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Isolation and Identification of Isolation and Identification of Isolation and Identification of Isolation and Identification of Isolation and Identification of Isolation and Identification of Isolation and Identification of Isolation and Identification of Malassezia Malassezia Malassezia Malassezia Species in Patients Species in Patients Species in Patients with Pityriasis Versicolorwith Pityriasis Versicolor with Pityriasis Versicolor with Pityriasis Versicolorwith Pityriasis Versicolor with Pityriasis Versicolor with Pityriasis Versicolorwith Pityriasis Versicolorwith Pityriasis Versicolorwith Pityriasis Versicolor with Pityriasis Versicolor with

Authors: Jasim M. Karhoot --- Adil A. Noaimi --- Warkaa F. Ahmad
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2012 Volume: 11 Issue: supplement Pages: 724-730
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:BACKGROUND:Malassezia are unipolar yeasts that comprised from eleven species and recognized as commensally skin flora that may be pathogenic under certain conditions.OBJECTIVE:To isolate and identify different species of Malassezia in Iraqi patients with pityriasis versicolor.MATERIALS AND METHODS:This case investigative study was done in Microbiology and Dermatology Departments, College of Medicine, University of Baghdad- Baghdad, Iraq during the period from April 2008 - October 2008.One hundred patients had pityriasis versicolor were evaluated regarding all points related to the disease. Wood's light and skin scraping for mycological examinations were done. Methylene blue stained samples were examined for the presence of clusters of yeasts, budding cells, and hypha. Tween assimilation and splitting of esculin tests were carried out.RESULTS:The most common isolated species were Malassezia globosa 40(51%), followed by Malassezia furfur 24(30%), Malassezia symbodialis 8(10%), Malassezia obtuse 5(6%) and Malassezia restricta2(3%).CONCLUSION:Malassezia globosa was the most predominant species involved in etiology of pityriasis versicolor lesions followed by Malassezia furfur.


Article
Clinico-Histopathological Study of Calcinosis Cutis among Iraqi Patients

Author: Adil A. Noaimi د.عادل عبد الغفور النعيمي
Journal: IRAQI JOURNALOF COMMUNITY MEDICINE المجلة العراقية لطب المجتمع ISSN: 16845382 Year: 2013 Volume: 26 Issue: 2 Pages: 118-123
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract:Background: Cutaneous calcification results from deposition of insoluble calcium phosphorous salts in the cutaneous tissues. There are wide clinical presentations of calcinosis cutis and it's a rare dermatological problem. However serious implication may arise due to delayed diagnosis.Objective: To highlight and elaborate different clinical types of calcinosis cutis among Iraqi patients. Patients and Methods: This observational, descriptive, clinical and histopathological study was done in Department of Dermatology- Baghdad Hospital-Medical City, Baghdad, Iraq during the period from January 1997-Decmber 2012.History, examination and complete investigations if needed were done for each patient including all demographic points related to the disease. Excisional or incisional biopsies from each patient for histopathological evaluation were done. Results: A total of 72 patients were included. They were 46 (63.01%) females and 27(38%) males. Their ages ranged from 3.5– 65(24.74±15.9) years. They were classified into 2 groups: Group A the dystrophic type with 65(89.04%) patients and was subdivided into calcinosis cutis universalis which constituted from 6(8.2%) cases. The 2nd subtype is calcinosis cutis circumscriptum which consist of 58(79.7%) cases. Group B: 8 (11.11%) patients with idiopathic type, 1 (12.5%) with idiopathic scrotal calcinosis and 2(25%) with subepidermal calcified nodule. Conclusion: Calcinosis cutis is a rare medical problem with multiple etiological factors in which we see calcified deposits mainly in the skin. This is the first report appeared from Iraq.Keywords: Calcinosis cutis, pilometricoma, pseudoxanthoma elasticum, Iraqi patients.


