Raised inflammatory markers (C - reactive protein or erythrocyte sedimentation rate) in patients with AS at the start of anti - tumor necrosis factor therapy associated with more clinical response.Aim of the study : To assess the role of raised inflammatory markers (C - reactive protein and erythrocyte sedimentation rate) in predicting response to anti - tumor necrosis factor drugs in patients with ankylosing spondylitis.Patients and methods : A prospective cohort study enrolled a total of 71 patients with AS, all of them were fulfilling the modified New York criteria for Ankylosing Spondylitis and Assessment of Spondyloarthritis International Society classification criteria for diagnosing spondyloarthropathy. Nineteen patients were excluded from the study due to discontinuation of anti - TNF therapy and 52 patients continued in the study and were followed for three months. Demographic data, disease duration, type of treatment, Bath Ankylosing Spondylitis Disease Activity Index and Bath Ankylosing Spondylitis Functional Index were collected from the patients. They were also investigated for C - reactive protein, erythrocyte sedimentation rate, white blood cell, hemoglobin and platelet count. Results : The mean age of the patients was 35.2±9.6 years, males constitute 84.6% of them and the median disease duration was 5 (3 - 10) years. Univarite analysis showed that the predictors of response to anti - TNF were raised baseline C - reactive protein, erythrocyte sedimentation rate, Bath Ankylosing Spondylitis Disease Activity Index and Bath Ankylosing Spondylitis Functional Index. Multivariate analysis showed that the only independent predictor for response to anti - tumor drugs was raised baseline C - reactive protein. The optimal cut point for C - reactive protein to predict response was >7.5 mg/l with a sensitivity 94.29% and specificity 88.24% , while for erythrocyte sedimentation rate was > 32 mm/hour with a sensitivity 74.29% and specificity 94.12%. For both drugs (etanercept and infliximab) there was significant reduction in Bath Ankylosing Spondylitis Disease Activity Index and Bath Ankylosing Spondylitis Functional Index after 3 months of therapy. Other variables which were studied including demographic data, disease duration, hemoglobin, white blood cell, platelet, type of treatment, presence of peripheral arthritis, enthesitis or uveitis did not predict response.Conclusions : Raised inflammatory markers (C - reactive protein and erythrocyte sedimentation rate) at baseline predict better response to anti - tumor necrosis factor drugs in Ankylosing Spondylitis patients. C - reactive protein had better prediction of response to anti - tumor necrosis factor dugs than erythrocyte sedimentation rate.

انتشار متلازمة شيغرن الثانوية لدى عينة من المرضى المصابين بداء الذاب الحمامي المجموعي Prevalence of Secondary Sj?gren’s Syndrome in a Sample of Patients with Systemic Lupus Erythematosus

اسم المؤلف: نور عباس
اسم المشرف: سامي سلمان شهاب
الموضوع العام: الطب
السنة: 2017
الموضوع الدقيق: الامراض - المفاصل
الدرجة: دبلوم عالي
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: Background : Systemic lupus erythematous is a common autoimmune disorder occurring predominantly in women during reproductive years, the hallmark of SLE is its diversity of presentation with accumulation of manifestations over time and undulating disease course. Sj¨ogren’s syndrome (SS) is a chronic autoimmune disease that characteristically affects salivary and lacrimal glands such that patients have severe dry eyes and dry mouth. The disease may also involve numerous other organs, including the lungs, kidneys, joints, skin, peripheral nerves, and brain. Objective : To assess the prevalence of secondary sjogren syndrome in SLE patients.Patients and Methods : This cross sectional study involved a total of 50 patients with SLE diagnosed according to the revised American College of Rheumatology classification criteria, Sociodemographic data and medications were recorded. Disease activity for SLE was assessed with the SLE Disease Activity Index Case histories and personal information were assessed : age, SLE disease duration, body mass index, all subjects were screened for secondary Sj¨ogren’s syndrome by American - European Consensus Group Classification Criteria for Sj¨ogren’s Syndrome.Results : Prevalence of secondary Sj¨ogren’s syndrome in SLE patients was (8.4%). SLEDA was significantly higher in patients with Sj¨ogren’s syndrome (100%), there was no important or statistically significant correlation of all variable including disease duration, age, White blood cell count, Hemoglobin, Platelet count, antinuclear antibodies and anti - double Deoxyribo nucleic acid antibodies and the decrease in complement (C3 and/or C4) with secondary Sjogren’s syndrome. The anti - LA was statistically higher in patients with Sj¨ogren’s syndrome.Conclusions : The prevalence of secondary Sj¨ogren’s syndrome among SLE patients was relatively low. SLE disease activity as well as Anti SSB was significantly higher in patients with secondary Sj¨ogren’s syndrome

