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هرمون مضاد مولريان كعلامة للحمل بعد عمليات التلقيح المجهري عند النساء اللاتي يعانين من متلازمة تكييس المبايض == Anti - Mullerian Hormone as a Marker for Pregnancy following Intracytoplasmic Sperm Injection in Women with Polycystic Ovarian Syndrome

Author name: انعام عبد الواحد ذيب
Supervisor name: عفان عزت حسن | باسل عويد محمد صالح
General topic: Medicine
Specific topic: Physiology
Degree: Doctorate
Language: English
University location: Baghdad
First pages:
Abstract: العقم هو مرض من امراض الجهاز التناسلي يقصد به عدم قدرة الزوجين على الانجاب او تحقيق الحمل السريري بعد 12 شهرا او اكثر من الجماع الطبيعي الغير المحمي. هرمون مضاد مولريان (AMH) هو البروتين الذي يرتبط هيكليا الى اكثر من 35 الببتيدات مثل انهيبين، اكتيفين، وبروتينات العظام الشكلية وعوامل تمايز النمو، وكثير من هذه الببتيدات تشارك في الوظيفة الانجابية في كلا الجنسين. هرمون مضاد مولريان يمثل علامة بيولوجية للحجم النسبي لاحتياطي المبيض، وعدد الخلايا في الاحتياطي الجريبي الذي يساعد في التقنيات المساعدة على الانجاب ويمكن استخدامها للتنبؤ بتوقيت انقطاع الطمث. قد يكون هرمون مضاد مولريان مفيد كعلامة لضعف المبيض في متلازمة تكيس المبايض، حيث تعكس مستويات هرمون مضاد مولريان عدد الجريبات النامية من المبيض. وهومفيد ايضا في التنبؤ ببعض حالات عجز المبيض في متلازمة تكيس المبايض لكون مستويات هرمون مضاد مولريان تعكس عدد جريبات المبيض النامية. وهو مفيد ايضا في التنبؤ في حالة عدم استجابة المبيض خلال عمليات التخصيب في المختبر او اطفال الانابيب (IVF). مستويات هرمون مضاد مولريان مفيدة في اتخاذ قرار بشان بروتوكولات التحفيز في عمليات اطفال الانابيب (IVF) ويساعد في تحديد عدد الاجنة التي يتم نقلها في عمليات التقنيات المساعدة على الانجاب لزيادة معدلات نجاح الحمل وتقليل خطر متلازمة فرط المبيض. اجريت هذه الدراسة في مستشفى كمال السامرائي لعلاج العقم واطفال الانابيب ومركز بغداد التخصصي لعلاج العقم واطفال الانابيب / بغداد - العراق، تم تقسيم مجموعات الدراسة الى مجموعتين، اللواتي لديهن متلازمة تكيس المبايض والمجموعة الثانية تتالف من الذين ليس لديهم تكيس المبايض (انثى عادية على ما يبدو مع عامل العقم ذكري)، وقد سجلت في هذه الدراسة المرتقبة ، خمسة واربعين مريضة تتراوح اعمارهن بين 18 و42 عاما يخضعن لعملية الحقن المجهري. وقد صممت الدراسة لمعرفة دور مستويات مصل الدم ومستويات السائل الجريبي( (FFمن هرمون مضاد مولريان(AMH)، الهرمون المنبه للجريب ((FSH ،الهرمون المنشط للجسم الاصفر( (LH،هرمون الاسترادايول (E₂) والانسولين في التنبؤ بالنتيجة السريرية (الحمل) بعد عمليات الحقن المجهري في النساء اللواتي يعانين من متلازمة تكيس المبايض واللواتي لديهم اباضة اعتيادية (عامل ذكري). ولاعداد قيم قطعية محددة لهرمون مضاد مولريان في مصل الدم والسائل الجريبي للاستفادة منها في التنبؤ بنتائج الحمل، وكدلك تقييم العلاقة بين النتائج التي تم الحصول عليها للهرمونات المدروسة في مصل الدم والسائل الجريبي. اظهرت نتائج هذه الدراسة وجود زيادة معنوية في مستوى هرمون مضاد مولريان في مصل الدم لدى النساء اللواتي يعانين من تكيس المبايض من النساء اللواتي لا يعانون من تكيس المبايض (P = 0.001)، فيما يتعلق بالهرمونات المقاسة الاخرى، اظهرت النتائج عدم وجود فرق معنوي بين مستويات الهرمونات في مصل الدم بين النساء اللواتي يعانين من تكيس المبايض من النساء اللواتي لا يعانين من تكيس المبايض (P = 0.034)، كما لوحظ وجود زيادة معنوية في مستوى هرمون الاسترادايول في مصل الدم في اليوم الثاني للدورة الشهرية لدى النساء اللواتي يعانين من تكيس المبايض من النساء اللواتي لا يعانين من تكيس المبايض (P = 0.025) فيما يتعلق بالهرمونات المقاسة الاخرى، كشفت النتائج عن عدم وجود فرق معنوي بين مستويات السائل الجريبي لهذه الهرمونات في النساء اللواتي يعانين من تكيس المبايض من النساء اللواتي لا يعانين من تكيس المبايض. عند اجراء المقارنة بين مستوى هرمون مضاد مولريان في مصل الدم وسائل الجريبات ومستويات الهرمونات الاخرى عند النساء اللواتي يعانين من تكيس المبايض والنساء اللواتي لا يعانين من تكيس المبايض من خلال قياس قيم الاختلافات المقترنة، كانت اكبر القيم في مستوى هرمون الاسترادايول ₂E بعده هرمون مضاد مولريان ، ثم هرمون المنبه للجريب (FSH) ، ثم الهرمون المنشط للجسم الاصفر (LH)،ثم الانسولين تعاقبا. عند اجراء دراسة القيم القطعية في مصل الدم والسائل الجريبي لهرمون مضاد مولريان لغرض التنبؤ بنتائج الحمل باستخدام منحنى النسب المئوية 90 و95 عند النساء اللواتي يعانين من تكيس المبايض والنساء اللواتي لا يعانين من تكيس المبايض وجميع المرضى في الدراسة، وهذا قد يساعد في التنبؤ بالنتائج السريرية (الحمل). لوحظ ارتباط مستوى هرمون مضاد مولريان مباشرة مع نتائج الحمل السريري. باستخدام غير الحوامل (الذين لديهم تكيس المبايض والذين لا يعانون من تكيس المبايض) بشكل عام لادخال مستوى قيم قطعية للتنبؤ بنتيجة الحمل. اظهرت مؤشرات حساسية وخصوصية هرمون مضاد مولريان والهرمونات الاخرى في المصل والسائل الجريبي ان مؤشر حساسية وخصوصية هرمون مضاد مولريان في المصل هي (79٪) وفي السائل الجريبي هي (70.3٪) وهما يمثلان اعلى قيمة مقارنة بالهرمونات المقاسة الاخرى، وهي هرمون الاسترادايول ₂E ، هرمون المنبه للجريب (FSH) ، الهرمون المنشط للجسم الاصفر (LH)، الانسولين ومقاومة الانسولين. ومن خلال دراسة منحنى روك للمصل والسائل الجريبي لهرمون مضاد مولريان وغيرها من الهرمونات وهي الاسترادايول ₂E ، هرمون المنبه للجريب (FSH) ، الهرمون المنشط للجسم الاصفر (LH)، الانسولين ومقاومة الانسولين ، تبين ان اكبر مساحة لما تحت المنحنى ((AUC كانت تعود لهرمون مضاد مولريان في المصل وبعدها لهرمون مضاد مولريان في السائل الجريبي. من هذه الدراسة نستنتج الاهمية السريرية لقياس هرمون مضاد مولريان في المصل وفي السائل الجريبي في تقييم النتائج السريرية (الحمل) بعد عمليات الحقن المجهري في النساء اللواتي تعانين من متلازمة تكيس المبايض ، ايضا ان قياس مستويات هرمون مضاد مولريان في المصل وفي السائل الجريبي مهمة في التنبؤ بحالات متلازمة تكيس المبايض في النساء التي تقوم بعملية الحقن المجهري، حيث ان زيادة مستويات هرمون مضاد مولريان تعكس شدة المرض. ان القيم القطعية التي تم الحصول عليها من تركيزات هرمون مضاد مولريان في المصل وفي السائل الجريبي مهمة جدا للتنبؤ بنتائج تقنية الحقن المجهري (ICSI) واستكمالها او انهاءها في (النساء اللواتي يعانين من متلازمة تكيس المبايض والنساء اللواتي لا يعانين منها ). | Infertility is a disease of the reproductive system refers to an inability of a couple to achieve a clinical pregnancy after 2 years or more of regular unprotected sexual intercourse. Anti - Müllerian hormone (AMH) is a protein that is structurally related to more than 35 peptides like inhibin , activin, bone morphogenetic proteins (BMPs) and growth differentiation factors, many of these involved in reproductive function in both sexes. AMH serves as a biomarker for the relative size of the ovarian reserve; the number of cells in the follicular reserve that helps in assisted reproduction and can be used to predict the timing of menopause. AMH may be useful as a marker of ovarian impairment in polycystic ovary syndrome, since AMH levels reflect number of the developing ovarian follicles. It is also useful in prediction of poor ovarian response during in vitro fertilization (IVF). AMH levels are useful in deciding what stimulation protocols for IVF cycles and helps in decisions about the number of embryos to transfer in assisted reproduction techniques to increase the pregnancy success rates and decreasing the risk of ovarian hyperstimulation syndrome. The study was designed to investigate the role of serum and follicular fluid levels of AMH, Follicular stimulating hormone (FSH), Luteinizing hormone (LH), Estradiol (E2) and insulin in prediction of clinical outcome (pregnancy) in women with PCOS undergoing intracytoplasmic sperm injection(ICSI) and those with normal ovulation and to set up the cutoff values of serum and follicular fluid AMH concentration for prediction of pregnancy outcome, and to evaluate the relationship between the obtained results of the studied women’s in blood serum and in follicular fluid (FF). This study was conducted in Kamal Al - Samarrai hospital for infertility treatment and IVF and in Baghdad Specialist Center for treatment of infertility and IVF/Baghdad - Iraq, the study groups were divided into two groups, those with polycystic ovarian syndrome (PCOs) and those without PCOs (normal female with male factor infertility), forty five female patients aged between 18 - 42 years undergoing IVF/ICSI treatment were enrolled in this prospective study. The results of this study showed a significant increase in serum AMH level of PCOs women’s than that of non PCOs women’s (0.001), in regard to other measured hormones, the results revealed that there was no significant difference between serum levels of these hormones in PCOs and non PCOs women’s. There was significant increase in follicular fluid (FF) AMH level of PCOs women’s than that of non PCOs women’s (P= 0.034).There was also a significant increase in FFE₂ level in non PCOs women’s than in PCOs women’s (P=0.025), in regard to other measured hormones, the results revealed that there was no significant difference between FF levels of these hormones in PCOs and non PCOs women’s. In comparison between the serum and follicular fluid ( FF) AMH level and other parameters in PCOs women’s and in non PCOs women’s by measuring the paired differences values, the greatest values was in the E₂ level after that the AMH, then the FSH, LH, Insulin consequently. By studying the cutoff values of the serum and follicular fluid AMH concentration for prediction of pregnancy outcome by using the percentiles 90 and 95 in PCOs, non PCOs and all patients in the study, this may help in prediction of clinical outcome (pregnancy). AMH was directly correlated with clinical pregnancy outcome. Using non pregnant (PCOs and non PCOs) in general to introduce a cutoff level for prediction of pregnancy outcome. The sensitivity and specificity index of serum and follicular AMH and other hormones, revealed that the sensitivity and specificity index of serum AMH (79%) and of follicular AMH (70.3%) have the highest value in comparison with other routine measured hormones, E₂, FSH, LH, Insulin and Insulin resistance. The Receiver operating characteristic (ROC) curve for serum and follicular fluid AMH and other parameters, E₂, FSH, LH, Insulin and Insulin resistance, the greater area was founded belong to serum AMH then the FF AMH. From this study concluded the clinical importance of the measurements of serum and FF levels of AMH in assessment of successful ICSI techniques in PCOS infertile women, also the measurements of serum and FF levels of AMH are important in prediction of cases of PCOS in women’s undergoing ICSI techniques. The obtained cut - off values of serum and FF AMH concentrations are very important for prediction of the outcome of the ICSI technique and its continuation or termination in (PCOs and non PCOs).

تقييم شكل البطين الايسر ووظيفة القلب الانبساطية لعينة من الرجال المصابين بالسمنة بواسطة جهاز صدى القلب (الايكو) == ECHOCARDIOGRAPHIC ASSESSMENT OF LEFT VENTRICULAR GEOMETRICAL PATTERNS AND DIASTOLIC FUNCTION IN OBESE MALE SUBJECTS

Author name: ريم جمال جابر
Supervisor name: عفان عزت حسن
General topic: Medicine
Specific topic: Physiology
Degree: Master
Language: English
University location: Baghdad
First pages:
Abstract: السمنة هي مشكلة مهمة في الصحة العالمية وتكون مصحوبة بزيادة احتمال المشاكل الصحية. السمنة تسبب تضخم في عضلة القلب عن طريق زيادة نسبة الانسولين وزيادة مادة IGF - 1 وزيادة حجم السوائل وهي مشابهة لتاثير زيادة ضغط الدم الشرياني.طبيا عندما يكون معامل كتلة الجسم بين 25 - 29.9 (كيلوغرام/متر مربع) تدعى الحالة زيادة في الوزن, وعندما يكون اكثر من 30 كيلوغرام/متر مربع تدعى السمنة.ان هذا الفحص يهدف الى تقييم الجزء الايسر لعضلة القلب (وظيفة وشكلا) في الاشخاص مرتفعي الوزن وفي الاشخاص ذوي السمنة في عينة من الاشخاص باستعمال جهاز صدى القلب, اكتشاف وتعيين نسبة ونوع تغييرات شكل عضلة القلب اليسرى وعجز القلب الانبساطي فيها حسب درجة ذلك العجز ولتقييم الضغط الامتلائي للجهة اليسرى وذلك لتعيين الاشخاص الذين يكونون اكثر عرضة للاصابة بعجز القلب ذومعامل الدفع الطبيعي .شارك في هذه الدراسة مئة وسبعة اشخاص من الرجال بمعدل عمر حوالي تسعة وثلاثون سنة وتم تقسيمهم الى ثلاثة مجاميع حسب معامل كتلة الجسم : المجموعة الاولى وهم ذوي معامل كتلة الجسم 18,5 - 24,9(كيلوغرام/مترمربع) وكان عددهم اربعة وثلاثون شخصا صحيحا من الرجال كشاهد او مراقب وبمعدل عمرسبعة وثلاثون سنه.المجموعة الثانية وهم ذوي معامل كتلة الجسم 25 - 29,9 وهم ذوي زيادة الوزن وكان عددهم سته وثلاثون شخصا من الرجال وبمعدل عمرثمان وثلاثون سنه.المجموعة الثالثة ذوي السمنة وبمعامل كتلة الجسم اكثر من ثلاثين كيلوغرام/متر مربع وبمعدل عمر واحد واربعون سنه.اجريت هذه الدراسة في وحدة صدى القلب التابعة لمستشفى ابن البيطار لجراحة القلب للفترة بين شهر ايلول لسنه الفين واثنا عشر ولغاية تموز لسنه الفين وثلاثة عشر.خطة الدراسة تضمنت اخذ التاريخ الطبي لكل مريض واجراء الفحص الطبي السريري, واجراء تخطيط كهربية القلب لكل مريض وكذلك اجراء فحص صدى القلب وكذلك فحص عينات الدم للدهون, السكر ,اليوريا والكرياتين.لغرض تقييم جزء عضلة القلب الايسر تم قياس العمل الانقباضي والانبساطي باستعمال M - mode , الفحص ثنائي الابعاد وصدى امواج القلب لغرض تقييم عرض عضلة القلب اليسرى الانقباضي والانبساطي وسمك الجزء الوسطي الفاصل بين البطينين لعضلة القلب والجزء السفلي لعضلة القلب الايسر, كتلة العضلة اليسرى , معامل كتلة العضلة اليسرى حجم الاذين اليسر ومعامل حجم الاذين الايسر. نتائج الدراسة اظهرت وجود تغيرات شكلية ووظيفية في البطين والاذين الايسر عند الاشخاص ذوي زيادة الوزن وذوي السمنة علما انهم غير مصابين بمرض في القلب او اي مرض اخرعام في الجسم , حيث ان عجز عضلة القلب الانبساطي كان موجودا في واحد وخمسون بالمائة من العدد الاجمالي لذوي السمنة وفي سبعة وعشرين بالمائة من ذوي زيادة الوزن .كما بينت الدراسة وجود ثمان وستون بالمائة من العدد الاجمالي لذوي عجز القلب الانبساطي من المجموعة الثالثة واثنان وثلاثون بالمائة من المجموعة الثانية., وبينت الدراسة ايضا ان سبع وخمسون بالمائة من ذوي العجز الانبساطي هم من الدرجة الاولى وثلاثة واربعون بالمائة هم من الدرجة الثانية.كما واظهرت الدراسة ان ستة وعشرون بالمائة لديهم تضخم البطين الايسر من النوع المتراكز (ثمان وستون بالمائة في المجموعة الثانية واثنان وستون بالمائة في المجموعة الثالثة) اما الاشخاص الذين لديهم تضخم لا متراكز فيبلغ عددهم خمسة اشخاص(اربعون بالمائة منهم في المجموعة الثانية وستون بالمائة في المجموعة الثالثة).نتائج هذه الدراسة اظهرت ان جهاز فحص صدى القلب اداة مفيدة في تقييم شكل وعمل عضلة القلب اليسرى في الاشخاص ذوي السمنة, كما وبينت ان العلاقة بين معامل كتلة الجسم مع عمل القلب الانبساطي هي علاقة مستمرة وغير معتمدة على عوامل الخطورة الاخرى التي تكون مصحوبة بزيادة الوزن مثل زيادة ضغط الدم ,داء السكري وتضخم عضلة القلب.وكذلك اظهرت هذه الدراسة ان زيادة الوزن تكون مصحوبة بعرقلة عمل عضلة القلب اليسرى الانبساطي وهو مشابه لما يحصل في الاشخاص ذوي السمنة وان زيادة الوزن والسمنة فيها خطورة العمل الانبساطي الكاذب. واخيرا بينت الدراسة ان لدى الاشخاص ذوي زيادة الوزن والسمنة ارتفاع في ضغط الدم بالمقارنة مع الاشخاص الصحيحين ذوي الوزن الطبيعي. | Obesity is a public health concern worldwide associated with significant health risks and comorbid conditions. Obesity induces left ventricular hypertrophy and diastolic dysfunction via hemodynamic changes caused by hyperinsulinemia, increased insulin like growth factor - 1 expression and volume overload which are similar to the effect caused by hypertension. In clinical terms, a body mass index between 25 and 29.9 kg/m represents overweight, and a body mass index greater than 30 kg/m represents obesity. This study aimed to evaluate the left ventricular geometrical remodeling and diastolic function in a sample of overweight and obese subjects by Doppler Echocardiography, explore the percentage and type of left ventricular geometric remodeling and diastolic dysfunction in those people according to the grades of diastolic dysfunction and to assess the left side filling pressure to early specify and diagnose people at risk for development of normal ejection fraction heart failure. One hundred and seven (107) normal male subjects with a mean age of (39.3± 7.5) years involved in this study, they divided into three groups according to their body mass index(BMI) : Group 1with normal body mass index (18.5 - 24.9kg/m²).Group2 overweight (BMI 25 - 29.9kg/m²).Group3 obese (BMI ≥30 kg/m²).This study was performed during the period from September 2012 until July 2013, at the echo unit of Ibn Al - Bitar hospital for cardiac surgery.The plan of the study consisted of the following steps : Case history, Clinical & physical examination, Body mass index (BMI) measurement, Electrocardiography (ECG), Echocardiographic examination and Blood sampling for lipid profile, sugar, urea and creatinine estimation.In order to assess the left ventricular function ( systolic & diastolic) and geometry, the 2 - D echocardiography, M - mode echocardiography, blood flow Doppler and the tissue Doppler echocardiography were performed in all subjects for determining the left ventricular dimensions, interventricular septal thickness, posterior wall thickness, relative wall thickness, left ventricular mass, left ventricular mass index, left atrium volume and left atrium volume index. The results of this study showed structural and functional changes in the left ventricular and left atrium in a sample of healthy subjects with excess weight who have no other clinically appreciable cause of heart disease or any other systemic disease. These changes appear to be related to the obesity and overweight. Diastolic dysfunction was present in 51% of the total number of the obese group and 27% of the overweight group. Sixty eight percent of the total number of the impaired diastolic function grade 1 were from obese group while 32% from overweight group, While 57% of the diastolic dysfunction grade 2 (pseudonormal pattern) were from obese group and 43% from overweight group. This study showed that 55% percent of the total number with diastolic dysfunction had an increased left atrium volume index. Twenty six subjects had concentric remodeling (38% in overweight group and 62% in obese group) and five subjects had eccentric hypertrophy (60% in overweight group and 40% in obese group). Regarding the posterior wall thickness, interventricular septum thickness, left ventricular mass and left atrium volume, a significant statistical difference was found between the group 1 (normal weight) and both the overweight (group 2) and the obese group (group 3). The findings of this study indicate that : Echocardiography is a valuable tool in evaluating Left ventricular geometry and function in obese subjects, the relationship between BMI and diastolic function parameters is continuous and independent of cardiovascular risk factors that cluster with obesity; such as hypertension, diabetes, and left ventricular hypertrophy, the overweight status is already associated with an impairment of left ventricular diastolic function close to that observed in obese persons, overweight and obese subjects developed high percent of a pseudonormalized diastolic pattern with the tendency of an increase in blood pressure (both systolic and diastolic) with increasing body weight