Article
Efficacy and Safety of Topical Podophyllin 5% Ointment in Patients with Mild Plaque-Type Psoriasis

Authors: Khalifa E.Sharquie --- Adil A.Noaimi --- Wesal K. Al-Janabi*
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2013 Volume: 12 Issue: 2 Pages: 251-258
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT: BACKGROUND: Psoriasis is a common chronic condition of the skin that is resistant to many therapies. There is a need for the development of novel non-steroidal topical drugs for the treatment of psoriasis.OBJECTIVE: To assess the efficacy and safety of topical podophyllin 5% ointment in patients with mild plaque-type psoriasis.PATIENTS AND METHODS: Sixty two patients with mild plaque-type psoriasis were enrolled in this study. They were dividedinto 3 groups: GroupA (21patients)were treated with podophyllin 5% ointment every other day,while Group B(20patients)were treated with clobetasol propionate 0.05%ointment twice daily and21 patients in Group C were treated with Vaseline twice daily for 8 weeks as a control group.Efficacy was evaluated every 2 weeks for 8weeks using Psoriasis Area and Severity Index (PASI)score and relapse was recorded after cessation of treatment in those patients who achieved goodresponse during 8 weeks follow up period.RESULTS: A total of 62patients were 44(70.9%) males and 18(29.0%) females, with: male: female ratio 2.3:1.Their ages ranged from 18-65 (37.5±12.9) years. Their baseline PASI score ranged from 1.29(5.2±2.4).Attheendof8weeksoftherapy:nostatisticallysignificantdifferenceinPASIreductionbetweenGroupA(66.3±20.7) and Group B(68.1±34.2) treated patients, P-value =0.831 and both of themwere statistically significant higher PASI reduction than patients with Group C,34.1±28.8, P-value=<0.001.Regarding the percentage of patients who achieved good response, there was nostatistically significant difference between Group Aand Group B, 95.3% versus 70% ( Pvalue=0.083)and both of them achieved a statistically significant higher percentage of patientswith good response than Group C,47.6%, P-value=<0.001. Although the percentage of patientswith complete clearance (PASI≥90%) in the Group Awas much less, 9.5%, than that of Group B,65% (statistically significant, P-value=< 0.001), the total relapse rate during 8 weeks follow up wasmuch lower among Group Apatients, 25% versus 70%, P-value=0.043.On the other hand nocomplete clearance was achieved in the Group Cand their relapse rate was 80%.Regarding side effects: Group A, 9.5% of patients developed hypopigmentation, Group B, 10% ofpatients developed pyoderma and Group C, no side effects were reported. There was no statisticallysignificant difference among the three groups regarding the frequency of side effects (P = 0.355).CONCLUSION: Podophyllin 5% ointment on every other day regimen was as effective as clobetasole 0.05%ointment twice daily at the end of 8 weeks treatment with no side effects and with a much lowerrelapse rate.


Article
Frequency of Genodermatoses Among Iraqi Patients

Authors: Haider R. Al-Hamami --- Adil A. Noaimi --- Makram M.Al-Waiz --- Abdulkaleq S. Al-Kabraty
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2010 Volume: 9 Issue: 1 Pages: 62-67
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:BACKGROUND:Genodermatoses are hereditary skin disorders or anomalies which can be grouped into three categories: chromosomal, single gene and multifactorial. Most genodermatoses show single gene or Mendelian inheritance (autosomal dominant, autosomal recessive or X-linked recessive genes).OBJECTIVE:To asses the frequency of genodermatoses among Iraqi patients in outpatients Dermatology and Venereology comparison with other countries.PATIENTS AND METHODS:This case series descriptive epidemiological study included eighty three patients (57males and 26 females) with genodermatoses. They consulted the out patient clinic/ Department of Dermatology and Venereology Baghdad Teaching Hospital fromApril 2005 through April 2006. Their ages ranged from 2months-60 years (Median 10 years),With various genetic diseases.Full history, dermatological and clinical examinations were done to establish the clinical diagnosis of genodermatoses regarding all demographic points related to these disorders.RESULTS:The frequency of genodermatoses among outpatient attendant in Dermatology and Venereology Department was 83/ 20000 (0.42%).This study had shown that the most common genodermatoses were; ichthyosis: 21 (25.3 %) patients and epidermolysis bullosa which contain 16 (19.3 %) patients when taken together they constituted 37 (44.6%) patients of the total, neurofibromatosis 8 (9.6 %), hereditary palmoplantar keratoderma 6 (7.2%), darier's disease 5 (6 %) and xeroderma pigmentosa 4 (4.8 %).Positive family history of the same disease was obtained in; 8 (38.1 %) patients with ichthyosis, 4 (66.6 %) in hereditary palmoplantar keratoderma, 2 (12.5 %) in epidermolysis bullosa and all patients with Hailey-Hailey disease had positive family history of the same condition.Consanguinity was positive in; 13 (61.9 %) patients of ichthyosis, 12 (75 %) epidermolysis bullosa, 2 (33.3 %) hereditary palmoplantar keratoderma and (100 %) patients with xeroderma pigmentosaCONCLUSION:Genodermatoses are frequently encountered among Iraqi dermatological outpatients and more common in families with positive consanguinity and were comparable to other countries


