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The Vallue off Pollymerase Chaiin Reacttiion iin tthe Diiagnosiis off Tubercullous Meniingiittiis iin a Samplle off Iraqii Pattiient

Authors: Akram M. Al-Mahdawi --- Kareem M.Al-Tameemi --- Eman Sh. Al-Obeidy --- ***,Laith Ahmed
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2012 Volume: 11 Issue: 3 Pages: 382-391
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Tuberculous meningitis (TBM) is a medical emergency. Early diagnosis is of utmost importance to minimize morbidity and mortality. Polymerase chain reaction (PCR) seems to be a promising test for rapid and early diagnosis of TBM.OBJECTIVE:To investigate whether PCR detects tubercle bacilli in CSF specimens that are missed by direct microscopy and culture, and if so whether PCR has significant diagnostic value compared to conventional methods.METHODS:PCR, culture and acid- fast bacilli (AFB) were performed on CSF samples taken from 43 patients with TBM (based on clinical features and cytochemical parameters of the CSF) and 15 with non- TBM as control group.RESULTS:Of the 43 CSF specimens from highly probable TBM patients, 33 were positive by PCR (76.7%), whereas only 5 was acid-fast microscopy (AFM) positive (11.6%) and 22 were culture positive (55.2%). No positive results were found by AFM, culture or PCR in the non-tuberculous control group.CONCLUSION:The results of this study indicate that application of PCR is extremely useful for the diagnosis of TBM.The PCR is superior to the currently available techniques for the diagnosis of tuberculous meningitis in terms of sensitivity, specificity and rapidity and can play a critical role in the diagnosis of suspected cases.


Article
Possible Role of Anti-Cyclic Citrullinated Peptide Antibody (Anti-CCP Ab) in Rheumatic Diseases
الدور المحتمل للاجسام المضادة لبيبتيدات ال Cyclic Citrullinated(اضداد ال CCP) في الامراض الروماتيزمية

Authors: Eman Sh. Al-Obeidy ايمان العبيدي --- Nahida R. Abbas نادية عباس --- Karim S. Ali Al-Ajeeli كريم سعدون العجيلي
Journal: Diyala Journal of Medicine مجلة ديالى الطبية ISSN: 97642219 Year: 2012 Volume: 3 Issue: 1 Pages: 82-89
Publisher: Diyala University جامعة ديالى

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Abstract

Background: Anti-cyclic citrullinated peptide (anti-CCP) antibodies are highly specific for RA, but are not detectable in all RA patients, in addition their usefulness to identify rheumatic arthritis (RA) from other rheumatic diseases presenting with joint pain is not well studied.Objective: To establish whether the clinical phenotypes of anti-CCP positive and negative disease are distinct at the earliest clinically apparent phase of disease and to assess the diagnostic accuracy of the anti-CCP antibodies assay to separate RA patients from a group of patients with (SLE).Patients and Methods: One hindered ten blood samples were collected from patients, 75 with RA (58 seropositive and 17 seronegative) and 35 patients with SLE attending the Rheumatology Clinic of the Al-Yarmook Teaching Hospital for period between March 2009 and November of 2010 were included in this study. Then sera were stored at -20° and tested for anti-CCP antibodies by a commercially available enzyme-linked immunosorbent assay (ELISA) kit (Euroimmun, while CRP and Rheumatoid factor was test by latex agglutination (LA). Results: Forty five of 58 seropositive RA patients (77.6%) were positive for anti-CCP, while 13 patients tested negative for anti-CCP antibodies. Among the seronegative group, antibodies to anti-CCP could be demonstrated in 22.4% of patients. Anti-CCP positive patients were rheumatoid factor positive (77.6% vs. 22.4%, p < 0.005). There was no significant difference in the pattern of joint involvement. In the SLE group, anti-CCP antibody was positive in only 8 of 35 (22.8 %) patients. Conclusions: Patients with and without anti-CCP antibodies present in a similar way, and anti-CCP antibody have high sensitivity for diagnosis of RA.Keywords: Anti-CCP antibodies, C-reactive protein, rheumatoid arthritis, rheumatoid factor, systemic lupus erythematosus.

الخلفية: ان الاضداد المضادة للبيبتيد الحلقي cyclic citrullinated peptide هي عالية التخصص كأجسام مضادة لالتهاب المفاصل الروماتويدي، ولكن لا يمكن كشفها في كل مرضى التهاب المفاصل الروماتويدي، بالإضافة الى ذلك فان فائدتها لتحديد التهاب المفاصل الروماتيزمية (RA) من الأمراض الروماتيزمية الأخرى المصحوبة بآلام في المفاصل لم تدرس جيدا.الاهداف: لتحديد ما إذا كانت الظواهر السريرية للمرض الموجب او السالب لمضادات ال CCP هي مميزة في المرحلة السريرية المبكرة للمرض وتقييم الدقة التشخيصية لفحص الأجسام المضادة المقاومة لل CCPلفصل مرضى التهاب المفاصل الروماتويدي عن مجموعة من المرضى الذين يعانون من (SLE)النتائج: اظهرت النتائج ان خمسة وأربعين من 58 مريضا من المرضى الموجبين مصليا لمرضى التهاب المفاصل الروماتويدي (77.6٪) موجبين ايضا لاضداد الCCP ، في حين أن 13 مريضا ظهروا سالبين لاضداد ال CCP.اما المرضى السالبين مصليا لمرض التهاب المفاصل فقد تبين ان 22,4% منهم هو موجب لاضداد ال CCP. وظهر ايضا ان المرضى الموجبين لاضداد ال CCP هم ايضا موجبين ل rheumatoid factor (0,005>p , 22,4% .vs77,6%)لم تظهر اية فروق معنوية في نمط شمول المفاصل.وظهر في مجموعة ال SLE ان 8 مرضى من 35 مريضا (22,8% ) هم موجبين لاضداد ال CCP.الاستنتاجات: المرضى مع وبدون اضداد ال CCP ظهروا بشكل متشابه وان اضداد ال تمتلك حساسة عالية لتشخيص الامراض الروماتيزمية.

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