احتساب هرمون الميلاتونين في مصل مرضى احتشاء العضلة القلبية الحاد == ESTIMATION OF SERUM MELATONIN HORMONE IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

Author name: حيدر عامر توفيق
Supervisor name: اسراء فائق جعفر | معتز فوزي الحديثي
General topic: Medicine
Specific topic: Physiology
Degree: Master
Language: English
University location: Baghdad
First pages:
Abstract: هرمون الميلاتونين ، وهو منتج الغدد الصماء من الغدة الصنوبرية ، يفرز الهرمون تحت تاثير الساعة البيولوجية التي تنظم العديد من الوظائف الفسيولوجية والهرمونية العصبية . هورمون الميلاتونين له ادوار مهمة في مجموعة متنوعة من العمليات الفزيولوجية المرضية للقلب والاوعية الدموية مثل مضاد للالتهابات ، مضاد الاكسدة ، وظائفه الخافضة للضغط والمضادة للدهون .احتشاء العضلة القلبية الحاد هو السبب الرئيسي للوفيات في جميع انحاء العالم . في حالة احتشاء عضلة القلب الحاد يزداد انتاج انواع الجذور الحرة مثل الفائق انيون الراديكالي ( O2 • - ) وبيروكسيد الهيدروجين ( H2O2 ) ويمكن ان يؤدي الى توليد تاكسد اكثر سمية مثل الهيدروكسيل ( OH • ) . الميلاتونين ومكوناته ومنتجاتها من الايض هي قادرة على الحد من التفاعلات المؤكسدة من خلال تنظيفها الجذور الحرة المباشرة وغير المباشرة وكذلك من خلال النشاط المضاد للاكسدة لذلك للهرمون دورا هاما في حماية القلب . تصلب الشرايين هو العامل المسبب الرئيسي لاحتشاء العضلة القلبية الحاد ، حيث الاكسدة والالتهابات هي المكونات الرئيسية لتصلب الشرايين وان هورمون الميلاتونين من خلال وظيفة النشاط المضاد للالتهابات ومضادة للاكسدة فانه بمثابة عاملا مضادا للدهون . الهدف من هذه الدراسة هو : 1 - تقييم مستوى هرمون الميلاتونين في الدم في المرضى الذين يعانون من احتشاء العضلة القلبية الحاد . 2 - مقارنة بين مستوى الميلاتونين في المجموعة الضابطة والمرضى. 3 - دراسة التغيرات في مستوى الميلاتونين في المرضى الذين يعانون من احتشاء العضلة القلبية الحاد بعد خمسة ايام من الاصابة . 4 - تحديد العلاقة بين مستوى تحليل الدهون في الدم ومستوى الميلاتونين في المرضى والمجموعة الضابطة.وكان العدد الاجمالي المشمولة في الدراسة ( 80 ) من كلا الجنسين ، تتراوح اعمارهم من ( 40 - 60 ) سنة ، وتم تقسيمهم الى مجموعتين : 1 - اربعة واربعون المرضى الذين يعانون من احتشاء العضلة القلبية الحاد مع متوسط عمر ( 51.2 ± 6.12 سنة ) مدة دخولهم في ,وحدة العناية القلبية اقل من 24 ساعة . 2 - ستة وثلاثون شخصا اصحاء بمتوسط عمر ( 46.94 ± 4.86 سنة ) . وقد تم اخذ التاريخ الطبي الكامل ، تخطيط القلب الكهربائي وقياس ضغط الدم لكل الاشخاص , كما تم جمع عينات من الدم لتقدير هرمون الميلاتونين وصورة لنسبة الدهون في الدم .نتائج هذه الدراسة اكدت وجود فرق كبير فيما يتعلق بالميلاتونين في الدم بين مجموعة المرضى والمجموعة الضابطة ( P < 0.0001 ) ، ومستوى الميلاتونين في المرضى هو( 5.15 ± 1.56 ) والاصحاء هو( 9.37 ± 2.76 ) .وفيما يتعلق بصورة الدهون في الدم ، كشفت هذه الدراسة مجموع الكولسترول في الدم اعلى بكثير في مجموعة المرضى ( 196,16 19.2 ± ) مقابل في المجموعة الضابطة هو ( 185.58 ± 21.88 ملغ / دل ) وP = 0.0262 وذو دلالة معنوية احصائية .و بالنسبة للدهون الثلاثية في مجموعة المرضى فكان المعدل ( 190.64 ± 53.19 ملغ / دل ) مقابل في المجموعة الضابطة هو ( 171.39 ± 31.96 ملغ / دل ) وP = 0.0493 .و اما الدهون عالية الكثافة فكان المعدل في مجموعة المرضى ( 35.91 ± 6.89 ملغ / دل ) مقابل في المجموعة الضابطة ( 45.58 ± 8.93 ملغ / دل ) وP < 0.0001 .و بالنسبة للدهون قليلة الكثافة فكان المعدل في مجموعة المرضى ( 122.12 ± 19.13 ملغ / دل ) مقابل في المجموعة الضابطة كانت ( 105.72 ± 21.01 ملغ / دل ) وP < 0.0006 .اما مؤشر تصلب الشرايين فكان في مجموعة المرضى هو ( 0.72 ± 0.17 ) مقابل في المجموعة الضابطة هو ( 0.58 ± 0.14 ) وP< 0.0001 . نتائج هذه الدراسة لم تكشف عن فروق معنوية بين مستوى الميلاتونين في يوم الدخول واليوم الخامس من الدخول الى المستشفى بالنسبة للمرضى المصابين باحتشاء العضلة القلبية الحاد.نستنتج من هذه الدراسة وجود نقص واضح في مستوى هرمون الميلاتونين بالنسبة للمرضى المصابين باحتشاء العضلة القلبية الحاد مقارنة مع المجموعة الضابطة وان مستوى الكولستيرول , الدهون الثلاثية , الدهون قليلة الكثافة ومؤشر تصلب الشرايين اعلى منه في مجموعة المرضى مقارنة بالمجموعة الضابطة ، في حين ان مستوى الدهون عالية الكثافة اقل منه في مجموعة المرضى مقارنة بالمجموعة الضابطة . هذا الانخفاض في مستوى هرمون الميلاتونين يمكن تفسيره بان الميلاتونين تم استهلاكه للحد من الجذور الحرة التي تشكلت بعد نقص التروية القلبية | Melatonin hormone is an endocrine product of the pineal gland , it is released follow a circadian rhythm that regulates several physiological and neuroendocrine functions .Melatonin has an important roles in a variety of cardiovascular pathophysiologic processes like anti - inflammatory , antioxidant, antihypertensive and antilipidemic functions. Acute myocardial infarction ( AMI ) is the major cause of mortality worldwide . In acute myocardial infarction, excess production of active oxygen species such as superoxide anion radical ( O2• − ) and hydrogen peroxide (H2O2) can lead to the generation of more toxic oxidants such as the Hydroxyl radical ( •OH ) . Melatonin and it's precursors are able to reduce oxidative reactions by direct free radical scavenging and indirect antioxidant activity so it has an important role in cardioprotection . Atherosclerosis is the major causative factor of AMI , where oxidation and inflammation are key components of atherogenesis and melatonin by it's anti - inflammatory and antioxidant activity acts as antilipdemic factors. The aim of this study was to : 1 - Evaluate the level of serum melatonin hormone in patients with AMI . 2 - Compare melatonin level between normal control group and AMI patients. 3 - Study the changes in melatonin level in patients with AMI after 5 days of hospital admission. 4 - Correlate between lipid profile and melatonin level in AMI patients and in normal control subjects.Forty four Patients with AMI with a mean age of (51.2±6.12) of either sex and Thirty six age and sex matched healthy control subjects were enrolled in this study. Each patient and control subject was submitted to full medical history, ECG and blood pressure determination. Blood samples were collected for estimation of melatonin hormone and lipid profile expect that for patient group another blood sample was collected at day 5 for estimation of melatonin hormone .The results of this study revealed significant difference regarding serum melatonin between patient and control subject p > 0.0001, melatonin level in AMI patients was (5.15±1.56) and in control subjects was (9.37±2.76).Regarding lipid profile , this study revealed significantly higher total serum cholesterol in AMI patients ( 196.16± 19.2 mg / dl ) versus ( 185.58 ±21.88 mg / dl ) in control subjects , p = 0.0262 . S.TG in AMI patients was (190.64±53.19 mg / dl) versus (171.39±31.96 mg / dl) in control subjects , p = 0.0493 . S.HDL in AMI patients was (35.91±6.89 mg / dl) versus (45.58±8.93 mg / dl) in control subjects, p>0.0001. S.LDL in AMI patients was (122.12±19.13 mg / dl) versus (105.72±21.01 mg / dl) in control subjects, p> 0.0006. Atherogenic index of plasma (AIP) in AMI patients was (0.72 ± 0.17) versus ( 0.58 ± 0.14 ) in control subjects , P > 0.0001 .The results of this study revealed no significant difference between melatonin level at day 0 and day 5 in AMI patients.From this study we can conclude that serum melatonin is obviously decreased in patient with AMI than control group .Lipid profile show higher level of total S.CH, S.TG, LDL and AIP in patients than control group, while HDL was lower in patient group. Melatonin level is decreased in day 5 but statistically it was not significant

دراسة مقارنة بين الرياضيين وكثيري الجلوس من ناحية وظائف الرئة وتشبع الاوكسجين وتركيز الشوارد في الدم == Comparative Study of Pulmonary Functions, Oxygen Saturation, and Electrolytes in Athletes and Sedentary Controls at Rest

Author name: زياد طارق عبد الرزاق
Supervisor name: زيد عبد المجيد المدفعي
General topic: Medicine
Specific topic: Physiology
Degree: Doctorate
Language: English
University location: Baghdad
First pages:
Abstract: علم وظائف الاعضاء الرياضية هو دراسة الاثار طويلة المدى وقصيرة المدى للتدريب والظروف على الرياضيين، لمعرفة كيف يتفاعل رياضيا لانواع معينة من التمارين الرياضية.العضلات، والشوارد وتشبع الاكسجين تتاثر في الغالب في ممارسة. وفقا لنوع من الرياضة، ومدة التدريب والعضلات تتاثر في الغالب من قبل هذا التمرين، تتاثر قراءات الرئوية ايضا، وتميل الى ان تكون اعلى لدى الرياضيين من تلك التي من الناس المستقرة وبين المجموعات الرياضية انفسهم.1. هذه الدراسة وسط لتحديد احتراما في استجابة لاختبار وظائف الرئة، الشوارد وتشبع الاكسجين بين الرياضيين والمستقرة.2. التعرف على الفروق في استجابة لاختبار اداء الرئتين، وتشبع الاكسجين والشوارد بين الرياضيين من مختلف الرياضة الاكثر شعبية في العراق.اجريت قياس التنفس، ومستوى تشبع الاكسجين والدم الشوارد بما في ذلك الكالسيوم والمغنيسيوم والصوديوم والبوتاسيوم على 66 الرياضيين المستوى الوطني مختلفة تتراوح اعمارهم بين [24.36 ± 4.65 سنة]. وكان لاعب من خمس مجموعات رياضة مختلفة وكانوا جميعا من الذكور. للخروج منها، كان هناك 20 المصارعين، 15 لاعبي كرة القدم، 8 سباحين و8 عدائين و15 الكاراتيه مختلطة المقاتلين جميعهم رجال الرياضية المتخصصة، في حين كانت المستقرة 40 طلاب الطب، والذكور. وتبين هذه الدراسة ان الرياضيين لديها اعلى اختبارات وظائف الرئة من الجلوس في حين اظهر تشبع الاكسجين والشوارد في الدم في هذه الدراسة لا يوجد فرق كبير بين الرياضيين في الراحة وتلمس المستقرة | Sports physiology is the study of the long - and short - term effects of training and conditions on athletes, to learn how an athlete reacts to specific types of exercise.Muscles, electrolytes and oxygen saturation are mostly affected in exercise; and according to the type of sport, duration of training and muscles mostly affected by this workout, pulmonary readings are also affected and tend to be higher in athletes than those of sedentary people and between athletic groups themselves.1. This study is amid to Identify the deference in response of pulmonary function test, electrolytes and oxygen saturation between athletes and sedentary.2. Identify the differences in response of pulmonary function test, oxygen saturation and electrolytes between athletes of different most popular sport in Iraq.Spirometry, oxygen saturation level and serum electrolytes including calcium, magnesium, sodium and potassium were conducted on 66 different national level athletes aged [24.36 ± 4.65 years]. The athletes were from five different sport groups and were all males. Out of them, there were 20 wrestlers, 15 footballers, 8 swimmers, 8 runners and 15 karate mixed fighters all of them are specialized sports men, while sedentary were 40 medical students, males. This study shows that athletes have higher pulmonary function tests than sedentary while oxygen saturation and serum electrolytes in the present study showed

خلل الوظائف اللاارادية في مرضى الشلل الرعاشي == DYSAUTONOMIA IN PARKINSON'S DISEASE

