تفاعل انزيم البلمرة المتسلسل النسخي العكسي ذي الوقت الواقعي كاداة تشخيصية جزيئية في التحري عن الجينات المدمجة الشائعة في عينة من الاطفال العراقيين المصابين بابيضاض الدم اللمفاوي الحاد == Real time reverse transcriptase polymerase chain reaction as diagnostic molecular tool in screening of common fusion genes in sample of Iraqi children with acute lymphoblastic leukemia
اثار حبوب منع الحمل الفومية احادية الطور على فعالية عامل التخثر السابع ومستوى ثنائي ال دي - دايمر في النساء الاصحاء والبدينات == The Effect of Regular Monophasic Oral Contraceptive Pills on Factor VII Activity and D - dimer Level in Healthy and Obese Women
Author name:
اسراء سعدي عباس
Supervisor name:
هيثم احمد الربيعي
Abstract:
The combined oral contraceptive pill includes a combination of estrogen and progestin. Clinical and epidemiological studies indicate that the use of these pills is associated with an increased risk of thrombotic disorder including both deep vein thrombosis and pulmonary embolism.The pathogenesis of increased thrombotic risk with pills use is that the estrogen content in the pills has many effects on coagulation system that results in shifting of the hemostatic balance toward a prothrombotic state.Obesity is defined as abnormal or excessive fat accumulation that may impair health. Body mass index is commonly used to classify overweight and obesity. It is an independent risk factor for venous thromboembolism and increases the risk of thrombosis 2 - fold, since obese individuals have higher levels of several procoagulant factors. There may be an additional risk of thrombosis caused by venous stasis that also occurs with obesity. Oral contraceptive use in conjunction with obesity increases the risk of thrombosis about 10 - fold.Aim of the studyTo assess the level of FVII activity, D - dimer level, and other hemostatic changes in healthy non - obese and obese women on contraceptive pills and compare them to that found in normal healthy non - user women.Patient, materials and methodsThis case - control study included 50 females attending the family planning clinic at Baghdad Teaching Hospital of Medical City. TheyIIIwere regularly using monophasic regular dose estrogen containing combined oral contraceptive pills (Microgynon® ED Fe) for at least 3 months. Their ages were between 18 and 45 years. Females on pills were divided into 2 groups : Non - obese group : enrolled 25 females with BMI of < 30 kg/m2 (15/25 females were overweight, and 10/25 were of normal weight) Obese group : composed of 25 females with BMI of ≥ 30 kg/m2Twenty five healthy, non - obese (16/25 were overweight and 9/25 had normal weight), age - matched non - pregnant females neither on pills, nor taking any hormonal therapy and having no history of malignancy or previous thrombosis, were assigned as a control group.Relevant clinical data were collected from all participants. Weight and height were measured (in kilograms and centimeters, respectively), and then the BMI was calculated accordingly for each participant.Platelet counts were measured by a hematology auto - analyzer (Cell - DYN, RUBY ABBOTT Diagnostic, USA). Prothrombin time, activated partial thromboplastin time, and factor VII activity were measured using semi - automated coagulometer (STart4®, DIAGNOSTICA STAGO/France). D - dimer levels were measured by turbidimetric immunoassay using an automated analyzer (ARCHITECT c4000, Abbott Diagnostics, USA).ResultsThere was significant reduction in prothrombin time in the non - obese, obese, and pills users groups compared to that in the control group (P= 0.014, 0.020, and 0.006 respectively), while the activated partial thromboplastin time was insignificantly reduced in all of these groups.Moreover 22% of pills user cases had shortened prothrombin time compared to the lower limit of prothrombin time in the control group (11.8 sec), and 8% of them were found to have shortened activated partial thromboplastin time compared to the lower limit of activated partial thromboplastin time in the control group (24.6 sec).The correlations between the duration of pills use (< 1 year and > 1 year) and prothrombin time and activated partial thromboplastin time showed statistically insignificant differences in both study groups.The factor VII activity in the non - obese, obese, and pills users groups were significantly higher than that of the control group (P= 0.041, 0.001, and 0.004 respectively). It had been observed that 22% of pills user cases had FVII activity above the highest value of activity that was found in the control group (95%). Also there was a significant inverse correlation between the prothrombin time and factor VII activity with P - value of 0.008.The D - dimer levels were found to be significantly higher in the non - obese and obese group compared to that of the control group (P= 0.029 and 0.038, respectively). The mean D - dimer of the pills users group was insignificantly higher than that of the control group, P value = 0.053.The platelet count was insignificantly increased in the non - obese group when compared with that in the control group (P= 0.106), while it was significantly increased in the obese and pills users groups compared with that in the control (P = 0.027, and 0.034, respectively). There were no statistically significant differences in the means of prothrombin time, activated partial thromboplastin time, factor VII activity, D - dimer level, and platelet count between the non - obese and obese groups (P > 0.05).