Article
Scarring and None Scarring Facial Acne Vulgaris and the Frequency of Associated Skin Diseases

Authors: Khalifa E. Sharquie --- Khalil I. Al-Hamdi --- Adil A. Noaimi --- Razan A. Al-Battat
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2009 Volume: 8 Issue: 4 Pages: 332-338
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:BACKGROUND:Acne vulgaris(AV)is chronic inflammatory disease of pilosebaceous unit of young people. Patients with acne with or with out scarring might differ in regard to their immunological background from those free from acne.OBJECTIVES:To evaluate the problem of facial AV especially patients with scarring and to determine the frequency of associated skin diseases and to be compared with acne free control.METHODS:A cross sectional randomized controlled epidemiological study was conducted from Oct.2005-Oct. 2006.Three hundred students from Basra University; 132 (44%) males and 168 (56%) females were enrolled, their ages ranged from 18-25 (20.9±1.8) years. They were divided into: Group A those free from acne (98 individuals),Group B with non scarring facial AV (96 patients), and Group C with scarring facial AV (106 patients). History and examination were done for their acne, scarring acne and associated skin diseases. Allen and Smith grading system for AV were used, and a new invented multiparametric scoring system for scarring acne was applied.RESULTS:AV was in 98(73.24%) males and 104 (61.9%) females. Scarring was 54 (50.95%) males and 52 (49.05%) females. Greasy skin was the most common type among Group B 67 (69.8%) versus 39 (39.8%) among Group A(P=0.000029) and was more common among Group C 84(79.2%) (P=0.00000001).Family history of AV was nearly similar in A and B Groups 55(57.29%) and 56 (52.83%) respectively, while in Group A was 39 (39.79%). Family history of scarring acne was in 35(33.02 %) of Group C, 16 (16.66 %) of Group B, and 3 (3.1%) in Group A; (P=0.00000017). The age of onset was similar in A and B Groups between 15-16 years. Majority of patients in Group B had non inflammatory type or mild inflammatory (papular) 65 (67.8%) patients, most of case were mild and moderate 86 (89.58%) patients, while high percent in Group C had inflammatory type 95 (89.62%), and more than half of them had severe and very severe types upon grading 56 (52.8%). The aggravating factors were similar in A and B Groups with stress and hot weather being the leading aggravating factors. Squeezing and digging habit was in 53 (50%) in Group C versus 23 (23.95%) in Group B (P=0.00024). In most cases of scarring acne, scarring was mild and moderate 85 (80.19%), and the most common type scars was the flat hyperpigmented [50 (47.17%) and 66 (62.26%) respectively].The most common effect of scarring acne on psyche was mild discomfort and mild dysmorphophobia 75 (70.75%).Associated skin diseases were more common among Group A 31 (31. 63%) than among Group B 22 (22.91%) and least common among Group C 14 (13.20%) (P=0.0067) and they were mainly dermatitis and skin infections.CONCLUSION:AV might reflect the immunological status especially among patients with scarring. The frequency of skin diseases was much less among patients with scarring acne