Author name: اسماء خلف حمود
Supervisor name: اسراء فائق جعفر | فرقد بدر حمدان
General topic: Medicine
Specific topic: Physiology
Degree: Doctorate
Language: English
University location: Baghdad
First pages:
Abstract: يؤثر على كبار السن بشكل اساسي، ولكن تتاثر الفئة العمرية الشابة ايضا. انه ينتج عن موت او تحلل الخلايا العصبية المنتجة للدوبامين بشكل رئيسي في المادة السوداء وقد يمتد الى اجزاء اخرى من الدماغ تحتوي على هذه الخلايا العصبية . ان السبب الرئيسي لهذا المرض لا يزال غير معروف، على الرغم من ان هناك العديد من العوامل التي تساهم في حدوثه.احد هذه العوامل هو الالتهاب، الاكسدة، واختلال عمل بيوت الطاقة (الميتوكوندريا) بالاضافة الى الاستعداد الوراثي للمريض المصاب بهذا المرض.ان الاعراض المرتبطة بمرض باركنسون هي الاعراض الحركية ، غير الحركية وغيرها من الاعراض بما في ذلك اعراض اختلال الجهاز العصبي اللاارادي.تربط هذه الدراسة بين اعتلال الجهاز العصبي اللاارادي من مرض باركنسون مع مواد استيل كولين، ومضادات الاكسدة، وعامل نخر الورم في ثلاث مجموعات دراسية التي هي مرضى باركنسون مع خلل الوظائف التلقائية (اللاارادية)، ومرضى باركنسون دون خلل الوظائف التلقائية ومجموعات الاشخاص الاصحاء.يتم ذلك من خلال دراسة الفحوصات اللاارادية بما في ذلك فحوصات القلب والاوعية الدموية اللاارادية (نسبة فالسالفا، ونسبة 30 : 15، والتغير في ضغط الدم عند الوقوف)، واستجابة الجلد السمبثاوي (SSR)، بالاضافة الى اختبار الكيمياء الحيوية من مستويات الاستيل كولين، ومضادات الاكسدة، وعامل نخر الورم.فيما يتعلق الاختبارات اللاارادية، اظهرت النتائج ان التغيرات في ضغط الدم عند الوقوف كان لها دلالة احصائية بالاضافة الى ذلك، نقص ضغط الدم الوضعي يمثل اهم اعراض خلل الوظائف التلقائية في مرض باركنسون.اما بالنسبة لمستوى الاستيل كولين فقد انخفض مع تطور مرض الشلل الرعاشي وذلك باصابة جهاز الوظائف التلقائية (اللاارادية). اضافة لذلك فان مستوى مضادات الاكسدة لم يظهر اي دلالة احصائية.من ناحية اخرى، نسبة عامل نخر الورم يزداد بتتفاقم المرض ليشمل خلل الوظائف التلقائية اللاارادية.بينت الدراسة ان عامل نخر الورم وعامل شدة الاكسدة يؤثران على تقدم مرض باركنسون ككل وخلل الوظائف الاارادية لهذا المرض بشكل خاص. | Parkinson disease is regarded as a common neurodegenerative disorder in the whole world that affects mainly elderly people, but young age group are also affected. It results from dopaminergic neuronal degeneration mainly in substantia nigra that may extend to other parts of the brain. The main cause of this disorder still unknown, although many factors that contributes in its pathogenesis. Of these factors, there are inflammation, oxidative stress, and mitochondrial dysfunction in addition to genetic predisposition.Symptoms related to Parkinson’s disease are motor, non - motor. The present study relates the autonomic dysfunction of Parkinson disease with the acetylcholine, antioxidants, and tumor necrosis factor in three study groups which are Parkinson patients with autonomic dysfunction, Parkinson patients without autonomic dysfunction and the control groups. The autonomic assessment is done by studying the autonomic tests including cardiovascular autonomic study (Valsalva ratio, 30 : 15 ratio, blood pressure change with posture), and sympathetic skin response, in addition to biochemical testing of acetylcholine, antioxidant, and Tumor necrosis factor levels. Regarding autonomic testing, the results difference that is statistically significant regarding changes of blood pressure in response to posture, in addition Parkinson disease. Acetylcholine level decrease as the disease progress from Parkinson patients without autonomic dysfunction to Parkinson patients with autonomic dysfunction. While antioxidant level was not significant difference between Parkinson patients with and without dysautonomia. On the other hand, tumor necrosis factor increases as the disease worsen to involve autonomic dysfunction. This study shows the effect of tumor necrosis factor and oxidative stress affecting the pathogenesis of Parkinson disease as a whole and autonomic dysfunction in specific

تقييم كهروتشخيصي لمرضى اعتلال جذور الاعصاب العنقية == ELECTRODIAGNOSTIC ASSESSMENT IN PATIENTS WITH CERVICAL RADICULOPATHY

Author name: زينه سليم فخري
Supervisor name: نجيب محمد | احسان محمد
General topic: Medicine
Specific topic: Physiology
Degree: Doctorate
Language: English
University location: Baghdad
First pages:
Abstract: Cervical radiculopathy can be defined as pain in a radicular pattern in one or both upper extremities related to compression and/or irritation of one or more cervical nerve roots. In the electrodiagnostic laboratory, various types of electrodiagnostic studies may be considered when evaluating a patient for cervical radiculopathy. Potential tests including (needle electromyography, motor and sensory nerve conduction studies, late responses, and somatosensory evoked potentials) serves to confirm the presence of radiculopathy, establish the involved nerve root level, determine if axon loss or conduction block is present, grade the severity of the process, estimate the age of the radiculopathy and exclude other peripheral nerve diseases that mimic radiculopathy.The aim of this study was to approve the usefulness of the electrodiagnostic studies (NCS, EMG and SSEP) in the diagnosis of cervical radiculopathy, asses the role and accuracy of the SSEP test (specifically spinal N13 component) in the diagnosis of cervical radiculopathy, identify the extent and distribution of cervical paraspinal muscles denervation in cervical radiculopathy and match the electrodiagnostic results with imaging data in the localization of the root lesion involved.This is case control study had been conducted during the period from April 2016 to October 2017. Ninety five (95) patients with cervical radiculopathy with a mean age of (48.4±11) years and twenty six (26) healthy control subjects with a mean age of (45.2±10.1) years involved in the study. Each subject submitted for medical history, clinical examination and electrophysiological study using Nicolete Viking Quest , EMG, NCS, EP measuring system.XIIFor SNCS, Onset latency, SNAP amplitude and conduction velocity, while for MNCS, distal motor latency, CMAP amplitude and conduction velocity, in addition to the minimal F wave latency (that assess the late response) of median and ulnar nerves are performed.Whereas for right and left sides median nerve SSEP test, the following peak and interpeak latencies (1) N9; (2) N13; (3) N20; (4) N9 - N20; (5) N9 - N13 ; (6) N13 - N20 are measured.Concerning the needle EMG, the following parameters; insertional activity, spontaneous activity and motor units action potential characteristics (duration and phases) of the right and left trapezius, rhomboids major, deltoid, biceps, triceps, extensor indicis and first dorsal interosseous muscles are considered and recorded. In addition to the assessment of the spontaneous activity of the cervical paraspinal muscles.The results of this study revealed that there are significant differences; higher values for the patients when compared with that of control groups regarding Rt and Lt sides N13 peak latency, N9 - N13 and N13 - N20 inter - peak latency. Moreover, the sensitivity of SSEP components in comparison with the MRI (as a gold standard) is the higher for that of spinal N13.From the EMG and MRI findings, C6 and C7 cervical roots are the most roots affected in respect to C5, C8 or C4 roots.Consequently, there are mismatching in the percentages of cervical radiculopathies when diagnosed by the MRI of the cervical spine, needle EMG of the upper limbs muscles and that of the cervical paraspinal muscles, in such a way that Rt C7 radiculopathy 71.6% by cervical spine MRI mismatched with that of upper limbs EMG (66.3%) and 5.3% by the cervical paraspinal muscles.However, the percentages of each level of cervical radiculopathy proved to be higher by the combination of the EMG abnormaities of the cervical paraspinalXIIImuscles with that of the upper limbs muscles than by using the EMG of the paraspinal muscles or upper limbs muscles in an isolation (for Rt C6 radiculopathy 4.2% by paraspinal muscles EMG, 66.3% by upper limb and 68.4% by combination.Furthermore, the sensitivity of the EMG in cervical radiculopathy (using the MRI as a gold standard) increases by the combination of the abnormalities of the cervical paraspinal muscles with that of the upper limbs muscles, for example the sensitivity of Lt C6 radiculopathies 89.9% by upper limbs EMG, 93.2% by the combination of the EMG of PSM with that of the upper limbs muscles.In conclusion, traditional electrodiagnostic tests (NCS, EMG and SSEP) proved to be useful and complementary to the clinical examination in the evaluation of patients with cervical radiculopathy. The benefit of SSEP test for the evaluation of radiculopathies is based on the fact that signs and symptoms in radiculopathies can usually be related to injury of the afferent fibers and the SSEP test can monitor injury to these fibers.In addition to, spinal N13 is a sensitive technique suitable for detecting early and mild symptomatic cervical nerve root lesion.Moreover, cervical paraspinal muscles EMG is complementary to the upper limbs muscles EMG since that significant percentages of cervical radiculopathy will be missed if the examination of PSM is not part of the electrodiagnostic evaluation of patients with suspected radiculopathy. Furthermore, the sensitivity of the needle EMG is increased by the combination of the EMG of the paraspinal muscles with that of the upper limbs muscles, without paraspinal muscles needle EMG the screen of cervical radiculopathy misses much of its sensitivity. Finally, EMG and MRI are valuable and complementary diagnostic tools in the localization and extent of the cervical roots lesion.

دراسة الجهد البدني - الحسي المثار في مرضى اعتلال النخاع الناتج عن داء الفقار الرقبية == Somatosensory Evoked Potentials Study in Cervical Spondylotic Myelopathy Patients

Author name: رؤى محمد كريم
General topic: Medicine
Specific topic: Physiology
Degree: Master
Language: English
University location: Baghdad
First pages:
Abstract: Cervical spondylotic myelopathy (CSM) is considered the most serious consequence of cervical spondylosis and accounts for the majority of non_traumatic paraparesis and/or quadriparesis. The electrical property of the spinal cord and its susceptibility to injuries renders electrophysiology relevant to the management of CSM. SEPs study is an objective assessment of the functional integrity of the neural pathway.With the introduction of MRI, increasing numbers of cases are identified where spondylotic changes and disc herniation reach and compress the cervical spinal cord; however, the significance of these radiological findings with respect to the development of myelopathy is unclear.It is recommended that preoperative sensory - evoked potentials may be considered for patients with CSM in whom clinical factors do not provide clear guidance and would potentially change therapeutic decisions.In this study 22 patients with CSM (11 male and 11 female) and matched with 25 subjects of the control group were enrolled. All subjects were tested with bilateral SNCV of median and sural nerves and with bilateral median and tibial SSEPs tests. Results of SSEPs studies show 19(86.36%) out of 22 patients had abnormal SSEPs study (either tibial or median or both tests abnormal), with 68.2% abnormal tibial and 63.6% abnormal median study. There was no difference between median and tibial SSEPs results in patients (P>0.05) and most of the abnormalities were bilateral and there was no difference between right and left side study of neither median nor tibial SSEPs studies (P>0.05).Median SSEPs showed that abnormality in cortical response N20 and cervical spinal potential N13 compared to control group were highly significant (P<0.0005). Also IPLs were significant regarding (N9 - N13), (N9 - N20), (P14 - N20) and (N13 - N20) with (N13 - N20) was the most significant with 63.6% right and 54.5% left side abnormality. Abnormal cortical response (P37) following tibial stimulation was highly significant compared to control group (P<0.0005) with 14 cases (63.6%) abnormal bilateral tibial SSEPs and 1 patient with unilateral right tibial SSEPs abnormality. Abnormal tibial SSEPs associated with slightly more frequent loss of components than delayed responses. IPL (LP - P37) was highly significant (P<0.0005) with 68.2% right and 63.6% left abnormal results. Patients were classified clinically according to Nurick grading system of cervical myelopathy. Four out of 8 cases with normal median SSEPs of the patients were grade - 1 Nurick, 5 out of 7 cases with normal tibial SSEPs of patients were grade - 1 and 3 out of total 22 patients had normal both median and tibial SSEPs were all grade - 1 and this suggests that normal SSEPs findings mostly correlate with mild and early myelopathy. Six out of 10 cases with abnormal both median and tibial SSEPs were grade - 1 and grade - 2(2 cases grade1 and 4cases grade - 2) and this suggests that abnormal SSEPs findings are useful in prediction the progression of myelopathy in patients with mild clinical neurological deficits in the early stages of the disease.This study concluded that both median and tibial SSEPs montages should be performed to evaluate patients with CSM as the progression of the cervical cord compression may take variable pathways. MRI and SEPs may evaluate different aspects of the disease process; therefore, SEPs study is a useful important objective assessment of the spinal cord function

التقييم الكهروفسلجي لالياف الاعصاب الصغيرة والكبيرة قبل وبعد الديلزة للمرضى المصابين بالعجز الكلوي المزمن == Electrophysiological Assessment of Small and Large Nerve Fibers Dysfunction Pre and Post Dialysis in Patients with Chronic Kidney Disease

