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Article
Vascular Cognitive Impairment in Ischemic Stroke Patients

Authors: Salman Isa Haza --- Nawfal Madhi Sheaheed --- Akram M. Al-Mahdawi
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2014 Volume: 13 Issue: 4 Pages: 532-537
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND: Stroke is associated with considerable physical and psychological impairment. Cognitive impairment is common sequel of stroke and small vessel ischemic disease. Potentially modifiable risk factors for vascular cognitive impairment (VCI) include hypertension, DM, hyperlipidemia and others. Because of the close association of these factors with stroke, prevention of VCI is largely tied to control of stroke risk factors. OBJECTIVE: The main aims of the study were to ascertain the significant determinants of cognitive impairment in stroke patients and the associated risk factors.PATIENTS AND METHODS: This is a case series descriptive study that enrolled 100 patients whose ages were 50 years and above with stroke attending at Al-Yarmouk Teaching Hospital in Baghdad-Iraq during the period between the 1st of January 2007 to the 31st of January 2008. All of the patients were asked about demographic and atherogenic risk factors and subjected to cognitive assessment by MMSE and executive function also the patients subjected to thorough clinical assessment, laboratory investigations and radiological studies.RESULTS: This study revealed that distribution of VCI in stroke patients was 27%, the patients with vascular CIND represent 19% and those with VaD represent 8%. The mean age of the patients was 65. The most common risk factors were hypertension 25%, hypercholesterolemia 20%, smoking 17%, acute myocardial infarction 10%, diabetes 10% and atrial fibrillation 5%. We observed that increasing age, low level of education and acute myocardial infarction were significant determinants of cognitive impairment in stroke patients.CONCLUSION: Considerable proportion of stroke patients presented with cognitive impairment which is determined by modifiable risk factors like atherogenic and demographic risk factors.


Article
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
Association of Vitamin D Metabolite Levels with Relapse Rate and Disability in Multiple Sclerosis

Authors: Akram M. Al-Mahdawi --- Gheyath Al Gawwam --- Raad A. Al Ethawi
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2014 Volume: 13 Issue: 3 Pages: 298-305
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Multiple sclerosis is an inflammatory demyelinating disease of the central system. It estimated to affect more than 2・5 million people worldwide. It is the most common non-traumatic cause of disability in young adults. Although the cause of multiple sclerosis remains undetermined, number of risk factors for MS have been identified and they can loosely be put into one of two categories; genetic or environmental components. Epidemiologic studies have suggested there is an increase in incidence and prevalence of MS with increasing latitude north and south of the equator. Latitude has implicate vitamin D status as a determinant of risk.OBJECTIVE:To study the association of vitamin D level with relapse rate and disability in patients with relapsing remitting multiple sclerosis in Iraq.PATIENTS AND METHODS:Thirty patients (6 males and 24 females) with relapsing remission multiple sclerosis (RRMS), their age range from 16 to 45 years, recruited from MS clinic of neurology department of Baghdad teaching hospital in the medical city in Baghdad and twenty five completely healthy controls (6 males and 19 females) from general population and their age range from 20 to 40 years were enrolled in this study in the period from April 2011 to the end January 2012. RESULTS:The present study shows low vitamin D levels for both patient with RRMS and control group. There is significantly lower 25(OH)D level in patients with relapse compared with patients without relapse in the last 6 weeks. Also we found higher expanded disability status scale (EDSS) in patients with relapse compared with patients without relapse in the last 6 weeks. Lastly, we didn’t find any correlation between vitamin D level and EDSS in patients group study.CONCLUSION:We concluded from this study that there is low circulating level of 25(OH)D in RRMS patients, especially during relapses. Also there is no effect of vit D on disability


Article
Old patient migraine in comparrision with younger adult migrain
اعراض الشقيفه فوق الخمسين سنه مقارنة بالشيقه تحت الخمسين سنه