Article
Female Pattern Alopecia and Lipoproteins

Authors: Khalifa E. Sharquie --- Adil A. Noaimi --- Husam Ali Salman --- Nibras A. Hindy
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2009 Volume: 8 Issue: 2 Pages: 120-122
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:BACKGROUND:The meaningful association of androgenetic alopecia and coronary heart disease had been well documented, but few studies had been focused on the importance of lipid parameters in patients with androgenetic alopecia.OBJECTIVE:To investigate the lipid profile and its relation to female pattern alopecia.PATIENTS & METHODS:This is a case controlled study conducted at the Department of Dermatology & Venereology- Baghdad Teaching Hospital, between January 2001 and April 2002. Sixty female patients with androgenetic alopecia were enrolled in this work. From each patient a detailed history and full clinical examination were performed regarding all demographic points relative to the disease, grading of alopecia and measurement of serum lipoproteins was done. Female pattern alopecia was classified according to Sharquei’s classificationSixty age and weight matched females with normal hair status were considered as a control group. Measurement of serum lipoproteins also performed for them.RESULT:Sixty patients, their ages ranged between 20-60 years with mean + SD of 30.3 + 9.4 years. Twenty (33.3%) patients were having grade I, 20 (33.3%) patients grade II and another 20 (33.3%) patients grade III.. The mean levels of total serum cholesterol, triglycerides, low density lipoprotein and very low density lipoprotein in all patients and those with grade II and III separately were significantly higher when compared to the control group. On the other hand, the mean levels of high density lipoprotein in all patients and those with grade I and III separately were lower in comparison to the control.CONCLUSION:The atherogenic index or risk ratio was found to be significantly high in patients with female patteren alopecia and this goes parallel with the severity of baldness.


Article
Ventral Penile Papillae as a New Anatomical Structure: A Clinical-Epidemiological Study Among Iraqi Males

Authors: Khalifa E. Sharquie --- Jamal R. Al-Rawi --- Adil A. Noaimi --- Munqithe M. Jabir
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2009 Volume: 8 Issue: 3 Pages: 296-300
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:BACKGROUND:Ventral Penile Papillae (VPP) are benign asymptomatic structures that are found on the skin of the ventral aspect of penile shaft of many adult males; yet, no frank record or description of them is found in the English medical literatures.OBJECTIVE:To hit light on the VPP, finds their frequency among circumcised Iraqi adult males, seeks about their associations with other skin conditions, and examines the histological picture.PATIENTS AND METHODS:Forty seven Iraqi circumcised adult males were included in this case descriptive ,comparative study which extended between July 2007-November 2007 was conducted in Department of Dermatology- Baghdad Teaching Hospital. All 47 persons were asked about sociodemographic aspects, medical and skin conditions. They were evaluated clinically regarding different clinical aspects. Statistical data were deduced. Biopsies were done for 8 papillae from 6 persons for histological assessment. Also, 50 circumcised children under the age of 10 years were examined for the presence of these papillae as a control group.RESULT:Forty seven males were enrolled the present work, their ages ranged from 14-59(29.72+10.57) years. Twenty five (53.2%) persons had VPP, while 22 (46.8%) subjects showed no papillae. Fifty circumcised children of ages ranged from 3.5-10(5.97+1.42)years, all were lacking the papillae. The papillae were asymptomatic. Shapes of papillae were distributed as follows: skin tag-like papillae were 53.93%, dome-shaped 40.44%, while wartlike in 5.61% of these papillae. Histology was normal apart from finding of dermal encapsulated structures which simulate mechanoreceptor nerve endings, so called Meissner’s corpuscles.CONCLUSION:All facts start as speculative thoughts as had been proved by the present study. Ventral penile papillae are normal anatomical and physiological structures that are present in only adult males while completely absent in children. So the age of onset lies during adulthood. The location, morphology, age of onset, and the histology of these papillae are very suggestive of their sexual stimulatory function. Still further physiological and histological studies are strongly recommended.