Author name: فارس كاظم خضير
Supervisor name: نجيب حسن محمد
General topic: Medicine
Specific topic: Physiology
Degree: Doctorate
Language: English
University location: Baghdad
First pages:
Abstract: يتم التشخيص لمرضى الكلى المزمنة وظيفيا وتتتميز بالانخفاض التتدريجي لراجعة فيه في معدل الترشيح الكبيبي . ومما يزيد من تعقيدها هو عدم القدرة على الحفاظ على مستويات طبيعية من منتجات الايض للبروتين (اليوريا والكرياتينين) وكذلك الحفاظ على مستوى ضغط الدم الطبيعي واختلال في انتاج كريات الدم الحمراء والهيموغلوبين واختلال في معدلات الصوديوم والماء والاملاح . يعتبر اعتلال الاعصاب المحيطية من المضاعفات الشائعة للمرضى المصابين بالفشل الكلوي وهم معرضين اكثر من غيرهم للاصابة بالتهاب الاعصاب المحيطية المتعدد . الفحص الكهروفسلجي مهم اضافة الى الفحص السريري لاجل التشخيص المبكر لمثل هذه المضاعفات وكذلك للتمييز والتفريق بين الانواع المختلفة للاعتلال العصبي المحيطي. هدفت هذه الدراسة الى : (1) تقييم وظيفة الدراسة الكهروفسلجية في تشخيص الاعتلال العصبي للمرضى الذين يعانون من الفشل الكلوي المزمن .(2) معرفة القيم القياسية الاكثر ضرورية من دراسة توصيل العصب، ليتم تنفيذها كاختبار اولي في تشخيص الاعتلال العصبي الالياف الصغيرة.(3) الارتباط بين شدة الاعتلال العصبي المحيطي ومستوى الكرياتينين في الدم.ثلاث مجموعات من المواضيع المدرجة في هذه الدراسة : المرضى البالغين من مرض الكلى المزمن ليس على غسيل الكلى بعد، المرضى على غسيل الكلى ومراقبة الموضوعات.اجريت هذه الدراسة في وحدة الفسلجة العصبية في مستشفى اليرموك التعليمي، في الفترة من يونيو / حزيران 2016 الى سبتمبر / ايلول 2017.اجريت هذه الدراسة على ثلاثة مجاميع بكلا الجنسين تالفت المجموعة الضابطة من اثنان واربعين (42) متطوعا اصحاء (22 ذكور و20 اناث). تراوح عمر هذه الفئة بين 20 و75 سنة بمتوسط (52.48 ± 10.63) سنة. 22 - 75 سنة للذكور بمتوسط العمر (53.54 ± 14.57) سنة، و20 - 74 سنة للاناث بمتوسط العمر (51.42 ± 11.91) سنة. كان جميع الاشخاص الذين تم فحصهم من هذه المجموعة لا يعانوا من امراض مزمنة، مع عدم وجود تاريخ طبي من امراض الجهاز العصبي. لا يوجد تاريخ من تعاطي الكحول او تناول المخدرات. وقد كان اغلبهم من الاقارب العاديين، والعاملين الطبيين، والطلاب والعاملين . شملت الدراسة ثمانون مريضا يعانون من الفشل الكلوي المزمن. قسموا الى مجموعتين : ا - اربعون (40) مريضا مصابين بامراض الكلى المزمنة يراجعون عيادة امراض الكلية والغسيل الكلوي وهم غير خاضعين للعلاج بالديلزة ومعدل الكرياتنين في مصل الدم لديهم مرتفع بشكل مطرد اكبر من 2.5 ملغ / دلزمن كلا الجنسين (22 ذكور و18 اناث)، تراوحت اعمارهم بين( 35 و72 سنة) بمتوسط حسابي (55.35 ± 9.05) سنة.وتتراوحت مدة الاصابة بالاعتلال بين (2 - 10) سنوات، مع متوسط (8.72±3.65) سنواتب - اربعون (40) مريضا مصابين بامراض الكلى المزمنة خاضعين للعلاج بالديلزة الدموية من كلا الجنسين (21 ذكور و19 اناث)، تراوحj اعمارهم بين (43 - 70 سنة) بمتوسط (56.98 ± 7.40) سنة. تراوحت مدة الاعتلال بين (7 - 15) سنة بمتوسط (13.87 ± 5.41) سنة.تم تعريف جميع الاشخاص ال 122 (المرضى والسيطرة) في هذه الدراسة حول هدف وطبيعة الدراسة وتم استحصال موافقتهم على شمولهم بالدراسة. شملت الاستقصائات الكهروفسلجية تخطيط الاعصاب المحيطية الكهربائي وتخطيط العضلات الكهربائي،اذ شمل تخطيط الاعصاب المحيطية كفاءة الاعصاب الحسية بواسطة قياس الكمون الحسي، ارتفاع الجهد الحركي للاعصاب الحسية وسرعة التوصيل الحسي لكل من ( العصب الناصف"الوسطي"، العصب الزندي، والعصب الربلي)،اضافة الى دراسة وظائف الاعصاب الحركية من خلال دراسة الكمون الحركي القاصي ،سرعة التوصيل الحركي ،ارتفاع الجهد الحركي للاعصاب الحركية، قيمة الكمون الوسطى لموجة اف، التشتت الزمني وانعدام التوصيل الكهربائي لكل من الاعصاب التالية : - (العصب الناصف "الوسطي"، العصب الزندي ، العصب الشظوي المشترك والعصب الظنبوبي). في تخطيط العضلات الكهربائي تم فحص العضلات التالية : العضلة ذات الراسين والعضلة الاولى الظهرانية بين العظام للاطراف العليا اما بالنسبة للاطراف السفلى تم فحص العضلة المتسعة الانسية للفخذ ،العضلة الظنبوبية الامامية والعضلة الباسطة القصيرة للاصابع اذ تضمن الفحص استقصاء سعة الموجة، مدة كمون الفعل للوحدة الحركية والزيادة التدريجية في شدة المنعكس عند استمرار التنبيه. وكذلك تم فحص الاستجابة المتعاطفة للجلد للعصب الناصف "الوسطي"و العصب الشظوي المشترك الايمن. بينت الدراسة الكهروفسلجية لوظائف الاعصاب الحسية انخفاض ذو معنى في وظائف الاعصاب الحسية لدى المرضى الذين يعانون من الفشل الكلوي المزمن مقارنة بالاشخاص الاصحاء .اذ لوحظ زيادة في الكمون الحسي، انخفاض الجهد الحركي للعصب الحسي ونقصان في سرعة التوصيل الحسي . ولا يوجد فرق معنوي(p> 0.05) بين كلا النوعين من المرضى عدا فيما يتعلق بالكمون الحسي وسرعة التوصيل الحسي للعصب الناصف والزندي وكذلك العصب الربليز . اما فيما يخص تخطيط الاعصاب الحركية لكلا المجموعتين من المرضى بينت الدراسة انخفاضا ذو معنى لدى هؤلاء المرضى مقارنة بالاشخاص الاصحاء والتي شملت زيادة في الكمون الحركي القاصي وقيمة الكمون الوسطى لموجة اف ونقصان في سرعة التوصيل الحركي. اما الاستجابة المتعاطفة للجلد فقد اظهرت تدنيا معنويا(p< 0.05) لدى مرضى الفشل الكلوي المزمن في كلتا المجموعتين من المرضى عند مقارنتها مع الاشخاص الاصحاء . كما اظهرت الدراسة زيادة في التشتت الزمني في مرضى الفشل الكلوي في مجموعة قبل الديلزة وجدت في 39 عصب من اصل 204 عصب (19.3٪) وكانت اعلى نسبة في العصب الشظوي المشترك الايمن (28.57٪) ، في حين كانت اقل نسبة في العصب الزندي الايمن (12.5٪). وظهرت ايضزايادة التشتت الزمني في المرضى الخاضعين للديلزة وجد في 36 عصب من اصل 203 عصب (17.73٪) وكانت اعلى نسبة في العصب الشظوي المشترك الايمن(24.13٪)، في حين ان اقل نسبة مئوية في العصب المتوسط الايمن (12.5٪). كما اظهرت الدراسة ايضا وجود انعدام جزئي للتوصيل الكهربائي في المرضى الغير خاضعين للديلزة وكانت اعلى نسبة في العصب المتوسط الايمن (25٪)، في حين ان اقل نسبة شملت العصب الظنبوبي الايمن (11.11٪)، واظهرت الدراسة ان 38 عصب من اصل 204 عصب تم فحصها (18.62٪) تعاني من انعدام جزئي للتوصيل. اما المرضى الخاضعين للديلزة الغسيل الكلوي فقد كان هناك 34 عصب من اصل 203 عصب تم فحصها (16.74٪) يعاني من انعدام جزئي للتوصيل . وكانت اعلى نسبة هي في العصب المتوسط الايسر (25٪)، في حين ان النسبة المئوية الدنيا تشمل العصب الظنبوبي الايمن (7.69٪). نستخلص من هذه الدراسة ان تقييم الاعصاب الحسية اكثر اهمية من الحركية في تشخيص اعتلال الاعصاب الطرفية في وقت مبكر لدى مرضى الفشل الكلوي المزمن الغير خاضعين للديلزة كذلك الاستجابة المتعاطفة للجلد هي مفيدة جدا في الكشف عن اعتلال الالياف العصبية الصغيرة في المرضى المصابين بالاعتلال الكلوي المزمن ( قبل وبعد الغسيل الكلوي). وعلاوة على ذلك، فان مستوى الكرياتينين لديه علاقة عكسية واضحة مع كل معطيات دراسة توصيل العصب لدى المرضى الغيرخاضعين للديلزة (كلمزاادت نسبة الكرياتينين في مصل الدم يؤدي الى انخفاض قراات دراسة توصيل العصب). معظم مرضى الاعتلال الكلوي المزمن (الخاضعين وغير الخاضعين للديلزة) لديهم شذوذ في دراسة توصيل العصب في الاطراف، ولكن الاصابة في الاطراف السفلية هي اكثر من الاطراف العلوية.* اعتمد في تعريب المصطلحات العلمية على : 1. المعجم الطبي الموحد انكليزي عربي ،رئيس التجرير د.محمود الجليلي الطبعة الثانية،1978. 2. الموجز المصور لفحص الجهاز العصبي. ترجمة د.عبد الهادي الخليلي - بغداد - 1992 د.موريس فان الن. د.روبرت روزنسكي. | The Chronic Kidney Disease (CKD) is a purposeful identification portrayed by an irretrievable and step by step advancing decrease in glomerular filtration rate (GFR). Furthermore, it is intricate by a rising incapability to preserve common stages of protein metabolism products (such as urea, creatinine, standard blood pressure, hematocrit, sodium, water, calcium phosphate homeostasis, potassium and acid base balance). A further frequent involvement is the Peripheral neuropathy of Chronic kidney disease. Nevertheless, patients who suffer CKD are further exposed to increase peripheral polyneuropathy. Neurological impediments that is subsidiary to the uremic status, participate fundamentally to the sickness and death to patients who suffer renal failure. The occurrence of peripheral neuropathy stays extreme in advanced renal dysfunction Electrophysiological study (nerve conduction study NCS and electromyography EMG) is useful adjunct test to the medical history and clinical examination in the diagnosis of such complication, early detection and differentiation from an axonal type of peripheral neuropathy. The aims of this study are designed to : (1) Evaluate the function of electrophysiological study (NCS and EMG) in diagnosing the neuropathy for patients who suffer CKD. (2) Decide and rule out the most necessary parameters of NCS and EMG, to be performed as preliminary test in the diagnosis of small fiber neuropathy. (3) Correlation between the severity of the peripheral neuropathy and the level of serum creatinine.Three groups of subjects included in this study : Adult patients of chronic kidney disease not on dialysis yet, Patients on hemodialysis and control subjects. The present study was carried out at the neurophysiology unit in Al - Yarmouk Teaching Hospital, in the a period from June/2016 to September /2017.The control group consists of forty two (42) healthy volunteers (22 males and 20 females). The age of this group ranged between 20 to 75 years with a mean 52.48 ±10.63 years. Males are 22 - 75 years with a mean of age 53.54± 14.57 years, and 20 - 74 years for females with a mean of age 51.42±11.91 years. Eighty patients included in this study had chronic kidney disease. They consist of two groups : A - Forty (40) patients with chronic kidney disease on customary attend the Kidney and Dialysis clinic not on dialysis with steadily high serum creatinine (> 2.5 mg/dl of) either sex (22 males and 18 females), their ages ranging between 35 and 72 years with a mean 55.35 ± 9.05 years. The duration of CKD is ranged between 2 – 10 years, with mean 8.72 ± 3.65 yearsB - Forty (40) patients with chronic kidney disease on regular hemodialysis (21 males and 19 females), their ages ranging between 43 to 70 years with a mean 56.98 ±7.40 years. The duration of CKD is ranged between 7 - 20 years with mean 13.87 ± 5.41 years. All of 122 subjects (patients and control) that were included in this study were informed about the aim and technique of the study and their acceptance was taken.Each subject was submitted to medical history and electrophysiological tests (NCS and EMG) of the two limbs i.e. the upper and the lower. These tests include : 1 - Sensory nerve conducting study (SNCS) for Median, Ulnerand Sural nerves, in which, distal sensory latency, sensory nerve action potential (SNAP) amplitude and sensory nerve conduction velocity (SNCV) are performed. 2 - Motor nerve conducting study (MNCS) for Median, Ulnar, Fibular (Common peroneal), and tibial nerves , which includes measurement of distal motor latency (DML), compound muscle action potential (CMAP) amplitude, Motor nerve conduction velocity (MNCV), Mean F - wave latency, Terminal latency index (TLI), Temporal dispersion (TD%) and Conduction block (CB%).3 - Sympathetic skin response (SSR) of right median and right fibular nerves. 4 - Needle EMG for proximal and distal muscles like : biceps, and 1st dorsal interosseous muscles for upper limb and vastusmedialus, tibialis anterior and Extensor digitorium brevis for lower limb, in which insertional activity, spontaneous activity, motor unit action potential (duration, amplitude and polyphasia%) and recruitment pattern are considered. The results of this study revealed that sensory NCS was considerably altered in all kinds of CKD patients as weigh against the healthy control subjects in the form of prolonged distal sensory latency, decreased SNAP amplitude and slowing of SNCV. However, there were not statistically significant differences (P>0.05) between pre dialysis and post dialysis Peripheral Neuropathy except in the SNAP amplitude of right and left median and right ulnar and sural sensory nerves whereas the differences are statistically significant (p<0.05).As for the study of motor nerve conduction, theprolonged DML, slowing of conduction velocity and prolonged mean F - wave latency are perceived in both groups of patients when compared with those of healthy control subjects. However, the differences are also statistically significant (P<0.01) in the TLI of right median and ulnar nerves, distal CMAP amplitude of the right ulnar nerve, distal motor latency (DML) of left median and right ulnar nerves, MNCV (m/sec.) of left median nerve and prolongation or mean F - wave latency of left median, common peroneal and right tibial nerves (P<0.05). Also Sympathetic Skin Response significantly (P<0.01) changed detected in both groups of patients when compared with those of healthy control.Moreover, in both patients groups, abnormal TD% are observed increased temporal dispersion in CKD pre dialysis patients is found in 39 out of 204 nerves (19.3%) However the higher percentage of abnormal TD% is in the right common peroneal nerve (28.57%), while the lower percentage is in the right ulnar nerve (12.5%).Increased temporal dispersion in CKD post dialysis patients is found in 36 out of 203 nerves (17.73%) However the higher percentage of abnormal TD% is in the right common peroneal nerve (24.13%), while the lower percentage is in the right median nerve (12.5%).In both patients groups, abnormal CB% are observed that the higher percentage of conduction block (CB%) in motor nerves of CKD pre dialysis patient involves right median nerve (25%), while the lower percentage involves right tibial nerve (11.11%).Whereas there are 38 out of 204 examined nerve with conduction block (18.62%).And also show that the higher percentage of conduction block (CB%) in motor nerves of CKD post dialysis patient involves left median nerve (25%), while the lower percentage involves right tibial nerve (7.69%). Whereas there are 34 out of 203 examined nerve with conduction block (16.74%).In conclusion, this study reveals Sensory NCS is more useful and helpful than the motor NCS in the diagnosis of early peripheral neuropathy in CKD pre dialysis also Sympathetic skin response (SSR) abnormality are very useful in the detection of small fiber neuropathy in CKD patients (pre and post dialysis).Moreover, the serum creatinine level have strong correlation with NCS parameters in CKD pre dialysis patients (when increase level of s.cr lead to decrease the NCS parameters).Most CKD patients had abnormal NCS parameters in both limbs, but the abnormalities in the lower limbs are more than the upper limbs

علاقة معامل ضغط الدم الشرياني للكاحل نسبة للعضد بعمل البطين الايسر للمصابين بمرض قصورالشرايين التاجية == RELATION OF ANKLE BRACHIAL INDEX TO THE LEFT VENTRICULAR FUNCTION IN PATIENTS WITH CORONARY ARTERY DISEASE

Author name: محاسن محمد عبد المجيد
Supervisor name: نجيب حسن محمد | هلال بهجت الصفار
General topic: Medicine
Specific topic: Physiology
Degree: Master
Language: English
University location: Baghdad
First pages:
Abstract: يعد تصلب الشرايين من اهم العوامل المتسببة في مرض الشرايين التاجية ويعد فحص قياس ضغط الدم الشرياني الانقباضي للكاحل نسبة للعضد من الفحوصات الامنة وطريقة اجراءه سهلة وبسيطة لتشخيص امراض الشرايين الطرفية .حيث استخدم في وقت لاحق كمؤشر على تصلب الشرايين في مواقع اخرى للاوعية الدموية. ويعد فحص صدى القلب ( الايكو) من الفحوصات الامنة واداة تشخيصية ويوفر امكانية لتقييم وظائف القلب.الهدف من هذه الدراسة هو : 1) تقييم فائدة ودقة فحص قياس ضغط الدم الشرياني للكاحل نسبة للعضد في تشخيص الخلل في عمل البطين الايسر. 2) تحديد نوع اختلال عمل البطين الايسر في المرضى الذين لديهم نتائج غير طبيعية في فحص قياس ضغط الدم الشرياني للكاحل نسبة للعضد سواء اكان الاختلال في عمل البطين الايسر انقباضي او انبساطي او كليهما. 3) ايجاد علاقة فحص قياس ضغط الدم الشرياني للكاحل نسبة للعضد بشدة وعدد الشرايين التاجية المصابة بالتضييق الشرياني لدى مرضى قصور الشرايين التاجية.ثمانون (80) شخصا مصابون بقصور الشرايين التاجية كما هو موثق عن طريق فحص تصوير الشرايين التاجية (قسطرة الشرايين التاجية) من كلا الجنسين شاركوا في هذه الدراسة للفترة من كانون الاول 2013 الى ايار عام 2014 حيث اجريت هذه الدراسة في المركز العراقي لامراض القلب / مستشفى غازي الحريرى التعليمي. تم اخذ عينة من المرضى المحالين الى المركز العراقي اما لغرض اجراء فحص تصوير الشرايين التاجية (قسطرة الشرايين التاجية) او لاجراء عملية التمييل للشريان التاجي ومن المرضى الراقدين في قسم جراحة القلب في المركز لاجراء عملية مجازة الشريان التاجي.المرضى خضعوا للفحص السريري , القياسات الفيزياوية للجسم (الطول والوزن ومعامل كتلة الجسم ومحيط الورك، ومحيط الخصر ونسبة الخصر الى الورك) وقياس ضغط الدم ثم فحص قياس ضغط الدم الشرياني للكاحل نسبة للعضد وتم حساب قيمة معامله بقسمة ادنى قيمة لضغط الدم الانقباضي للكاحل ( ضغط الانقباضي لشريان ظهر القدم اوشريان الظنبوب الخلفي ) على اعلى قيمة لضغط الدم الشرياني للعضد. وقد حسب المعامل لكل ساق على حدة، وادنى القيمتين استخدمت لتحديد قيمة معامل فحص قياس ضغط الدم الشرياني للكاحل نسبة للعضد للمريض باستخدام جهاز hand - held 8MHz Doppler كما واجري فحص تخطيط صدى القلب لكل مريض M - mode, Doppler , tissue Doppler ثم ارسل المرضى لاجراء فحص تصوير الشرايين التاجية ( القسطرة). صنف المرضى الى ثلاث مجموعات وفقا لنتائج فحص قياس ضغط الدم الشرياني للكاحل نسبة للعضد : المجموعة الاولى ذات النتائج الغير طبيعية المنخفضة ) 0.79±0.12) ؛ تتالف من تسعة وعشرين (29) من المرضى)20 رجلا و9 امراة بمتوسط عمر مقداره 58 ± 6 سنة) والمجموعة الثانية ذات النتائج الغير طبيعية العالية (1.43±0.05 )؛ تتالف من ثلاثة عشر (13) من المرضى(10 رجال و3 امراة بمتوسط عمر مقداره 56 ± 6 سنة والمجموعة الثالثة تمثلت بالمرضى اصحاب النتائج الطبيعية للفحص (1.03±0.10) والذي يمثل مجموعة السيطرة؛ تتالف من ثمانية وثلاثين (38) من المرضى (27 رجلا و11 امراة بمتوسط عمر مقداره 58 ± 7 سنة).كما واظهرت نتائج هذه الدراسة بخصوص المقارنة بين الاختلال الوظيفي الانقباضي للبطين الايسر فقد سجلت نتائج نسبة الكسر القذفي (EF%) انخفاضا ملحوضا في المجموعتين الاولى والثانية مقارنة بالمجموعة الثالثة وكذلك اظهرت النتائج انخفاضا ملحوظا في التقصر التجزيئي FS٪ .بالاضافة الى ذلك تبين بان هنالك تباين ملحوظ في الاختلال الوظيفي الانبساطي للبطين الايسر عند المقارنة بين المجموعة الاولى والثانية مع المجموعة الثالثة حيث سجل تباطؤا ملحوظا في عامل الوقت التباطؤي (DT) مع زيادة ملحوظة في عامل E/Em في حين لم تظهر النتائج تباينا ملحوظا في عامل سرعة موجة E وEm ونسبة E/ A وIVRT.فيما يخص مؤشر معامل اداء عضلة القلب (MPI) بينت الدراسة زيادة كبيرة في المعامل لدى المجموعتين الاولى والثانية مقارنة بالمجموعة الثالثة كما واظهرت نتائج هذه الدراسة ان الذكور اكثر عرضة للاصابة بقصور الشرايين التاجية من الاناث . وتبين من النتائج ان هنالك ازدياد في نسبة عدد الشرايين التاجية المصابة بالتضيق من شريان واحد الى شريانين الى ثلاثة شرايين في المجموعتين الاولى والثانية مقارنة بالمجموعة الثالثة خصوصا لدى المرضى المصابيين بداء السكري حيث تزداد نسبة الشرايين المصابة بالتضيق لديهم اكثر من باقي المرضى. واستنتجت هذه الدراسة ان فحص الضغط الشرياني للكاحل نسبة للعضد يكشف عن وجود علاقة ويعطي فكرة وانطباع عن وظائف البطين الايسر الانقباضي وعن عدد الشرايين التاجية المصابة بالتضييق الشرياني لدى المرضى المصابيين بقصور الشرايين التاجية. | Measurement of the ankle - brachial index (ABI) represents sensitive, specific, noninvasive, safe and simple objective way to diagnose peripheral arterial diseases. Coronary artery disease (CAD) is most commonly due to atherosclerotic occlusion of the coronary arteries. It was shown that the ABI is an indicator of coronary atherosclerosis in addition to other vascular sites and can serve as a prognostic marker and a predictor for cardiovascular events and functional impairment, even in the asymptomatic patients.The aim of this study is to : 1) Prove the usefulness and the accuracy of ABI in the assessment of left ventricular dysfunction. 2) Determine the type of left ventricular dysfunction whether systolic, diastolic or combined in patient with abnormal ABI. 3) Determine the relationship between ABI with the angiographic extent of coronary artery disease. Eighty (80) patients of either sex with coronary artery disease proved by coronary angiography included in this study. They are selected from those referred to the Iraqi Center for Heart Disease for either diagnostic coronary angiography or for percutaneous coronary intervention and from those admitted to the surgical department for coronary artery bypass graft. Each patient is submitted for Medical history and clinical examination, anthropometric measurements (height, weight, waist circumference and hip circumference to calculate body mass index and waist to hip ratio), systolic ankle - brachial index test and echocardiography examination in addition to coronary angiography. The systolic blood pressure (SBp) is measured at the right and left brachial, dorsalis pedis and posterior tibial arteries using Doppler probe. The ABI for each leg was calculated by dividing the lowest value of either ankle SBP (dorsalis pedis or posterior tibial) by the highest value of either brachial SBP where the lower of the two values was considered to define the patient ABI. Then after that, Transthoracic M - mode, pulsed - wave Doppler and tissue Doppler echocardiography are performed for all participants to obtain measurements to assess left ventricular function and interpreted with the ABI results. This study was conducted from December 2013 till May 2014 at Iraqi Center for Heart Disease / Ghazi Al - Hariry Teaching Hospital.The patients are classified according to the normal cut off values of the ABI (0.9< ABI ≤1.30) : Group І with abnormally low ABI (0.79±0.12) including twenty nine (29) patients (20 men and 9 women with a mean age of 58 ± 6 years), Group ІІ with abnormally high ABI (1.43±0.05); composed of thirteen (13) patients (10 men and 3 women with a mean age of 56 ± 6 years) and Group ІІІ with normal ABI (1.03±0.10) which represents the control group; composed of thirty eight (38) patients (27 men and 11 women with a mean age of 58.93 ±7.85years).The results of this study reveal that male gender being involved by CAD more than females among the studied groups (69 %, 84 % and 71 % respectively with p < 0.05). Regarding left ventricular systolic function, the results account a statistically significant decrease in the left ventricular ejection fraction (EF %) among low and high ABI Groups when compared to that of normal ABI Group (53.4±14.7 and 42.6±10.4 vs. 63.1±8.9 respectively. Diastolic dysfunction when assessed by pulsed wave Doppler the results reveal a statistically significant comparison between abnormal ABI Groups (low and high ABI Group) and with those of normal ABI Group in the prolongation of the deceleration time (DT) (171 and 149vs.195) respectively, decreases in the Ea velocity(0.09 ± 0.03 and0.07 ± 0.02 vs. 0.10 ± 0.03) respectively and increasing E/Ea ratio (10.32 and 10.61 vs. 7.76 ) while there are no significant differences between abnormal ABI Groups (low and high ABI Groups) with those of normal ABI Group; regarding Peak E,A waves velocity, E/ A ratio and isovolumic relaxation time (IVRT). Moreover myocardial performance index (MPI) there is statistically significant increase in the MPI in low and high ABI Groups when compared to normal ABI Group (0.64 and 0.64 vs. 0.40). Concerning the number of coronary arteries involved as obtained from coronary angiography, this study reports increasing frequency from single vessel, two vessels to three vessels involvement in the abnormal ABI groups when compared to the normal ABI Group particularly in those patients with diabetes mellitus, more coronary vessels are involved. In conclusion, apart from that an abnormal ABI (<0.9 and > 1.4) serves as an indicator and predictor for coronary artery disease, it is associated with left ventricular systolic and diastolic dysfunction. In addition, ABI is a useful bedside predictor for the extent of coronary artery disease

