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Effect of Valsalva Maneuver on Cardiovascular Reflexes

Authors: Ahlam K. Abood --- Aamir S. Al-Mu'min --- Yesar M.H. Al-Shamma
Journal: Al-Qadisiyah Medical Journal مجلة القادسية الطبية ISSN: 18170153 Year: 2007 Volume: 2 Issue: 3 Pages: 8-21
Publisher: Al-Qadisiyah University جامعة القادسية

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Abstract

Valsalva maneuver (VM) is one of the most important tests used to investigate the integrity of the autonomic nervous system (ANS), it can be used to assess the baroreflex activity since the baroreceptors innervated by both sympathetic and parasympathetic nervous systems. Therefore (VM) used to investigate the changes in the hemodynamic variables in order to assess the integrity of cardiovascular system.
The procedure of (VM) involves four phases through these phases the following measurements take place:
1.Measurement of stroke volume (SV) which is the volume of blood pumped from the heart by each beat using echocardiographic technique.
2.Heart rate (HR) is recorded by ECG in order to count the number of heart beats per each minutes.
3.Cardiac output (CO) which is the volume of blood pumped from the heart per each minute can be calculated by the equation CO = HR × SV from the above points (1,2).
4.Blood pressure measurement during (VM) by using mercury sphygmomanometer by which measurement of SBP, DBP and MBP.
5.Peripheral vascular resistance (PVR) can be calculated from the equation PVR = BP/CO.
This study was carried out on seventy normal healthy subjects, their age range (20-40 years) with mean ± SD is (27.31 ± 5.28years).
In this study a totally non-invasive techniques were used during all phases of VM.
Concerning the responses in different phases of VM we found that there is sudden increase of BP with reflex bradycardia at the onset of straining(phase1). During phase2 (straining phase) there is significant reduction of SV and decreasing of BP to the low point lead to sympathetic stimulation and reflex tachycardia and increment in BP(systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean blood pressure (MBP), so phase 2 can be divided in to phase 2E and phase 2L. At release of strain of VM, there is transient reduction of SV and BP (phase3), phase 2E and phase 3 were not included in this study as BP changes need to be measured by invasive technique. few seconds after release of strain, the SV return to premaneuver level with BP “over shoot” (increased SBP, DBP and MBP) and peripheral vascular resistance (PVR) also increased as it is calculated from this equation (PVR = MBP/CO), and there is reflex bradycardia so cardiac output(CO) is decreased (phase4).

عصاب الرحام(الهستيريا)كلمة الرحام مشتقة من الكلمة الإغريقية "الهستريا" التي تعني تجوال الرحم في الجسم. ويعرف الرحام بأنه اضطراب عصابي يتصف بأعراض متعددة تصيب على الأغلب النساء. يصف العالمان فرويد وبريور بان أعراض مرض الهستريا تنشا نتيجة الكبوت الجنسي. إلا أن النظرية النفسية التحليلية في هذا الوقت أصبحت غير مقبولة .وفي النظام التشخيصي الصادر من جمعية أطباء النفس الأمريكية الثالث (1980) والاصدارات اللاحقة(الثالث المراجع 1988 ،والرابع 1994، والرابع المراجع لعام 2000) تم استعمال مصطلحي "التحول"، "والانشطار الذهني" بدلا من مصطلح عصاب الرحام "الهستيريا". ووضع اضطراب "التحول" تحت عنوان الاضطرابات النفسية ذات الأعراض الجسمية "سوماتوفورم". أجريت الدراسة لمرضى الرحام للمرضى المتعالجين في مستشفى أزادي العام في محافظة كركوك خلال الفترة من تموز لغاية كانون الأول من عام 2007. وتم تشخيصهم بموجب النظام التشخيصي الرابع المراجع الصادر من جمعية أطباء النفس الأمريكية لعام2000. وكانت النتائج ،(81%) من المرض من النساء بينما (19%) هم من الرجال،(85%) من المرضى يعانون من عارض واحد بينما(15%) يعانون من مجموعة أعراض. وتبين أن أكثر الاضطرابات انتشارا بين المرضى الأميين وذوي المستويات التعليمية المتدنية ومن المناطق الريفية .أكثر الأعراض تكرارا هو فقدان الشعور(25%) ويليها الشلل الرحامي(21%) . كما تبين من الدراسة أن(86%) من المرضى يعانون من ضغوط نفسية سبقت حالتهم المرضية بينما (14%) ينفون تعرضهم لأي أجهاد نفسي.

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Article
The Behavior of the Plasma Homocysteine and Selenium Concentrations in Patients with Acute Myocardial Infarction
سلوك مستويات الهوموسيستين والسيلينيوم في بلازما دم المصابين باحتشاء العضلة القلبية الحاد

Authors: H. Renz --- S. Mkhlof --- Aamir S. AL-Mu'min --- Abdulsamie H. Alta'ee عبدالسميع حسن الطائي --- et al.
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2008 Volume: 5 Issue: 3-4 Pages: 543-550
Publisher: Babylon University جامعة بابل

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Abstract

Background: Increased concentrations of plasma total homocysteine and decreased concentrations of plasma selenium are separately associated with cardiovascular disease. Objective: Investigate the correlation between plasma total homocysteine and selenium in patients with acute myocardial infarction (AMI). Methods: Patients of present study was thirty nine men with AMI admitted to Marburg Hospital in Marburg city, Germany on 2007. Plasma total homocysteine was determined using HPLC. Plasma selenium was determined using atomic absorption spectrometry. Results: Plasma homocysteine of patients found to be increased, whereas plasma selenium found to be decreased when compared with reference range . The correlation between plasma homocysteine and selenium found to be negatively correlated. Conclusion: The negative correlation between plasma tHcy and selenium may indicate that they have a significant impact on the process of atherogenesis. The change in the levels of plasma total homocysteine and plasma selenium might be result from oxidative stress associated with AMI.

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