Article
Treatment of Tinea Corporis by Topical 10% Zinc Sulfate Solution

Authors: Khalifa E. Sharquie --- , Adil A. Noaimi --- Sarmad A. Al-Hashimy --- Iqbal G. F. Al-Tereihi
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2013 Volume: 12 Issue: 2 Pages: 247-250
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT: BACKGROUND: Tinea corporis is a dermatophyte infection of the glabrous skin. Multiple modalities of therapy havebeen used in the treatment of tinea corporis including both systemic and topical agents, such asimidazols, triazols, allylamines, ciclopirox and griseofulvin. OBJECTIVE: To evaluate the efficacy and safety of topical 10% zinc sulfate solution in the treatment of tineacorporis and tap water as placebo controlled in treatment of tinea corporis. PATIENTS AND METHODS: This opened labeled blind-therapeutic trial done in the Department of Dermatology -BaghdadTeaching Hospital, during October 2004 – March 2006.It consisted from 63 patients with tineacorporis, 33 patients treated with 10% zinc sulfate (Group A) and 30 patients received distilled water as the placebo-control group (Group B). Full history and clinical examinations were done for all patients including all demographic aspectsrelated to the disease.Every patient was instructed to apply treatment twice daily and to be seen every 3 weeks for2months. All patients were assessed clinically and by skin scraping test before, during and aftertreatment. RESULTS: Sixty three patients with tinea corporis met the inclusion criteria and enrolled in this study. Sixtypatients completed the study, three patients defaulted from the study in Group A . In Group A 30patients received topical 10% zinc sulfate solution twice daily for two months, 17 (56.7%) femalesand 13 (43.3%) male patients. Their ages ranged from 4-64 (27.87+17.68) years, while the durationof the disease ranged from 1-13 (3.7 + 3.249) weeks. Complete cure response was observed in 13(43.33%) patients, partial response in 7 (23.34%) patients and no response in 10 (33.33%) patientswhile in in Group B, 30 patients received distilled water twice daily for two months as placebocontrolgroup,10(33.33%)femalesand20(66.67%)malepatients. Theiragesrangedfrom8-66(30.67+ 15.66) years, and the duration of the disease ranged from 1-30 (7.48+ 6.98) weeks. Theclinical response was two (6.67 %) patients with partial improvement and 28 (93.33%) patients withno improvement.No side effects reported apart from mild irritation in the beginning of treatment which resolved soonafter continuation of therapy that did not require stopping the treatment. CONCLUSION: Topical 10% zinc sulfate solution is a new effective, safe and non costly formulation in the treatment of tinea corporis but it is slow in clearance of the lesions and higher concentrations of zinc sulfatelike 20% might increase the effectiveness of the drug and shorten the duration of therapy


Article
Clinical and Sequential Histopathological Study of Scabietic and Postscabietic Nodules

Authors: Khalifa E. Sharquie --- Sabeeh A. Al-Mashhadani --- Adil A. Noaimi --- Wissam M. Katof
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2013 Volume: 12 Issue: supplement Pages: 693-699
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:BACKGROUND:Scabietic nodules are common problem seen before and after effective therapy of scabies that might persist for months.OBJECTIVE:To evaluates the clinical and histopathological features of these nodules during their sequential course.PATIENTS AND METHODS:Patients with scabietic nodules were enrolled in this study. Five (14.7%) patients had active scabies at the time of consultation. All recruited patients had personal and family history of treated scabies with persistent itchy nodules. Patients were fully examined for: sites, numbers and sizes of the persistent scabietic nodules. Histopathological evaluation was done from nodules in patients with active scabies before therapy and at different times during the course of the post-scabietic nodules . RESULTS:Thirty four male patients were studied with mean age (34.41±16.72) years. The lesions were more prevalent in young adult age group 20-29 (24.5±2.9) years. The nodules had persisted for a period ranged from 1-52(13.47±14.29) weeks. Intolerable itching was evident in all these nodules but without the nocturnal accentuation. The number of nodules ranged from 1-35(8.5±6.8) lesions. These nodules were more heavily involving: scrotum in 20(28.57%) patients and penile shaft 19 (27.14%), and less commonly involving the upper thigh, lower abdomen, axilla and penile corona. Differential white blood cells count revealed normal eosinophilic count in all patients with post scabeitic nodules, while high values were observed in 4out of 5 patients with active scabies.The histopathology of scabietic and post-scabietic nodules revealed: acanthotic epidermis with mild spongiosis, pseudoepithelial hyperplasia present in 2(5.8%) nodules. The infiltrate was mainly diffuse (papillary and reticular dermis) dense lymphocytic in 29 (85.2%) nodules and even in early stages, the density of the infiltrate decline when the nodules persisted more than 6 months. Scattered eosinophils were present in the dermis of all nodules regardless the age of nodule. Mild lymphocytic vasculitis recognized in 3 (8.8%) nodules in patients with short duration (3-9 weeks). Granulomatous reaction with Langhans giant and epitheliod cells was another important finding in4 (11.7%) nodules.CONCLUSION:Scabietic nodules tend to affect male adult with a predilection to the scrotum and penile shaft. The histopathological pictures consisted mainly of acanthotic epidermis and diffuse dense dermal lymphocytic infiltrate in 85% of scabietic nodules. No mites or mite parts could be detected. Lymphocytic vasculitis and granulomatous reactions present in few nodules.