علاقة هورمونات الغرلين, اللبتين, غلوكاغون والانسولين بمقاومة الانسولين بمرضى السمنة والناس الغير مصابين بالسمنة == Relationship between Ghrelin, Leptin, Glucagon and Insulin with Insulin Resistance in Obese Patients and Non - Obese Individuals

Author name: دعاء مهدي عمران
Supervisor name: علي حسين البياتي | سعد مرزة الاعرجي
General topic: Medicine
Specific topic: Physiology
Degree: Master
Language: English
University location: Babylon
First pages:
Abstract: تعتبرالسمنة وباءا عالميا حيث انها تؤثرفي حوالي اكثر من 2 مليار شخص حول العالم حتى عام2013, ان ارتفاع نسبة انتشار السمنة في كل من البلدان المتقدمة والنامية كانت نتيجة لعدد من الاسباب والتي تتمثل بالبيئة، الوراثة الطبية مثل اضطراب الغدد الصماء، والعلاج مثل العقاقير المضادة للذهان والمنشطات الستيرويدية, ان اغلب الناس البدينين يكونون عرضة للاخطار الكبيرة حيث تعرضهم للمضاعفات كداء السكري وارتفاع ضغط الدم وتصلب الشرايين، ومشاكل المفاصل، وامراض السرطان وخاصة السرطانات المحفزة بالهرمون، بالاضافة الى مشاكل في الجهاز التنفسي وغيرها من المضاعفات الاخرى, ان الهدف من هذه الدراسة هو اظهار تاثير زيادة الوزن على تمثيل تاهورمونات التالية : الغرلين, اللبتين, الانسولين والغلوكاكون في المرضى المصابين بالسمنة مع او بدون مقاومة الانسولين ومقارنتهم بالناس الغير مصابين بالسمنة مع او بدون مقاومة الانسولين, تم اخذ 100 شخصا منهم 50 شخصا مصابين بالسمنة و50 شخصا غير مصابين للفترة بين شهر كانون الثاني 2015 وشهر حزيران 2016 بمعدل اعمار بلغ (34.00±9.43) بالنسبة لمرضى السمنة و(34.50±7.40) بالنسبة للاشخاص الغير مصابين بالسمنة, تم الاعتماد على معامل كتلة الجسم لتفريق المجموعتين وتم سؤال الجميع حول ان كانوا مصابين بامراض معينة او يتناولون ادوية معينة تؤثر في وزنهم, وتم مختبريا اجراء الفحوصات التالية : فحص نسبة السكر في الدم, هورمون الانسولين, هورمون الغلوكاكون, هورمون اللبتين, هورمون الغرلين وتم قياس مقاومة الانسولين حسب المعادلة بين الانسولين والسكرو اظهرت النتائج وجود فرق معنوي بين المجموعتين (p value ≤ 0.05) فيما يخص اختلاف الجنس والتعليم وكذلك اختلافا معنويا (p value ≤ 0.05) فيما يخص الفحوصات المختبرية لنسبة السكر في الدم, نسبة هورمون الانسولين, هورمون اللبتين ومقاومة الانسولين فيما لم تظهر فرقا فيما يخص هورموني الغرلين والكلوكاكون.اعتمد الباحث في تعريب المصطلحات العلمية على : المعجم الطبي الموحد - انكليزي - عربي. رئيس التحرير د. محمود الجليلي - الطبعة الرابعه 2009 م , مطبعة المجمع العلمي العراقي. | Obesity is representing a global epidemic that affecting more than 2 billion peoples around the world on 2013. The obesity prevalence has risen in both developed and developing countries. Many causes have been implicated for developing obesity such as : environmental, hereditary, medical disease like endocrine disorders furthermore, some medication like antipsychotic drugs and steroids. Obese people are at high risk to develop much complication such as diabetes, hypertension, atherosclerosis, joints problems, cancers especially hormone dependent, respiratory problems and others. The aim of this study was to compare the impact of increase in weight on the clinical presentation of Ghrelin, Leptin, Insulin, and Glucagon in obese patients with or without Insulin resistance and compare it to that of non - obese individuals with or without Insulin resistance, one hundred people are included in this study attending Marjan medical city from December 2015 till June 2016, a fifty normal non - obese and fifty obese, the overall mean age of patients and controls were (34.00±9.43) and (34.50±7.40) years old, respectively, they are classified according to body mass index after measuring their weight, height, the mean BMI of case patients was (39.23±6.71 kg/m²) and (23.08±1.19 kg/m²) for the control individuals, a general questionnaire were done for all patients and control for diagnosis excluded disease and any treatment that effect on obesity, the investigations that were done include : fasting blood sugar with hormonal testing is performed by ELISA kits examining Serum Insulin, Glucagon, Leptin and Ghrelin and the results of this study showed a significantly higher difference in percentage (p value ≤ 0.05) between study and control groups concerning education and gender. Regarding investigation there is significantly higher difference in percentage (p value ≤ 0.05) between study and control groups in parameters of fasting blood sugar, HOMA IR, Leptin and Insulin, while no significant difference (p value ˃ 0.05) in percentage between study and control for Ghrelin hormone and Glucagon hormone, so the conclusion of the results of this study support the evidence that obesity associated with Insulin Resistance, high level of Insulin and Leptin hormones and low concentrations of Ghrelin hormone, while it did not found a link with Glucagon hormone

التشخيص الكهربائي المبكر لاعتلال الاعصاب القحفي غير السريري لدى مرضى السكري المصابين او غير المصابين باعتلال الاعصاب المحيطيه == Early Electrodiagnosis of Subclinical Cranial Neuropathy in Diabetic Patients with or without Peripheral Neuropathy

Author name: ولاء فاضل جلال الحسناوي
Supervisor name: سعد مرزة حسين الاعرجي | كريم مصحب التميمي
General topic: Medicine
Specific topic: Physiology
Degree: Master
Language: English
University location: Babylon
First pages:
Abstract: داء السكري من النوع الثاني هو مشكلة صحية منتشرة على نطاق واسع ويمتاز بمضاعفات عديدة تصيب الاوعية الدموية مما يؤدي الى ارتفاع معدلات الاعتلال والوفيات. الاعتلال العصبي المحيطي السكري هو اكثر المضاعفات شيوعا لداء السكري من النوع الثاني ، وفي الغالب يكون بشكل اعتلال الاعصاب القاصي المتناظر والذي يكون على هيئة قفازات وجوارب. ارتفاع السكر في الدم هو العامل المسبب الرئيسي لاعتلال الاعصاب المحيطية لدى مرضى السكري. اعتلال الاعصاب القحفية عادة تظهر مع الاعتلال العصبي المحيطي السكري اما سريريا او في شكل تحت السريري. الهدف الرئيسي من هذه الدراسة هو تقييم لدور منعكس الطرفة في التشخيص المبكر لاعتلال الاعصاب القحفية لدى مرضى السكري من النوع الثاني مع او بدون اعتلال الاعصاب. الطرق والاساليب : اجريت الدراسة خلال الفترة من شهر كانون الثاني الى شهر اب 2014. شملت الدراسة 83 مريضا ممن يعانون من داء السكري النوع الثاني ضمن الفئة العمرية من 35 - 69 سنة. اعتبر المرضى الذين يعانون من الاعراض السريرية لضعف الاعصاب الطرفية والذين لديهم تخطيط الاعصاب الكهربائي غير طبيعي بانهم مرضى اعتلال الاعصاب المحيطية السكري (61 مريضا)، في حين اعتبر المرضى الذين لايعانون من ضعف الاعصاب الطرفية وتخطيط الاعصاب الكهربائي لديهم كان طبيعيا بانهم لا يشكون من اعتلال الاعصاب المحيطية السكري ( 22 مريضا). شملت الدراسة ايضا اشخاص لا يعانون من اي مرض تتناغم اعمارهم وجنسهم مع المرضى المشمولين بالدراسة سميت مجموعة السيطرة(60مريضا).وقد خضع المرضى ومجموعة السيطرة المشمولين بالدراسة الى التقييم الكامل الذي شمل : التقييم السريري (التاريخ والفحص)، وتقييم الكيمياء الحيوية (قياس سكر الدم بعد الصيام، الهيموجلوبين السكري، قياس نسبة دهون الدم) وتخطيط الاعصاب الكهربائي الذي يشمل دراسات التوصيل الحسية والعصبية الحركية NCS)) مع منعكس طرفة.النتائج : وجدت الدراسة ان مرضى السكري لديهم تاريخ عائلي ايجابي، انخفاض المستوى التعليمي وارتفاع مؤشر كتلة الجسم بالمقارنة مع مجموعة السيطرة. مرضى السكري مع اعتلال الاعصاب المحيطية لديهم رابطة كبيرة مع زيادة العمر (القيمة P <0.01) ، وكبيرة للغاية مع مدة المرض (0.007=P)، واهمية عالية مع الفرق في مؤشر كتلة الجسم (قيمة P <0.01) بالمقارنة مع مرضى السكري من دون اعتلال الاعصاب المحيطية . وكان مرضى السكري المصابون باعتلال الاعصاب المحيطية علاوة على ذلك لديهم ضعف السيطرة على نسبة السكر في الدم التي تعكسها نسبة عالية لقياس سكر الدم بعد الصيام ونسبة الهيموكلوبين السكري, بينما اظهرت صورة الملف الشخصي لقياس دهون الدم قيمة غير مهمه. بينت دراسة التوصيل العصبي (الحسية والحركية) فرق كبير بين الكمون، والسعة، وسرعة التوصيل بين مرضى السكري مع اعتلال الاعصاب المحيطية والذين لا يعانون من هذه الحالة. واظهرت نتائج منعكس الطرفة فرق هام للغاية (قيمة P <0.01) بين مرضى السكري ومجموعة السيطرة.مناقشة : اظهرت نتائج هذه الدراسة ان اعتلال الاعصاب المحيطية السكري يرتبط مع العديد من عوامل الخطورة مثل العمر, مدة المرض، مؤشر كتلة الجسم، وضعف السيطرة على نسبة السكر في الدم . وكشفت الدراسة ايضا ارتفاع معدل اعتلال الاعصاب المحيطية السكري في المرضى قيد الدراسة (73.5٪). اعتلال الاعصاب القحفية تحت الاكلينيكي موجود ايضا في المجموعة قيد الدراسة بغض النظر عن وجود او عدم وجود اعتلال الاعصاب المحيطية السكري. وقد تبين ذلك من خلال منعكس طرفة غير طبيعي في 44.6٪ من المرضى. كان معظم المرضى الذين يشكون من منعكس طرفة غير طبيعي يعانون ايضا من اعتلال الاعصاب المحيطية السكري (89.2٪) . ووفقا لنتائج هذه الدراسة اعتلال الاعصاب المحيطية السكري يزيد من فرصة وجود منعكس طرفة غير طبيعي بخمس مرات اكثر، وهو ينبئ باعتلال قحفي تحت الاكلينيكي لوجود نسبة غريبة بين اعتلال الاعصاب المحيطية السكري ومنعكس طرفة شاذ لا ارادي هي 5.29.اعتمد الباحث في تعريب المصطلحات العلمية على : 1 - اطلس التشريح العصبي. الاستاذ الدكتور محمد توفيق الرخاوي. جمهورية مصر العربية - الطبعة الاولى 2000 م.2 - المعجم الطبي الموحد - انكليزي - عربي. رئيس التحرير د. محمود الجليلي - الطبعة الرابعه 2009 م , مطبعة المجمع العلمي العراقي.3 - الموجز المصور لفحص الجهاز العصبي. ترجمة د. عبد الهادي الخليلي - بغداد - 1992 م , د. موريس فان الن ود. روبرت روزنسكي. | Background : Type 2 diabetes mellitus is a widely spread health problem associated with countless micro - and macro - vascular complications leading to rise morbidity . Diabetic peripheral neuropathy (DPN) is the most common complication of type 2 diabetes mellitus and it may presents as distal symmetrical polyneuropathy in which the body involved in gloves and stock pattern. Hyperglycemia is the main causative factor for peripheral neuropathy in diabetic patients. Cranial neuropathies is usually presenting as mononeuropathies coexist with DPN either presented clinically or in subclinical form. The aim of this study is to detect cranial neuropathy in diabetic patients also to evaluate the role of blink reflex for early diagnosis of cranial neuropathy in diabetic patients with or without polyneuropathy. Materials and methods : The study was conducted from January till August 2014. Eighty three patients with type 2 diabetes mellitus within age group of 30 - 69 years were included in the study. Patients who had clinical features of peripheral nerve dysfunction and recognized with abnormal electrophysiological findings of their peripheral nerves were regarded as patients with DPN (61 patients), while those who did not have complains of peripheral nerve dysfunction and with normal electrophysiological study of their peripheral nerves were considered as patients without DPN (22 patients). The study also involved normal healthy persons whose age and gender are harmonized with that of our patients that were deliberated as control group (60 persons). The patients and the controls joined in the study had undergone full evaluation that included : clinical assessment (history and examination), biochemical assessment (measurement of fasting blood sugar, glycosylated haemoglobin, lipid profile) and electrophysiological assessment that included sensory and motor nerve conduction studies (NCS) with blink reflex.Results : The study found that diabetic patients had positive family history, low educational level and high BMI when compared with control. Diabetic patients with DPN had significant (P value <0.01) difference in age(they were older), highly significant (P value =0.007)difference in the duration of the disease(they had longer disease duration), and highly significance (P value < 0.01) difference in BMI(they were obese ) when compared with diabetic patients without DPN.Furthermore diabetic patients with DPN had poor glycemic control reflected by high FBS and HbA1c, while lipid profile picture showed insignificance difference. Nerve conduction study (sensory and motor) showed a significant difference between latency, amplitude, and conduction velocity between diabetic patients with DPN and those without DPN. The results of blink reflex showed highly significant (p value < 0.01) difference between diabetic patients and controls.Discussion : The results of this study showed that diabetic peripheral neuropathy associated with many factors like age, duration of the disease, BMI, and poor glycemic control.The study also revealed a high prevalence of DPN among the studied group (73.5%). Subclinical cranial neuropathies also present in the studied group which was reflected by abnormal blink reflex found in 44.6% of the patients. Most of the patients with abnormal blink reflex had diabetic peripheral neuropathy (89.2%).According to the results of this study, DPN increases the chance of having abnormal blink reflex five times more, which means prophecy of underlying subclinical craniopathy, since the odd ratio between DPN and abnormal blink reflex is 5.29

تاثير بعض معطلات الغدد الصم على بعض المعايير الفسلجية والتغيرات النسجية في ذكور الجرذان البالغة Rattus norvegicus == The Effect of Some Endocrine Disruptors On Some Physiological Parameters And Histological Changes In Adult Male Rats “ Rattus Norvegicus“