العلاقة بين المرضى العراقيين المصابين بداء الذاب الحمامي المجموعي ومتلازمة فرط مرونة المفاصل الحميد لدى عينة من مرضى نساء العراق

اسم المؤلف: سارة محمد نجيب
اسم المشرف: محمد هادي العصامي
الموضوع العام: الطب
السنة: 2017
الموضوع الدقيق: الامراض - المفاصل
الدرجة: دبلوم عالي
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:

تقييم فترة Tp - e ونسبة Tp - e/QT في المرضى العراقيين المصابين بالتهاب المفاصل الروماتويدي Evaluation of Tp - e interval and Tp - e/QT ratio in Iraqi Patients with Rheumatoid Arthritis

اسم المؤلف: وسام ابراهيم محمد
اسم المشرف: نزار عبد اللطيف جاسم
الموضوع العام: الطب
السنة: 2017
الموضوع الدقيق: الامراض - المفاصل
الدرجة: دبلوم عالي
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: Background : Several studies have suggested that the interval from the peak to the end of the electrocardiographic T wave (Tp - e) may correspond to the transmural dispersion of repolarization and that increased Tp - e interval and Tp - e/QT ratio are associated with malignant ventricular arrhythmias.Objectives : The aim of this study was to evaluate ventricular repolarization by using the Tp - e interval and Tp - e/QT ratio in patients with rheumatoid arthritis (RA), and to assess the relation with inflammation.Patients and methods : A case - control study includes Seventy patients (57 females, 13 male mean age 48.3±12.3years) with RA and 46 controls(39 females , 7males ; mean age , 46.8 ±13.1 years) were studied. From the 12 - lead electrocardiogram, Tp - e interval and Tp - e/QT ratio were measured. Blood samples were taken for erythrocyte sedimentation rate (ESR) .These parameters were compared between studied groups. The relationship between ventricular repolarization and inflammation was assessed by Pearson correlation coefficients. Results : Tp - e interval and Tp - e/QT ratio were increased in RA patients compared to the controls (72.47 ±6.6vs 66.17 ±3.4ms, 0.19 ±0.01 vs 0.17±0.01; p<0.001 and p<0.001, respectively). The Tp - e/QT ratio was also correlated with ESR(R=0.3, P=0.02) Conclusion : In RA patients, the increased frequency of ventricular arrhythmias may be explained by increased indexes of ventricular repolarization and their relationship with inflammation

العلاقة بين متلازمة الالم الليفي العضلي والعد الشائع لدى عينة من المرضى العراقيين Relationship Between Fibromyalgia Syndrome and Acne Vulgaris in a Sample of Iraqi Patients