تقييم الهبسدي الفيريتين بروتين سي التفاعلي لدى مرضى فقر الدم للمرحلة النهائية للفشل الكلوي == Assessment of Hepcidin, Ferritin and CRP in Anemic End Stage Renal Disease Patients on Hemodialysis
Author name:
ضلال صيول حسن
Supervisor name:
هيثم احمد الربيعي | رائد احمد الربيعي
Abstract:
Chronic kidney disease (CKD) is defined as kidney damage or glomerular filtration rate (GFR) <60 mL/min/1.73 m2 for 3 months or more.End stage renal disease corresponds to stage 5 chronic kidney disease with glomerular filtration rate <15 ml/min/1.73m2, all these patients require hemodialysis.Anemia of chronic disorders is a common normochromic or mildly hypochromic anemia that occurs in patients with chronic kidney disease.It is characterized by a reduced serum iron and iron binding capaci ty and normal or raised serum ferritin with adequate iron stores. The main cause of anemia is deficient erythropoietin synthesis. Blood loss is also a major contributory factor. Hepcidin plays a key role as mediator of anemia of inflammation.Aim of the study1 - To assess the types of anemia in end stage renal failure.2 - To compare the inflammatory parameters including hepcidin, ferritin, C - reactive protein and erythrocyte sedimentation rate between the two vascular accesses of hemodialysis (double lumen and arteriovenous fistula).Materials and methods This case control study was conducted at Al - Hayat center for hemodialysis in Al - Karama hospital, Baghdad, Iraq over 3 months from 1 November 2013 to 31 January 2014. The study populations consist of 60 [III]patients (44 males and 16 females). All patients were adult with documented end stage chronic kidney disease stage 5 on repeated hemodialysis with different durations of illness (1 month - 10 years).Hemodialysis patients were also divided into two groups depending on the vascular access of hemodialysis (double lumen and arteriovenous fistula).The following data were analyzed for all patients : Age, gender, history of hypertension and diabetes mellitus, causes of renal failure, vascular access, duration and frequency of hemodialysis. Complete blood counts, blood film and reticulocyte percentage by auto analyzer machine. Blood urea, serum albumin, serum creatinine, and transferrin saturation percentage, serum hepcidin, ferritin, C - reactive protein by clinical chemistry analyzer. erythrocyte sedimentation rate Twenty normal healthy individuals (age and sex matched) had been included as a control group in this study. All were subjected to the same investigations of the patients.ResultsThe vascular access of hemodialysis was ʺarteriovenous fistulaʺ in (61.7%) of the patients and "double lumen" in (38.3%) of them. The mean duration of hemodialysis was (18.6 ± 2.5) months (range : 1 month - 10 years), high proportion (28.3%) of the patients were on hemodialysis for a duration of 11 - 15 months.There was a significant decrease of absolute lymphocyte count, red blood cell count, hematocrit, hemoglobin and platelets count in patients than controls, but there were insignificant differences for total white blood cell count, absolute neutrophil count and mean corpuscular volume.Also there was a significant increase of red cell distribution width levels in patients than controls (14.8 ± 1.9 vs. 13.3 ± 1.6 respectively), p<0.05.According to the levels of hemoglobin, anemia was reported in 95% of the 60 end stage renal disease. Anemia of chronic disorders was the most frequent type of anemia (45%) among the patients, iron deficiency anemia was found in only (11.7%) while combined anemia was found in (25%), and others who had not any type of previous types of anemia (13.3%). No significant difference was observed between anemic and non - anemic patients according to the vascular accesses of hemodialysis.The mean serum level of hepcidin for patients was (186.1± 28.4 ng/ml) and for controls was (4.7 ±0.9 ng/ml) with a significant difference between both groups. The mean serum ferritin level of the patients (280.8 ± 53.1 ng/ml) was significantly higher than controls, (83.6 ± 14.5). The mean serum C - reactive protein level was higher in patients than control, (8.6 ± 1.1 vs. 3.0 ± 0.2 mg/l) respectively, furthermore, the mean erythrocyte sedimentation rate level was higher in patients (42.3 ± 4.7 mm/1st hr.) than that of controls (6.2 ± 0.8).There was no significant association between levels of hepcidin, hemoglobin, ferritin, C - reactive protein and erythrocyte sedimentation rate of the patients with the duration of hemodialysis. There was no significant difference in the mean levels of hepcidin, ferritin, C - reactive protein and erythrocyte sedimentation rate of the patients according to the vascular accesses of hemodialysis, while there was a significant difference regarding the hemoglobin level. The mean C - reactive protein of patients with serum ferritin level ≥ 800 ng/ml was (16.5 ± 4.2 mg/L) and for those with serum ferritin level < 800 ng/ml it was (7.6 ± 1.1 mg/L), however, the difference