Author name: سارة جعفر سعدون الازيرجاوي
Supervisor name: جاسم محمد احمد الكلبي
General topic: Veterinary Medicine
Specific topic: Physiology
Degree: Master
Language: English
University location: Basrah
First pages:
Abstract: اجريت الدراسة الحالية في البيت الحيواني لكلية الطب البيطري / جامعة البصرة خلال الفترة الممتدة من 22/2/2013 الى 1/6/2013. لتقييم التاثيرات الصميه والتكاثرية لمعطلات الغدد الصم وايجاد الرابط بينهما في الذكور البالغة. استخدم في هذه الدراسة عقارين : بروبيل | The present study was carried out in the animal house of the College of Veterinary Medicine /University of Basrah during the period extending from 22/2/2013 to 1/6/2013. To evaluate the endocrine and the reproductive effects of endocrine disruptors chemicals and find the link between them in adult male rats. This study was done using two drugs : propylthiouracil (PTU) and flutamide (FLU) (anti - thyroid and anti - androgen agents) respectively, as a model of endocrine disruptors; to reveal their effects, they were used separately and in co - treatment manner for the first time using adult male rats (Rattus norvegicus) as animal models. For this purpose the study was divided into two experiments : The first experiment : forty adult male rats weighed (146 - 200) gm were divided into four equal groups (10 rats/group). The first group (control) was administered 0.3 ml/rat of distilled water, the second group was administered (PTU) (15mg/ kg B.W), the third group was administered (FLU) (37.5 mg/ kg B.W), and the fourth group was administered (PTU+ FLU) (15mg/kg + 37.5 mg/kg B.W ) respectively, in co - treatment dose. The treatments extended for 45 days; in the end of experiment the rats were euthanized and blood was collected and stored for hormonal and biochemical parameters and some of internal organs were weighed and kept in 10% formalin for histological examination. The results of the first experiment revealed the following : 1 - A significant decrease (P?0.05) in body weight gain in 2nd and 3rd periods (The animals were weighed four times in the begining of the experiment and every 15 days till the end of the experiment) in PTU and PTU+FLU treated groups.2 - A hypothyroidism state were induced after treatment with PTU and PTU+FLU by significant decrease (P?0.05) of Thyroxine (T4) and Triiodothyronine (T3) and significant increase (P?0.05) of TSH.3 - A significant decrease (P?0.05) in testosterone (T), Follicle Stimulating Hormone (FSH), and Luteinizing Hormone (LH) of PTU group while a significant increase (P?0.05) in T, FSH, and LH of FLU group. Moreover a significant decrease (P?0.05) in T and LH of PTU+FLU group occurred.4 - A significant increase (P?0.05) in Aspartate Aminotransferase (AST) and Alanine Aminotransferase (ALT) in all treatments, except in FLU no significant change has been observed in ALT. 5 - A significant increase (P?0.05) in total cholesterol, triglycerides, low density lipoprotein and very low density lipoprotein in all treatment, while, there was a significant decrease (P?0.05) in high density lipoprotein in all treatments as well.6 - A significant decrease (P?0.05) in serum glucose and a significant increase (P?0.05) in total protein in PTU and PTU+FLU groups, while, a significant decrease (P?0.05) in total protein of FLU group occurred.7 - A significant decrease (P?0.05) in sperm count of FLU and PTU+FLU groups. And a significant decrease (P?0.05) in individual motility in all treatments, while, a significant increase (P?0.05) in dead and abnormal sperm was observed in all treatments.8 - A significant increase (P?0.05) in thyroid relative weight of PTU and PTU+FLU groups and a significant increase (P?0.05) in liver relative weight in all treatments, while, a significant decrease (P?0.05) in kidney relative weight of PTU and PTU+FLU groups observed. Prostate relative weight significantly decrease (P?0.05) in FLU group and seminal vesicles relative weight significantly decrease (P?0.05) in FLU and PTU+FLU groups.9 - At the end of experiment six rats of each group was sacrificed and some of internal organs has been removed for histopathological examination and it was revealed changes as follows : 1 - Thyroid gland of PTU and PTU+FLU groups show increased number of different sizes of thyroid follicles with some vacuolation of colloid. Some follicles are misshaped. 2 - Testis of PTU group, most of seminiferous tubules are normal, a little number of them suffers from dilated lumen containing little number of spermatogonia and abnormal arrangement with degenerated Sertoli cells, little number of immature spermatid in the lumen, some vacuolation in the spermatogonia and edematous of interstitial tissue, FLU group shows clear degenerative changes in the Sertoli cells, there are few spermatogonia in some tubules and clear vacuolation in the cell with empty lumen (no spermatids). PTU+FLU group show most of the seminiferous tubules contain large number of spermatogonia but there are very thin irregular lining epitheliums, and nearly disappearance of interstitial tissue. 3 - Prostate of PTU group shows clear destructive changes in the lobules of the prostate. FLU group shows misshaped acini of the prostate lobules some of them are very enlarged and contain a large amount of secretion, others are empty with thickened irregular lining epithelium. Absence of inter acinar tissue, and PTU+FLU group show irregular shape of multiple number acini of the lobules of the prostate gland filled with shrinkage prostatic secretion. Moreover, the interstitial tissue between acini somewhat thickened with enlarged nuclei of many cells in addition to degeneration of others.4 - The liver of PTU group shows flattening of hepatocyte, clear enlargement of pyknotic nuclei and disarrangement of hepatic architecture, FLU show normal central vein, engorged with blood, disarrangement of hepatocyte architecture, and enlarged nuclei of hepatocyte. PTU+FLU show engorgement of central vein with clear flattening of hepatocyte containing enlarged nuclei.5 - The kidney of PTU group shows narrowing of lumen of renal tubules, engorgement of blood vessels, irregular sizes of glomeruli and different structure of their Bowman's capsule, FLU group shows a complete disappearance of Bowman's capsule of some glomeruli. Other glomeruli shows shrinkage and destructive changes of the content. The cuboidal epitheliums of the renal tubules shows some disarrangement of basement membrane with clear enlarged nuclei, and PTU+FLU group shows an irregular shape of renal tubules with absence of walls of the cuboidal lining epithelial cells with enlarged nuclei and shrinkage of Bowman's capsule of some glomerli. The second experiment : This experiment was carried out on 32 well experience female rats. They have been mated with 16 adult male rats which remained from the first experiment; they were divided into 4 groups : The first group : Untreated 8 female rats mated with 4 untreated male rats, the second group : Untreated 8 female rats mated with 4 treated male rats with PTU, the third group : Untreated 8 female rats mated with 4 treated male rats with FLU, the fourth group : Untreated 8 female rats mated with 4 cotreated male rats with PTU +FLU. The results of second experiment revealed a decrease in number of offspring as well as reduction in percentage of fertility and pregnancy rates.

تاثير التمنيع الميسر ضد وحدات الانهبين الفا وبيتا اي وبيتا بي في نمو وتطور الغدة اللبنية لاناث الجرذان == Effect of Passive Immunization Against Inhibin - ?, ?A, or ?B Subunits On Mammary Gland Growth And Development In Female Rats

Author name: منهل جبار عبد السعيدي
Supervisor name: جبار عباس احمد الساعدي | جاسم محمد احمد الكلبي
General topic: Veterinary Medicine
Specific topic: Physiology
Degree: Master
Language: English
University location: Basrah
First pages:
Abstract: هنالك علاقة وثيقة بين اعضاء عائلة عوامل نمو بيتا الانتقالية TGF - ? مع توجيه الاحداث المتعلقة بالتكاثر. اجريت الدراسة الحالية في قسم الفسلجة بكلية الطب البيطري في جامعة البصرة خلال المدة بين شهر نيسان، 2013 وكانون الثاني، 2014، لاختبار دور التمنيع ضد وحد | The present study, which has been carried out at the department of physiology, College of Veterinary Medicine, University of Basrah, during the peroid extended from April, 2013 to May, 2014, has been designed to examine the role of immunoneutralization of endogenous inhibin - ?, ?A, and ?B subunits on mammary gland growth and development in primiparous female Wister rats, by evaluating serum growth and differentiation hormones, expression levels of pituitary GH and PRL, and mammary GH - r and PRL - r genes, and immunohistochemical expression of pituitary somatotrophic and lactotrophic cells, and mammary GH and prolactin.Eighty four pregnant female rats were randomly divided into four groups (21 per each). On 5th and 10th day of gestation, control was injected with saline (100?l, i.p.), Ta group was injected with inhibin - ? antiserum (1µg in 100?l of saline, i.p.), Tba group, was injected with inhibin - ?A antiserum (1µg in 100?l of saline, i.p.), and Tbb group was injected with inhibin - ?B antiserum (1µg in 100?l of saline, i.p.). Each group was allocated to 3 equal subgroups : pregnancy, delivery, and lactation subgroups was sacrificed on the 16th day of gestation, on the 1st day after parturition, and the 11th day of lactation, respectively. Body weights of females have been monitored during pregnancy. At parturition and 11th day of lactation, litters weight have been recorded. At the end of each subgroups period, females were anesthetized, dissected and blood samples were obtained for assessment of inhibin - A, - B, activin - A , - B, - AB, GH, and prolactin levels. Pituitary and mammary glangs from each female were removed for evaluation of expression levels of GH, PRL, GH - r, and PRL - r genes using qRT - PCR technique and other samples for histophysiological and immunohistochemical study.The results demonstrate significant increase in cumulative dam weight in Tba group during pregnancy period starting from 8th of gestation compared with control, Ta, Tbb groups. Litters of Ta group at parturition, revealed siginificant higher weight compared with Tba group, and no siginificant difference compared with control and Tbb groups. Litter of Tba group recorded a highest siginificant weight gain among experimental groups.Serum inhibin - A in Tbb group during pregnancy, recorded higher level among experimental groups. During delivery, the higher significant level has been registered in control and Tbb groups. During lactation, no siginificant difference has been recorded between groups. In comparison between periods, the level in control during delivery showed the higher level compared with pregnancy and lactation periods, whereas Ta and Tba groups recorded no difference between periods, while Tbb group showed significantly higher level during pregnancy and decreased during delivery and lactation. Inhibin - B during pregnancy in control females recorded the highest level among the experimental groups. During delivery, higher levels have been recorded in control and Tba groups. At lactation, there is no siginificant difference between Ta, Tba, and Tbb groups but they were significantly higher than control. In comparison between periods, the concentration in control during pregnancy recorded higher level than other periods. Ta, Tba, and Tbb groups recorded no siginificant differences between pregnancy and delivery periods but they were significantly higher in lactation period.Activin - A concentration during pregnancy and delivery in Tbb was higher among experimental groups. During lactation, there is no difference between experimental groups. In comparison between periods, all groups showed higher levels at delivery. Activin - B during pregnancy and delivery in Tbb group recorded the lowest concentration. During lactation, no differences has been shown between groups. In comparison between periods, the levels in all groups was higher at lactation followed by pregnancy period and delivery periods. Activin - AB concentration in control and Ta groups were higher during pregnancy and delivery periods, while no siginificancy was recorded during lactation. In comparison between periods, all groups showed higher levels at lactation period followed by pregnancy and delivery periods.Serum GH in Ta group during pregnancy recorded higher level among groups During delivery, the higher level has been recorded in Ta and Tba groups. During lactation, the higher level has been recorded by Ta group among groups. In comparison between periods, the levels in all groups were higher at delivery followed by pregnancy and lactation. Serum prolactin during pregnant, delivery, and lactation showed no siginificant difference between experimental groups. In comparison between periods, the levels in all groups showed higher levels at delivery followed by lactation and pregnancy.Result of pituitary GH gene expression levels in Ta and Tba groups increased significantly compared with Tbb in all of studied periods.Result of pituitary PRL gene expression levels during pregnancy increased siginificantly in Tba group among experimental groups. During delivery, the fold changes in Ta and Tba groups showed no significant difference between each other, but they were significantly higher than Tbb group. At lactation period, there is no siginificant difference between groups.Result of mammary GH - r gene expression levels during pregnancy and delivery registered siginificant elevation in Ta, whereas lactation period showed no siginificant difference between groups. Mammary PRL - r gene expression levels during pregnancy was higher in Tbb group, whereas delivery and lactation showed siginificant elevation in Ta and Tba groups.Expression of pituitary somatotrophic cells during pregnancy showed significant higher score (number of positive stained cells and intensity of staining) in Ta group among the experimental groups. At delivery and lactation, scores of Ta and Tba groups, increased significantly. In comparison between periods, in all groups, higher score has been shown at delivery, whereas the lowest score recorded at lactation. Expression of pituitary lactotrophic cells during each periods showed no difference between groups. In comparison between periods, in all experimental groups, higher score of staining was recorded at delivery and lowest score recorded at pregnancy.Expression of mammary GH during pregnancy showed significant higher score in Ta group among the experimental groups. At delivery, the score of Ta group increased siginificantly. At lactation, Ta and Tbb groups registreted no siginificant difference between them, whereas they were siginificant higher than control and Tba groups. In comparison between periods, in all groups, higher scores have been shown at parturition and the lowest at lactation. Expression of mammary PRL during pregnancy and lactation revealed no siginificant difference between experimental groups. In comparison between periods, in all experimental groups, higher score of staining has been shown at delivery, whereas the lowest score recorded at pregnancy.Histological findings in treated groups, pituitary sections reveals progress in the morphological appearance of secretory cells which appeared larger and contains profuse cytoplasmic secretory granules. Ta females reveals more proliferation and cytoplasmic secretory granules. These differences continued at delivery and retarded at lactation. Mammary glands of treated groups at pregnancy showed marked development in alveolar morphogenesis. At delivery, Ta and Tbb females showed high number of lobules and alveoli. Lactation period showed well - developed vacuolated epithelial cells.In conclusion, passive immunization against inhibin - ?, ?A, subunits but not ?B subunit, at 5th and 10th day of pregnancy, have potent role in mammary gland growth and development in primiparous female Wister rats.

دراسة تاثير مستخلص الشاي الاخضر مقارنة بالانسولين على بعض الصفات الفسلجية والتعبير الجيني في الارانب المستحدثة تجريبيا بالسكري == Study The Effect of Green Tea Extract As Compared With Insulin On Some Physiological Parameters And Gene Expression In Experimentally Induced Diabetic Rabbits

Author name: ماهر مهدي صالح العارضي
Supervisor name: حيدر عبد الكاظم نغيش الزاملي
General topic: Veterinary Medicine
Specific topic: Physiology
Degree: Master
Language: English
University location: Qadisiyah
First pages:
Abstract: هدفت الدراسه الحاليه لتحديد التاثيرات المحتملة للمستخلص المائي للشاي الاخضر200 ملغم / كغم في اناث الارانب المستحدث فيها السكري تجريبيا. استخدام 35 انثى ارنب بالغة من النوع المحلي تراوحت اعمارها 6 - 10 اشهر معدل اوزانها 1 - 1،5 كغم. قسمت الى خمسة مجاميع مت | The present study aimed to determine the effect of aqueous extract of green tea (200 mg / kg B.W) in experimentally induced diabetic female rabbits.Thirty five female rabbits with arange age of 6 - 10 months and 1 - 1.5 kg weight were used.They are divided into five equal groups.The first group used as negative control (C),The diabetes melltitus (DM) was induced in T1,T2 and T3 by injection of single dose of alloxan 100 mg /kg B.W in marginal ear vein , The T1 assigned as positive control. The T2 treated with 200 mg / kg B.W of aqueous extract of green tea for 8 weeks.The T3 treated with 3 IU/ SC of insulin for 8 weeks while the T4 was given 200 mg / kg B.W of aqueous extract of green tea alone for 8 weeks. After 5 days of diabetes mellitus induction the blood samples were taken from the same vein, the rabbits which have blood glucose more than 200 mg / dl blood consider as diabetic. At the end of the experiment blood samples were taken by cardiac puncture and the blood serum was separated by Centrifuge to measure glucose , albumin, total protein ,liver enzymes and lipid profile and histological sections for pancrease,liver and kidney were done. the Real - time PCR was done to measure the gene expression of (Ins 1) and (Ins 2) which are responsible for insulin hormone production.the results were revealed that there is significant ( p <0.05) decrease in glucose,Low density lipoprotein,very Low density lipoprotein , Triglyceride , Total cholesterol , Alkaline phosphatase , Aspartate Transaminase and Alanine transaminase and significant increase (p <0.05) in Highy density lipoprotein , albumin and total protein in T2 group compared with T1, there is non significant differences in these parameters with T3 group , also there is significant decrease in ( p < 0.05) in Low density lipoprotein,Very Low density lipoprotein , Triglycerid , Total cholesterol and significant increase ( p < 0.05) in Highy density lipoprotein in T4 group compared with all groups. The gene expression results revealed that there is significant ( p < 0.05) increase in Ins 1 and Ins 2 gene expression in T2 compared with T1.The histological study of T1 was explain that there is severe congestion in pancrease with necrosis and absent of islets of langerhans while in the liver there is congestion with large thrombus in central vein with hepatic necrosis. In the kidney there is thrombus and congestion in renal tissue and destruction in renal tubules. While in T2 most damage caused by alloxan was disappeared through regeneration of cells of studied organs

قياس تركيز الحديد والفرتين والارثروبويتين وفيتامين ب وحامض الفولك والبيروكسايديز الدرقي في مصل مرضى تضخم الغدة الدرقية حديثي التشخيص في محافظة بابل == Serum Iron,Ferritin,Thyroid Peroxidase ,B12,Erythropoietin And Folate Concentrations In Patients With Newly Diagnosed Hyperthyroidism In Babylon Province

Author name: سالينا عبد العباس ناصر الشمري
Supervisor name: محمد عبيد المحمدي | علاء صادق العواد
General topic: Medicine
Specific topic: Physiology
Degree: Master
Language: English
University location: Babylon
First pages:
Abstract: فرط نشاط الغده الدرقيه : هو مرض يصيب الغده الدرقيه وذلك نظرا لارتفاع هرمون تي ثلاثه وتي اربعه وهما هرمونات الدرقيه ولوحظ ان هذا المرض يصيب النساء بنسبه اعلى من الرجال بسبب التاثير الهرموني للاناث مما يجعلها الاكثر عرضه لهذا المرض,من علامات هذا المرض هي زيا | Background : Hyperthyroidism is endocrine disease that occur due to high levels of thyroid gland hormones and this disease affected female more than male due to hormonal effect, the female is more susceptible to this disease.Sign of disease including increase in metabolic rate of patient,sweating,increase pulse,enlargement of thyroid gland(goiter) which by this sign can diagnosis the patient.Objective : Evaluate serum erythropoietin and its relation with increase metabolic rate as well as hemopoiesis,evaluate serum folic acid and vitamin B12 and its role in hyperthyroidism ,evaluate the correlation of thyroid peroxidase with thyroid hormones and evaluate serum iron and ferritin.Materials and methods : This study was done from October/2015 till July/2016.The total number of patients group in this study was seventy man and women.their age ranged 26 - 65 years,58 women and 12 men who was in patients group and 35 female and 5 male in control group.Patients data in this study was history of hypertension ,parity ,age and sex. The difficulty in my research was in collection of spa icemen from patients.Result : The result which obtained from this study found that high significant increase in ferritin,thyroid peroxidase,folate and erythropoietin (p?0.01) in patients as compare to control group.High significant decrease in iron and B12(p?0.01) in patients group compare to control group. in case of the age found the 30 - 39 years more effected age among patients group and the female more effected with disease than male.Conclusion : From this study we conclude that thehyperthyroidism in female more than male due to hormonal effect. Reduce in iron due to high metabolic rate lead to decrease absorption of iron and B12 which lead to anemia.increase thyroid peroxidase which play a role in T3 and T4 synthesis.