اسم المؤلف: داليا محمد جاسم
اسم المشرف: محمد هادي العصامي احسان علي الطرفي
الموضوع العام: الطب
السنة: 2017
الموضوع الدقيق: الامراض - المفاصل
الدرجة: دبلوم عالي
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: Fibromyalgia syndrome is a chronic disorder characterized by widespreadmuscles and bones pain, general fatigue, non - restorative sleep, cognitivedisturbance, mood disorder in addition to variable somatic symptoms.Acne vulgaris is a common multifactorial skin disease of adolescents withsignificant physical and psychological morbidity particularly anxiety anddepression.Aim of the study : To assess the relationship between fibromyalgia syndrome and its relatedsymptoms with acne vulgaris in a sample of Iraqi patients.Subjects and Methods : This case - control study was carried out from the first of October 2016 tothe end of May 2017. One hundred acne patients and one hundred age - and sexmatchedapparently healthy individuals were enrolled in the study.A special questionnaire designed for the purpose of the study was usedfor recording information from the patients and controls, which included : name, age, sex, employment, menstrual cycle, marital status and smoking.Additional information were collected from the patients including duration ofacne, drug history including local and systemic steroids and hormonal therapy.The 2012 Canadian Guidelines for diagnosis of fibromyalgia were used todiagnose FMS among patients and controls and acne severity was assessedusing Global Acne Grading System method.VIResults : This study showed that there was a three - folds increase in the risk ofdeveloping fibromyalgia syndrome among acne patients compared to normalindividuals (12% vs. 4%). Moreover, widespread pain, cognitive disturbanceand anxiety were significantly higher among acne patients compared to healthyindividuals. It was found that there was a four times increase in the risk ofhaving fibromyalgia syndrome with the increase in the duration of acne.Somatic symptoms such as muscle cramps, irritable bowel syndrome,altered bowel motion, gases and hair loss were significantly more frequentamong acne patients.Conclusion : This study had revealed that fibromyalgia syndrome was more commonin acne patients and increase with the increase in acne duration.

التشخيص المتاخر وارتباطه بالنتائج السيئة والاستجابة الغير ملائمة للعلاج في المرضى المصابين بالتهاب الفقار اللاصق Delayed Diagnosis is Linked to Worse Outcomes and Unfavourable Treatment Responses in Patients with Ankylosing Spondylitis

اسم المؤلف: حيدر احمد نوري
اسم المشرف: زياد شفيق الراوي
الموضوع العام: الطب
السنة: 2017
الموضوع الدقيق: الامراض - المفاصل
الدرجة: دبلوم عالي
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: Background : Ankylosing spondylitis is a chronic inflammatory disease that affect the axial skeleton(spine and sacroiliac joints) , peripheral joints, enthesitis and specific organ involvement such as anterior uveitis, aortic valve disease. The hall mark of AS is inflammatory back pain associated with radiographic sacroiliitis and often spondylitis.Objective : This study was conducted to evaluate the period from symptom onset to diagnosis of ankylosing spondylitis (AS) in Iraqi patients and the effect of delayed diagnosis on response to treatment.Patients and Methods : A retrospective cohort study was conducted at the Rheumatology Unit of Baghdad Teaching Hospital with a total of 108 consecutive patients with AS according to the modified New York criteria . Diagnostic delay was defined as the gap between the first spondylo - arthropathic symptom and diagnosis of AS,The patients ,then, were classified into early and late diagnosis groups based on the median interval of the diagnostic delay, and a comparison was done between both groups for multiple parameters before and after 3months of etanercept or infliximab therapy.Results : the average of disease duration was 12.8yrs(range1 - 29).the average of age at disease onset was 25 years(range12 - 46) and average of age at time of diagnosis was 32.9 years(range15 - 54). The average of diagnostic delay was 6.9 years(range1 - 25) and the median was 7 years, on that basis our patients classified into early diagnosed group (<7years) and delay diagnosed group(≥7years). Mechanical back pain was the most common diagnosis prior to AS and Patients without articular involvement experienced a significantly longer delay in diagnosis compared to patients with articular involvement (29.1%vs 54.7%,p=0.001).At the time of diagnosis all parameters included in study were worse in late diagnosis group as compared with early diagnosis group, although none was statistically significant. After 3 months of treatment, BASDAI and BASFI score were significantly worse in delay diagnosis group(p=0.001).Conclusion : Patients with delayed diagnoses showed worse outcomes in activity and function scores and less favourable treatment response