Article
Lactic Acid 5% Mouthwash is an Effective Therapeutic and Prophylactic Agent in Treatment of Recurrent Aphthous Ulcer (Single blind placebo controlled therapeutic study

Authors: Khalifa E. Sharquie --- Sabeeh A. Al Mashhadani --- Adil A. Noaimi --- Raafa K. Al-Hayani --- et al.
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2012 Volume: 11 Issue: 3 Pages: 363-369
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Recurrent aphthous ulcer (RAU) is a common oral disease. It is treated by a variety of agents. Lactic acid has been used in the treatment of many skin diseases.OBJECTIVE:To assess the therapeutic, prophylactic effectiveness and safety of 5% lactic acid mouthwash in management of patients with RAU.PATIENTS AND METHODS:This single blind placebo controlled therapeutic study where 40 patients with early onset RAU were recruited in Department of Dermatology -Baghdad Teaching Hospital from April 2005-April 2006. Patients ages ranged 20-60 (29.6 ±9.6) years and were divided randomly into 2 groups (20 patients for each one):Group A used 5% lactic acid mouthwash,5 ml twice daily. Group B was instructed to use distilled water as placebo in a similar way to Group A. Short term assessment of each patient of both groups was done to evaluate the therapeutic effect of drug by using oral clinical manifestation index (OCMI), mean size of largest diameter of ulcers. A long term assessment was done for each patient to evaluate the prophylactic effect of drug by using OCMI before, after 1, 2& 3 months of therapy.RESULTS:The mean of OCMI in group A started to decline directly after 4 days of therapy and to its lower level after 8 days, and it was statistically significant (P value <0.05).The change in mean of OCMI of group B after 4 and 8 days of therapy was also statistically significant (P value <0.05).The response rate after 4 days of therapy in Group A was 33.3% and in Group B was 6.44%, while the response rate after 8 days of therapy in Group A was 69.16% and in Group B was 44.98%. The difference in response rates after 4 and 8 days between groups A and B was statistically significant (P value <0.05).The mean size of ulcers in Group A started to decline directly after 4 days of therapy and to its lower level after 8 days of therapy. It was statistically significant (P value <0.05). The change in mean size of ulcers of group B after 4 and 8 days of therapy was also statistically significant (P value <0.05). The response rate after 4 days of therapy in group A was 44.92% and in Group B was 15.08%, while the response rate after 8 days of therapy in group A was 85.68% and in group B was 55.36%. The difference in response rates after 4 & 8 days between Groups A and B was statistically significant (P value <0.05). The therapeutic action of lactic acid mouth wash was statistically significant more effective than placebo. Lactic acid mouth wash showed statistically significant prophylactic effect in comparison to placebo after 1,2&3 months from starting therapy using oral clinical manifestation index, (P value <0.05).CONCLUSION:Lactic acid 5% mouthwash is a new, safe effective therapeutic and prophylactic remedy in management of RAU.

Keywords

lactic acid --- RAU --- mouthwash.

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