التغيرات الحاصلة في نسب الانسولين والاحماض الصفراء والكوليسترول 7 الفا هيدروكسليز وفوق الاكسيد الفائق في مصل مرضى حصى المراره == Serum Insulin, Bile Acid, Cholesterol 7 - Alpha Hydroxylase And Superoxide Dismutase Changes In Patients With Gallstone

Author name: سماح سجاد كاظم الشمري
Supervisor name: محمد عبيد المحمدي | علي خير الله الشاعلي
General topic: Medicine
Specific topic: Physiology
Degree: Master
Language: English
University location: Babylon
First pages:
Abstract: يعتبر مرض حصى المرارةمن اكثر امراض الجهاز الهضمي شيوعا، ووتشكل عبئا كبيرا على انظمة الرعاية الصحية. معظم الناس (حوالي 80 ?) مع حصى المرارة ليس لديهم اعراض. وتشمل مضاعفات حصى المرارة التهاب المرارة والبنكرياس.الهدف من الدراسة : 1 - للتحقيق في العلاقة بين | A gallstone is a stone formed within the gallbladder out of bile components. Cholelithiasis or Gallstone disease (GD) is one of the most prevalent gastrointestinal diseases, with a substantial burden to health care systems. Most people (about 80%) with gallstones are asymptomatic. Complications of gallstones include inflammation of the gallbladder, pancreas. Objective 1. To investigate the association between serum level bile acid and cholesterol 7 - alpha hydroxylase and the development of gallstone disease. 2. To Evaluate the change serum level insulin changes and its effect on gallstone formation. 3. The determination of serum superoxide dismutase changes in patients with gallstone. Material and Methods In this study, one hundred sixty (160) patients with gallstone aged (20 - 70) years and one hundred sixty (160) age and sex match subject (control group) had involved in this study. The patients were intended to undergo surgical removal of gallbladder in Al - Hilla general teaching hospital during the period from November (2015) to May (2016). Blood samples were obtained from all patients prior to surgical treatment. Serum was obtained by usual methods and analyzed for insulin, insulin resistance Cholesterol 7 - alpha hydroxylase, Superoxide Dismutase, Bile acid (Deoxycholic acid and Chenodeoxycholic acid) and lipid profile {total cholesterol, triglyceride, high density lipoprotein - cholesterol and low density lipoprotein cholesterol}. And qualitative analysis of gallstone (Cholesterol stone, mixed stone, pigment stone), then these parameters compared with those of control groups. In addition, a demographic comparison regarding to the age, sex and body mass index between the patients and control groups was carried. Results The results of this study show higher significant percentage of gall stone in female (81%) than male (19%) in the patient group. There was an insignificant difference between male and female patients, according to age group (P<0.05). There is a higher significant (p>0.05) family history in the patients with gallstone compared with control subjects. Additionally, There is highly significant percent of female using oral contraception in pateints than control group (p > 0.01). Similarly, smoking, parity,Type 2 diabetes mellitus and Body Mass Index are found to be significantly higher inpatient group (p>0.01). This study demonstrate that insulin and insulin resistance are significant higher in sera of patients with gallstone as compared with the control group. (p>0.01) Regarding the cholesterol 7 - alpha hydroxylase, superoxide dismutase and Bile acids are found to be significantlylower in sera of patients with gallstone as compared with the control group, p< 0.01). It has also found that there are a higher significant difference in gallstone patients than control regarding total cholesterol, triglyceride, high density lipoprotein - cholesterol and low density lipoprotein cholesterol levels were significantly higher than that of control group (p>0.01). Meanwhile, all these parameters in the study are variated according to gender. However The qualitative analysis of stone that show cholesterol stone is more common than other types.Conclusions In this study the most studied parameters including of Insulin and insulin resistance, cholesterol 7 - alpha hydroxylase, superoxide dismutase and Bile acids, cholesterol, triglyceride, high density lipoprotein - cholesterol and low density lipoprotein cholesterol are significantly different in gallstone patients compared to control subjects and such differences are demographically affected depending on the age, sex, BMI, parity, contraceptive and smoking.

التقييم الفسلجي للاعتلال العصبي الذاتي لمرضى داء السكري

Author name: نسرين قادر كامل
Supervisor name: محمد شريف عبد الله | موسى محمود مربط
General topic: Medicine
Specific topic: Physiology
Degree: Master
Language: English
University location: Baghdad
Key words:
  • Autouomic neuropaty
  • diabetics mellitus
  • heart rate
  • blood pressure
  • E C G
  • cardiovascular reflex
First pages:
Abstract: (Diabetes Mellitus) D.M : - is the most common endocrine disease, characterized by abnormalities of glucose, protein and lipid metabolism. Diabetic neuropathy is one of the long term chronic complications, which contributes to increase the morbidity & mortality rate in diabetes. One of the earliest manifestations of diabetic autonomic neuropathy is denervation of the cardiovascular system, assessment of cardiovascular reflexes affords a satisfactory evaluation. Along duration time.A battery of bedside clinical tests was used to assess the autonomic function of the heart. This is the response of blood pressure to sustained handgrip and standing - up. The R - R interval change and Q - T interval change in the E, C G in response to standing - up, deep breathing and valsalva maneuver. Number of the patients was 40 diabetic subject and 22 age and sex matched healthy controls. Insulin dependent diabetes Mellitus (IDDM) was 25(62.50%) of cases, non insulin dependent Diabetes Mellitus (NIDDM) was 15(37.5%) of cases, autonomic neuropathy was detected in 23 patients (57.5%), Orthostatic hypertension in 19 cases (47.5 %), abnormal blood pressure response to sustained hand grip in 20 (50%), abnormal valsalva ratio in 10 (25%), abnormal heart rate response to deep breathing in 11 cases (27.2%).Among the 13 patients with cardiac diabetic autonomic neuropathy, had a Q - Tc interval of > 440 ms ( p < 0.05 ). Compared to the remaining 4 patients had normal Q - Tc interval of 399.5 ± 37.49ms.Cardiovascular tests for cardiac autonomic neuropathy showed increase prevalence with increase in the duration of Diabetes Mellitus above 15 years.This study showed that diabetics had significantly impaired cardio - autonomic reflexes compared to non diabetics. Also, other group of diabetics who have apparently normal cardio - autonomic reflexes were found to have significantly different values compared to the control group, (heart rate variations with deep breathing and valsalva maneuver had a negative correlation with age)

نمط اصابات الاعصاب المحيطية بين الجنود العراقيين في الحرب باستعمال فحص تخطيط الاعصاب والعضلات == The Pattern Of Peripheral Nerve Injuries In The War Among Iraqi Soldiers By Using Electromyography

Author name: قيصر عبد الرزاق عطيه
Supervisor name: صفاء حسين علي
General topic: Medicine
Specific topic: Physiology
Degree: Master
Language: English
University location: Baghdad
First pages:

تقييم المؤشرات السريرية وبعض الدلائل الحيوية في مرض دواعم الاسنان == Evaluation Of Clinical Parameters And Some Biomarkers In Periodontal Disease

Author name: امل عليوي حسن
Supervisor name: سعد مرزة حسين الاعرجي | وسام وهاب الحمادي
General topic: Medicine
Specific topic: Physiology
Degree: Master
Language: English
University location: Babylon
First pages:
Abstract: امراض دواعم الاسنان هي مجموعة من امراض الالتهابات التي تصيب التجويف الفموي وتعرض الهياكل الداعمة للاسنان للخطر. تحدث هذه الامراض بسبب عدم التوازن بين الجراثيم المحيطة بالاسنان واستجابة المضيف. يعتبر مرض التهاب اللثة ومرض النساغ المزمن هي من الاقسام الرئيس | Periodontal diseases are a group of inflammatory diseases that affect the oral cavity and jeopardize the supporting structures of teeth. They are caused by an imbalance between periodontal pathogens and host responses. Gingivitis and chronic periodontitis are the major categories of these diseases. The study sample consisted of 80 individual of both genders, their age ranged from 30 to 50 years, and they are divided into three main groups according to the clinical periodontal parameters (plaque index, gingival index, bleeding on probing index, probing pocket depth index and clinical attachment level index). Group ? comprised from 24 (15 female and 9 male) healthy gingival volunteers as a control, group ?? comprised from of 29 (12 female and 17 male) patients with gingivitis, lastly group ??? comprised from 27 (11 female and 16 male) patients with chronic periodontitis. Unstimulated whole saliva samples are collected to determine the levels of Prostaglandin E2, Matrix Metalloprotinase - 8 and Alkaline Phosphatase. Clinical periodontal parameters are recorded at four sites per tooth. The results of present study revealed a highly significant difference (P - value < 0.01) in the mean ± SD for all of clinical periodontal parameters and for the levels of salivary biomarkers (Prostaglandin E2, Matrix Metalloproteinasee - 8 and Alkaline Phosphatase) among chronic periodontitis, gingivitis and control groups. The chronic periodontitis group revealed the higher mean value followed by the gingivitis group and the control group presented the least value. Regarding the correlation between the salivary biomarkers levels and clinical periodontal parameters, the present study showed a significant positive correlation (P< 0.05) and a highly significant positive correlation (P - value < 0.01) between each of salivary biomarker levels and all of clinical periodontal parameters. In addition, this study showed a highly significant positive correlation (P - value < 0.01) between Prostaglandin E2 and Matrix Metalloproteinasee - 8 and a significant positive correlation (P< 0.05) between Prostaglandin E2 and Alkaline Phosphatase and between Matrix Metalloproteinasee - 8 and Alkaline Phosphatase for gingivitis and chronic periodontitis groups. The present study re - emphasized the importance of whole saliva as sampling method in relations of immunological purposes in gingivitis and chronic periodontitis and proposed that the elevated levels of Prostaglandin E2, Matrix Metalloproteinasee - 8 and Alkaline Phosphatase may be one of the host - response mechanisms connect with the clinical appearances of periodontal diseases. Salivary Prostaglandin E2, Matrix Metalloproteinasee - 8 and Alkaline Phosphatase levels may reflected the severity of disease, thus help in the early detection of the disease.

تاثير احمرار الدم الثانوي الدم على وظيفة بطانة الاوعية الدموية الجهازية في محافظة بابل == Effect Of Secondary Polycythemia On Systemic Endothelial Function In Babylon Province

Author name: احمد محي الدين سهراب
Supervisor name: غافل صيهود حسن الشجيري | عامر صاحب المؤمن
General topic: Medicine
Specific topic: Physiology
Degree: Master
Language: English
University location: Babylon
First pages:
Abstract: تغير قطر الشريان العضدي كاستجابة الى الاحتقان , يستعمل بصورة واسعة لتقيم وظيفة بطانة الاوعية الدموية الجهازية بواسطة تسجيل التغير كاستجابة للاحتقان. ضعف او قلة التوسع يلاحظ بصورة واضحة لدى المرضى المصابون باحمرار الدم الثانوي.التوسع المحدث بالمد يقاس كن | Brachial artery diameter variations in response to hyperemia were widely used for the assess endothelial function by recording variations in response to hyperemia. Vasodilation was markedly impaired in polycythemic patients.Flow mediated dilatation (FMD) was measured as the percentage increase in brachial artery diameter at diastole after 5 minute of ischemia.Objectives : Material and MethodsThe present study was conducted at Echo - Doppler department in Marjan medical city / Hilla , in cooperation with the department of physiology of College of medicine / University of Babylon, from November 2015 to April 2016. A history, physical examination, blood pressure, and laboratory were performed on all subjects (patients with secondary polycythemia, and control groups). Seventy subjects were included in the present study. Their ages was ranged between 40 - 60 years. They were divided into two groups. Group 1 : Included 30 healthy subjects without polycythemia, all men, their mean age was 47.20 ± 7.3 years and they served as control group.Group 2 : Included 40 patients, all men, with secondary polycythemia, their mean age 46.90 ± 7.3 years.Method : Measurement of flow - mediated and nitroglycerin - induced dilatation of the brachial artery.Measuring blood pressure, auscultatory method.Assessment of BMI.Laboratory analyses : Serum urea test.Serum creatinin test.White blood cells (WBCs) count : Platelets count.Estimation of packed cell volume (PCV %).Red blood cells (RBCs) count. Hb. level test.Cholesterol test.Triglyceride test.Urea test.Creatinine test.Results : The mean flow mediated dilatation (FMD) on two groups was significantly (p value < 0.01) decreased (16%) in patients group (8%) comparison to control group (24%). The mean Hb concentration was significantly (P value < 0.01) increased in patients group compared to control group.The mean packed cell volume (PCV) was significantly (P vale < 0.01) increased in patients group compared to control group.The mean FMD was found to be significantly (16%) decreased in smoker patients group (8%) compared to nonsmoker control group (24 %).The mean red blood cells count was significantly (P value < 0.01) increased in patients group compared to control group.It was found that triglyceride level significantly increased (P value < 0.01) in patients group compared to control group.There was negative correlation between triglyceride and FMD in patients group. Their are No correlation between age and FMD in patients group.The mean serum cholesterol level was not significantly ( p value < 0.07) increased in patients group compared to control group , while serum triglyceride level, serum creatinin, serum urea were significantly ( p value < 0.01) increased respect in patients comparison to control. Mean glucose, Platelets and red blood cells counts were significantly (P value < 0.01) increased in patients group (polycythemic group) respectively compare to control group respectively.Mean body mass index (BMI) and packed cell volume (PCV) were significant (P value < 0.01) increased respectively in patients group compared to control group. Ages of patients group was non - significantly (P value = 0.89) decreased (46.90 ± 7.00 years) in patients group compare to control group.Conclusions : 1 - The mean flow mediated dilatation (FMD) was significantly decreased (16%) in patients group compared to control group. 2 - The mean Hb concentration , mean packed cell volume (PCV) , red blood cells count, platelets , and body mass index count was significantly increased in patients group compared to control group.3 - Polycythemia as with endothelial dysfunctions that may perform in diagnosis of arterial disease. That used to estimate whereas endothelial dysfunctions result from problem in the cardiovascular system with problem in the prothrombin time.4 - Polycythemia can result in raises causes of thrombosis.Through increase platelet dysfunctions, increase ; white blood cell counts, Hb count, homocystein and cholesterol level as with endothelial dysfunctions.

تاثير معايير النطف ونضوج مادة الصبغين على نتائج عملية الحقن المجهري == Impact of Sperm Parameters And Sperm Chromatin Maturity On Intracytoplasmic Sperm Injection Outcome

Author name: هند عبد الكاظم
Supervisor name: يحيى كاظم السلطاني
General topic: Medicine
Specific topic: Physiology
Degree: Doctorate
Language: English
University location: Najaf
First pages:
Abstract: يعتبر العقم من المشاكل المتعلقة بصحة الانسان ويؤثرعلى سدس الازواج في عمر الانجاب تقريبا. يعد الذكر مسؤلا عن خمسين بالمئه من مجموع الحالات.الوظيفه الرئيسيه لتقنيات الانجاب المعان هي علاج العقم بما فيها حالات العقم الذكري وزيادة فرص الحمل من خلال التغلب عل | Infertility is a health concern affecting nearly 17% of young couples in their reproductive age. Male factor infertility accounts for 50% of all cases. The key responsibility of assisted reproductive technologies (ART) is the management of male infertility by bypassing seminal fluid disorders. Defective Sperm parameters were responsible for deciding the fertility potential and related to pregnancy rate in vivo as well as in vitro.Today, the classic seminal fluid analysis is found to be of limited importance in describing a couple’s fertility status. There is now clinical evidence to show that damage to human sperm DNA may adversely affect reproductive outcomes and the spermatozoa of infertile men possess substantially more DNA damage than do spermatozoa of fertile men and there appears to be a threshold of sperm DNA damage beyond which embryo development and pregnancy are impaired.In view of that, the aims of the present study were : Evaluation of the influence of defective sperm parameters including concentration, morphology and motility on intracytoplasmic sperm injection (ICSI) outcome represented by fertilization rate, cleavage rate, embryo quality and pregnancy rate. Assessment of the sperm chromatin maturity in infertile men using acidic aniline blue stain and compare it with that of men with normal spermiogram. Discovering the relationship between sperm chromatin status and the semen parameters in infertile males. Finding the relationship between sperm chromatin status and ICSI outcome.This study included 60 infertile couples complaining from either primary or secondary infertility attended the clinics of infertility treatment center and underwent intracytoplasmic sperm injection.They were classified according to their spermiogram to normozoospermic group (N), whose female partner had bilateral tubal block, oligoasthenoteratozoospermic group (OAT) and finally, asthenoteratozoospermic group (AT). The female partners of the last two groups had normal reproductive function according to gynecological examination and laboratory investigations. All female partners included in this study were less than 35 years old to minimize the influence of advanced maternal age on ICSI outcome. Seminal fluid analysis were done for all and aniline blue stain was used in this study to evaluate sperm chromatin integrity. The main results of this study showed that infertile couples with impaired sperm parameters show high percentage of positive aniline blue stain i.e., sperm chromatin maturity defect and it is significantly higher than that in couples with normal spermiogram. The best cut off point of positive chromatin percentage associated with pregnancy was 40% i.e., when sperm chromatin abnormality exceeds 40% as detected by aniline blue staining method; the pregnancy rate start to regress. No significant differences in fertilization rate, cleavage rate, embryo quality and pregnancy rate were found among studied groups.No significant difference in ICSI outcome including pregnancy rate between couples with high percentage of sperm chromatin damage ?30% and those with low percentage of sperm chromatin damage < 30% were found. So the main conclusions are : Defective sperm parameters and chromatin immaturity are significantly associated with each other.Forty percent is the threshold of sperm chromatin immaturity after which ICSI outcome deteriorate and depending 30% as a threshold in this study revealed no significant difference in ICSI outcome among studied groups. Intracytoplasmic sperm injection has corrective and therapeutic role for defective sperm parameters and shows a unique capability to treat the most difficult cases of male infertility.

تقييم جهاز كتلة غاز الزفير كوسيلة لفحص وظائف الرئتين عند العراقيين الاصحاء == Evaluation of Expiratory Gas Mass Device As A Measure of Lung Function Test In Healthy Iraqi Subjects

Author name: نبراس حسين عبد الساده الحسناوي
Supervisor name: يسار محمد حسن الشماع | باسم متعب هادي زوين
General topic: Medicine
Specific topic: Physiology
Degree: Master
Language: English
University location: Najaf
First pages:
Abstract: تعد فحوصات وظائف الرئتين من الوسائل المفيدة جدا لاغراض التشخيص والمتابعة والبحث العلمي للاصحاء ومرضى الجهاز التنفسي. وابسط تلك الفحوصات واكثرها معلومة هو الفحص السبايرومتري الذي يتضمن قياس السعة الحيوية القسرية (FVC) , وحجم الزفير القسري في الثانية الا | Lung function tests are very useful diagnostic, follow up and research measures for healthy and respiratory compromised subjects. The simplest, yet the most informative, lung function tests are the spirometric tests.They involve the forced vital capacity (FVC), the forced expiratory volume in first second (FEV1) and the forced expiratory volume ratio (FEV%). Several types of devices are used to perform spirometric tests based on the measurement of lung volumes and their subdivisions. Lung volumes, hence, are represented by the volume of expired air. There was a controversy about the difference between body and ambient temperatures which may extremely affect gas volume , but this is thought to be solved by temperature correction. Temperature correction, however, may not be the precise solution in extremely fluctuating environmental temperatures. A fixed amount of expired gas has a constant mass despite the changes in pressure or volume as is implied by the law of conservation of mass in a closed system by Antoine Lavoisier. The aim of this study is to construct and evaluate a simple device called expiratory gas mass device as a reliable, reproducible, accurate and convenient tool to substitute Vitalograph spirometer as a measure of lung function in healthy Iraqi subjects and testing the hypothesis that expired gas mass could significantly and acceptably alternate or conjugate its volume as measures of lung function. The design of the study is a cross sectional study. The statistically required number of participants was decided by a professional statistician to be 70 healthy subjects. However, 300 healthy subjects are included in the present research to cover the need for subgrouping (146 male and 154 female) aged 20 - 50 years (31.84 ± 9.28 years). The male and female were classified into three age groups for each one, ten years interval was considered to be suitable for classifying subjects.Subjects with abnormal lung function such as smokers were excluded. A uniform case sheet was assigned for every participant in the study which includes, name, gender, age, weight, height, smoking habits, residence, cultural status, socioeconomic status, present and past medical history, family history of respiratory illnesses. They were asked to perform the forced expiratory maneuver through the standardized spirometer and then through the newly constructed gas mass device.The accuracy (systematic error) and reproducibility (random error) were tested for the constructed gas mass device.A comparison between forced vital capacity (FVC) and adjusted gas mass (AGM) was made on two main groups , the male group and female group, both of them were subdivided to three age groups.The results revealed that there were no significant differences in values of FVC and AGM measured by standard Vitalograph spirometer and gas mass device respectively. Regression lines indicated that there were strong positive correlations between gas mass (GM) and FVC in male and female. Separate data for male and female are processed and the results indicated that FVC values and GM (or AGM) values are significantly higher in male than in female , P?0.05. Regression lines indicated that there was a negative correlation between age and both of FVC and GM, a positive correlation between height and both of FVC and GM and a weak positive correlation between weight and both of FVC and GM. From the present study, it can concluded that gas mass device is simple, portable and easily handled device. It is also reproducible and accurate device for the measurement of GM in normal subjects.

تاثير العلاج بعقار الميثوتركسيت على عامل النمو البطاني الوعائي، والعوامل الدموية ومضادات الاكسدة في الصدفية == Effects of Methotrexate Therapy On Vascular Endothelial Growth Factor, Hematological And Antioxidants Parameters In Psoriasis

Author name: شكرية حاتم علوان
Supervisor name: محمد عبيد المحمدي | محمد كاظم الحطاب
General topic: Medicine
Specific topic: Physiology
Degree: Master
Language: English
University location: Babylon
First pages:
Abstract: مبدا الدراسة : الصدفية مرض جلدي شائع ذو علامات جلدية ظاهرة، يتميز بالتهاب مزمن للجلد مع اختلاف في نضوج الخلايا الكيراتينية، التي تزيد من سمك الجلد. عملية تكوين الاوعية الدموية (Angiogenesis) هي المسؤول بالدرجة الاساس عن تطور افة الصدفية، واحد اهم عوامل تكو | Background : Psoriasis is a common skin disease with extra - cutaneous manifestations. It characterized by chronic inflammation of the skin with changes in the maturation of keratinocytes, which manifested by the hyperproliferation of the epidermis. Angiogenesis process is a central regulator of development psoriasis lesion and one of the important angiogenesis factor is vascular endothelial growth factor (VEGF).A major site of oxidative stress occurs in the skin due to reactive oxygen species, which play an important role in inflammatory skin diseases such as psoriasis. Objectives : The aim of this presented study is to evaluating the effect of MTX drug on psoriatic lesions by calculating psoriasis area and severity index (PASI) for three months. In addition, investigate the changes of the level of serum VEGF, antioxidants (GSH and SOD) and lipid profile, which include (TC, TG, HDL, LDL and VLDL). As well as, hematological assessment such as (RBCs, Hb, PCV, RBCs indices, ESR and WBCs) in patients with psoriasis before and after (one and three months) from treatment with oral methotrexate therapy in comparison to their levels in healthy control persons. Materials and Methods : This study was a cohort study in which a total of 80 subjects, half of them(40) with psoriasis (25 male and 15 female) had selected randomly from Marjan Medical City in AL - Hilla city and the other half (40)as healthy controls (21 male and 19 female). These subjects collected during the period from 28th/ October /2014 until 15th/ August/ 2015. Physical examination (body mass index) done to each subject that enrolled in the study. A clinical assessment of psoriasis disease activity in psoriasis patients and methotrexate efficacy was done with the Disease Activity Index (DAI) represented by PASI score. Blood collection was obtained from all psoriatic patients and control to use in determine the level of all biochemical parameter such as VEGF, GSH SOD and lipid profile , as well as hematological investigation which include RBCs, Hb, PCV, RBCs indices, ESR and WBCs. Result : The results of this work showed, The effect of systemic methotrexate therapy on psoriasis lesion by significant reduction of PASI levels after treatment and by a significant mean difference in psoriasis area severity index before and after (one and three months) from treatment in psoriatic lesions (P?0.05). Also, no significant differences (p> 0.05) between the mean of age for psoriatic patients group (male and female) and healthy control group (males and females). The body mass index shows significant increase (P?0.05) in psoriasis patients than control group. The serum of VEGF level was significant increase in patients with psoriasis when compare with control through study periods, and there was significant reduction in the level of VEGF in psoriasis patients as compared its level before and after treatment with MTX for one and three months (P?0.05). While, the level of GSH and SOD significant decrease in patients than control ,during the treatment with MTX ,there was significant difference increase in the level of GSH of patients as compare with baseline level (before treatment) (P?0.05). In addition, the level of SOD of patients appear there was no statically difference before treatment and after treatment with MTX. The results of the present study also show a significant increase (P?0.05) in total cholesterol(TC), triglycerides(TG), low density lipoprotein - cholesterol (LDL) and very low density lipoprotein - cholesterol(VLDL) concentration, while found a significant decrease (P?0.05) in level of HDL in serum of psoriasis group compared with those of the healthy control group. When compare between patients during follow up periods, found there was no significant different of level of TC, TG, LDL and VLDL between psoriasis patients in period before treatment when compared with after one months from treatment with MTX (P>0.05). While there is a significant increase between patients before treatment compare with after three months, and after one month from treatment compare with after three months from treatment with MTX (P? 0.05). The level of HDL in psoriatic patients was significant increase at (P? 0.05) before treatment as comparing with after (one month and three months) from treatment with MTX, but there is no significant difference between patients after one from treatment as compared to with after three month from treatment with methotrexate (P> 0.05). The result of hematological for the results of study showed , there is a significant decrease (P? 0.05) in RBCs counts, Hb, PCV and RBCs indices compared with healthy control. While significant increase in total WBCs counts and ESR in psoriatic patients in all periods of follow up periods as compare with control. When compare the RBCs, Hb, PCV, RBCs indices of patients in all periods before and after (one and three months) from treatment with MTX, found there is no significant difference among them at (P> 0.05). While the result of WBCs count show significant decrease (P?0.05) between patient before treatment and after three months from treatment with MTX , and between after one month from treatment with MTX as compare with after three month from treatment , but there is no significant difference between before treatment compare to after one month from treated with MTX. The results of ESR of psoriasis patient show significant decrease (P? 0.05) between before treatment as compare with after three months from treatment with MTX , and after one month from treatment compare to after three month from treatment.While there is no any significant difference between patient before treatment compare with after one month from treatment with methotrexate (P>0.05). Conclusion : The vascular endothelial growth factor have play important role in the evaluation of psoriasis severity, oral methotrexate therapy have efficacy upon serum levels of vascular endothelial growth factor. Efficacy of oral methotrexate therapy on psoriatic patient’s treatment, have there was faster remission of psoriatic lesions and this reflect the immune - modulatory anti - inflammatory role of The MTX in psoriasis patient.

دور تخطيط العضلات احادي الليف على مرضى اعتلال الاعصاب المحيطية السكري وعلاقته بمؤشرات الاكسدة == The Role of Single Fiber Electromyography In Patients With Diabetic Neuropathy And Its Relation To Oxidative Stress Parameters

Author name: زاهد محمد علي كاظم
Supervisor name: احسان محمد عبود عجينة
General topic: Medicine
Specific topic: Physiology
Degree: Doctorate
Language: English
University location: Najaf
First pages:
Abstract: الخلفية : يعتبر اعتلال الاعصاب المحيطية السكري من اكثر مضاعفات داء السكري شيوعا التي تؤثر على الاوعية الدموية الدقيقة. سريريا يؤثر المرض اولا على الاطراف القصيه مؤديا الى فقدان الاحساس في تلك الاطراف على نمط الجورب والقفاز. يؤثر المرض على كل من الالياف ال | Background : diabetic peripheral neuropathy (DPN) is the most common microvascular complication of diabetes mellitus (DM). Clinically, it affects the most distal extremities first resulting in a stock and glove pattern of sensory loss. It affects both small fibers (myelinated and un - myelinated) as well as the large myelinated nerve fibers. However, the earliest manifestations might be due to small fiber dysfunction. Hyperglycaemia and subsequent metabolic derangement is the main pathogenitic factor of DPN. However, oxidative stress, deficiency of neuroprotective factors and neurovascular insufficiency might play a role.AIMS : This study aims to : 1. Test the value of applying SFEMG in the diagnosis of diabetic peripheral neuropathy. 2. Determine the usefulness of SFEMG, compared to the standard NCS, in the early diagnosis of diabetic peripheral neuropathy. 3. Evaluate the correlation of the antioxidant/oxidant status in patients with and without diabetic peripheral neuropathy.Materials and methods : The study was conducted in the period from Nov. 2012 till Apr. 2014 and included 188 patients with type 2 DM that fall within age group of 45 - 65 years. Diabetics that suffer from clinical features of peripheral nerve dysfunction documented with abnormal electrophysiological findings were considered as patients with DPN (138 patients) and those who had no complaint of peripheral nerve dysfunction with normal electrophysiological study were considered as patients without DPN (50 patients). The study also included normal healthy persons who their age and gender matched that patients and considered as control subjects (50 persons). The patients and control enrolled in the study had undergone comprehensive assessment that included : clinical assessment (history and full examination), biochemical assessment (measurement of fasting blood sugar, glycated haemoglobin, total antioxidant capacity and advanced glycation end products) and electrophysiological assessment that included sensory and motor nerve conduction studies (NCS) with single fiber electromyography (SFEMG).Results : The study found that patients with DPN in comparison to patients without DPN and control subjects are older (p?0.05), had longer duration of DM (p?0.01), poorer glycemic control reflected by fasting blood sugar (p?0.01) and glycated haemoglobin (p?0.01), lower level of total antioxidant capacity (p?0.01) and higher advanced glycation end products level (p?0.01). Also, the study showed that the level of total antioxidant capacity and advanced glycation end products on one hand were correlated with the duration of the diabetes (p?0.01) and not correlated with glycated haemoglobin level on the other hand.The electrophysiological findings showed that patients with DPN had significant differences in NCS parameters when compared to patients without DPN and to control subjects in the form of axonal degeneration and demyelination with abnormal single fiber jitter and fiber density which were correlated with the duration of diabetes (p?0.01) but not correlated with glycemic control. Also the study demonstrated that SFEMG findings were correlated with NCS parameters (namely sural nerve) in patients with DPN. This study had concluded that the duration of diabetes, age, glycemic control and oxidative stress are important risk factors of DPN. Routine NCS is important mean for diagnosing DPN but it has limited sensitivity in the diagnosis of early stages of the disease and in assessing nerve degeneration and regeneration. Sensory nerves of lower limbs are helpful in discovering early stages of DPN when other tested nerves are normal. SFEMG examination in diabetic patients is important in showing the degree of re - innervation and nerve regeneration and in identification of subclinical nerve dysfunction.

دراسة العلاقة النسبية بين جريان الدم المخي - المشيمي والرحمي - المشيمي بالدوبلر للنساء الحوامل المصابات بداء السكري == A Study of Cerebro - Placental And Utero - Placental Ratio Doppler Velocimetry In Diabetic Pregnant Women

Author name: رياض وحيد العيساوي
Supervisor name: عقيل عبد المنعم حسن زوين
General topic: Medicine
Specific topic: Physiology
Degree: Doctorate
Language: English
University location: Najaf
First pages:
Abstract: يعتبر داء السكري المصاحب للحمل هو احد مضاعفات الحمل الاكثر شيوعا والتي ترتبط بمعدلات هامة من الاعتلال والوفاة ما حول الولادة , ان العلاج الفعال لداء السكري ما قبل الحمل ولداء السكر المصاحب للحمل قد تبين تحسين النتائج والحد من وفيات ما حول الولادة بالمقارن | Diabetes mellitus complicating pregnancy is one of the most common antenatal complications that are associated with significant perinatal mortality and morbidity(Magee et al., 1993, Schmidt et al., 2001and Platt et al., 2002). Effective treatment of pre - existing as well as gestational diabetes mellitus was shown to improve outcome and reduce perinatal mortality, as compared to untreated patients (Lao TT, et al., 2001and Langer , et al., 2005). Doppler studies have conventionally been utilized for fetal surveillance. The use maternal uterine artery Doppler as a screening tool to predict subsequent development of pre - eclampsia and fetal growth restriction in later gestation have gained acceptance in recent years. Umbilical artery Doppler, middle cerebral artery Doppler have been widely used for the assessment of growth restricted fetuses. The role of Doppler study in diabetic pregnancies has not been unequivocally evaluated. An atherogenic factor, that promotes vascular endothelial growth, insulin - like growth factor - 1 has been implicated with micro vascular complication during pregnancy (Kathryn 2000). Presently, short - term beneficial metabolic effects of recombinant human insulin - like growth nfactor - 1 (rhIGF) - 1 therapy have been demonstrated in numerous diabetic conditions, including type 1 diabetes mellitus, type 2 diabetes mellitus. Until recently, insulin - like growth factor - 1, based upon its endothelial growth promotion, was considered a mediator of vascular disease( Bayes - genis et al., 2001a; 2001b). Conversely, increasing evidence indicate the protective mechanism of insulin - like growth factor - 1 against vascular derangements, relating to its ability of nitric oxide production (Okura et al., 2001). We sought to investigate the impact of insulin - like growth factor - 1 levels on maternal/fetal blood flow in diabetic non - hypertensive pregnant women; an avenue of research that has yet to be fully explored. Taken together, this information will materialize the intervention needed to prevent or at least ameliorate diabetes maternal and fetal outcomes. OBJECTIVES1 - To evaluate effect of diabetes mellitus on utero - and cerebro - placental Doppler velocimetry in pregnant women, such as resistive index (RI), pulsatility index (PI), Systolic/diastolic ratio (S/D)2 - To find whether a meaningful correlation exists between the above mentioned parameters and the levels of HBA1c and maternal IGF - 1.3 - To predict the most sensitive parameter detecting complications of diabetes mellitus on fetal outcomes. MATERIAL AND METHOD In this prospective cohort study a total of 190 pregnant women with single viable fetus, cephalic presentation, were enrolled after having their verbal and written consent and approval of the ethical committee at Faculty of Medicine. They were divided into two Groups : group (Ia) women with gestational diabetes mellitus (n=70), group ( Ib ) women with pre - gestational diabetes mellitus (n=64) and the remaining (n=56) participants (group II) were free from diabetes and hypertension and served as a control group. The study performed at Al Ameer Diagnostic Center in Al Najaf, between March, 2013 and August, 2014.Examination of the participants done twice, in the second and third trimesters. In each time, history and clinical examinations performed with Doppler ultrasonography of the pregnant women including interrogations of bilateral maternal uterine arteries, fetal umbilical and middle cerebral arteries in addition to measurement of IGF - 1 and HbA1c concentrations. RESULTS AND CONCLUSIONS 1 - IGF - 1 mean± SD in second trimester was 582.61± 183.7 ng/ml in group Ia, 429.5± 231.3 ng/ml in group 1b and 278.6 ± 60.8 ng/ml in the group II with significant difference among the groups (P=0.0001) In the third trimester the mean± SD was 653.69 ±197.6 ng/ml in group Ia, 487.5± 242.4 ng/ml in group Ib and 316.6 ± 60.9 ng/ml in group II with significant difference among the groups (P=0.0001).2 - HbA1c mean± SD in second trimester was 6.59± 0.89 % in group Ia, 6.42 ± 0.9% in group Ib and 5.35 ± 0.56 % in group II with significant difference between group Ia and group II, as well as between Ib and group II, but no significant difference between Ia and Ib groups.Third trimester HbA1c mean value was 6.29 ± 0.78 % in group Ia , in group Ib 6.27 ± 0.87 % and 5.08 ± 0.57% in group II.There was no significant difference between group Ia and Ib (P=0.843) , while there was a significant difference between group Ia and group II as well as between group Ib and group II(P=0.0001).3 - Uterine artery Doppler velocimetry was considered more sensitive predictor than other arteries in evaluation of fetal outcomes and its sensitivity in the total studied population (190) was 44.3%, in gestational diabetic pregnancy group was 58.3%, in pregestational diabetic pregnancy 34.3% and in control was 29.4%.4 - Multiple maternal and fetal arterial Doppler studies at same time yield high predictive values in evaluation of fetal outcomes with general sensitivity in the total studied population was 63.6%, specificity 79.4%79, PPV 72.2% and NPV 71.7%. In gestational diabetic pregnancy the sensitivity was 94.4%, specificity was 61.8%, PPV was 72.3%, NPV was 91.3%. In pregestational diabetic pregnancy sensitivity was 88.6%, specificity was 86.2 %, PPV was 88.6 %, NPV was 86.2%. In control healthy pregnancies the sensitivity was 70.6 %, specificity was 71.8%, PPV was 52.2%, NPV was 84.8 %.
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