Authors: Saad Hadi Al-ANI سعد هادي --- Gheyath AlGawwam غياث شلال --- Akram M.AL-Mahdawi اكرم المهداوي
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 / 24108057 Year: 2015 Volume: 57 Issue: 2 Pages: 109-113
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Migraine is a common chronic episodic disabling primary headache disorder. Migraine can affect all age groups elderly and young age with different presentation of symptoms between two age groups. The prevelance of migraine is highest between 20 and 55 years peaking at age around 40 years of age and the declines thereafter, however the primary headache disorder does also exist in older population.Objective: This study was undertaken in order to find out the differences in the characteristics of migraine headache between elderly and young for easy diagnosis and treatment.Patient and Method: We retrospectively assessed subjects seen from March 2010 to October 2010 in Baghdad Teaching Hospital neurology out-patient clinic. We applied a questionnaire based the criteria of episodic migraine headache (with and without aura) according to the international Classification of headache disorder; we elect 50 migrainous patients with age < 50 years old and compare them with other 50 migrainous patients > 50 years old.. Results: headache was more unilateral in the young group (84%) compared with ( 52%) in older patients (p=0.001). Throbbing headache and disability had been reported less in old group than in young .Pain aggravation with activity was significant more in the young group (p=0.004), the duration of pain was less in the elderly .The number of attacks also less in general when compared with the young. The presence of aura in the older group (12%) versus (24%) in young. Photophobia and phonophobia were less in elderly (P<0.0001), (P<0.0001) respectively. While nausea, diarrhea, rhinorrhoea, tearing eyes were more in older group than young. Vomiting (P=0.025) and sleeping late (as a triggering factor) (P=0.017) were more prominent features in young than older group. Conclusion: The study showed a decrease of most features in the above 50 years old group whether the differences are significant like (unilateral site of pain ,aggravation with activity, Sleeping late, Photophobia, Phonophobia, Vomiting ) and no statistical significant differences like (nausea , tiredness, hungry, uncomfortable sleep, food and need rest).Key words: Migraine, elderly patient, Younger patient

الخلاصه: الشقيقه هي من الامراض المزمنه الصداع هي اهم الاعراض الشقيقه بالاظافه الى الاعراض الاخرى المصاحبه للشقيقه`الشقيقه تقسم الى نوعين الشقيقه المصاحبه للنسمه والشيقه غير المصاحبه للنسمه الهدف: تهدف هذه الدراسه الى تحديد الفروقات الموجوده بين الشقيقه تحت سن الخمسين مع الشقيقه فوق سن الخمسين.طريقة البحث: اعتمدت هذه الدراسه على اخذ التاريخ المرضي للمشارك بالبحث وشملت خمسين مريص من هم عمرهم فوق الخميسن سنه وخمسين مريص من هم عمرهم دون الخمسين,هولاء المرضى تم جمعهم من المرضى المراجعين لمستشفى بغداد التعليمي من تاريخ اذار 2010 الى تشرين الاول 2010. النتائج: لاتوجد نتائج احصائيه فيما يخص الصداع بين المجموعتين ولكن هناك زيادة نسبة الصداع النصفي في المرضى تحت الخمسين سنه (48%) مقارنه ب (55%).الصداع النبضي ونسبة العجز كانت اقل في عمر فوق الخمسين.الصداع المتهيج اثناء الجهد كان اكثر في عمر فوق الخمسين .الوقت المستغرق لنوبة الشقيقه اقل في مجموعه فوق الخمسين سنه. عدد نوبات الشقيقه في الشهر كانت اقل في فوق الخمسين سنه.النسمه المصاحبه للشقيقه كانت اقل في فئة فوق الخمسين سنه(12) مقارنه (24) دون الخمسين سنه.فيما يخص التحسس الضوءي والصوتي كان اقل في فئة فوق الخمسين .فيما يخص الغثيان واحتقان الانف والعين كانت اكثر في فئة فوق الخمسين سنه ولكنها ليست ذا قيمه احصائيه ولكن بينت الدراسه وجود قيمه احصائيه مهمه اشارت الى زيادة اعراض التقيء والارق في الفئه العمريه دون الخمسين سنه .الاستنتاجات: الاعراض المصاحبه للشقيقه تكون اقل في الفئه العمريه الاكثر من خمسين سنه بينما الصداع النصفي الارق والقيء اكثر في الفئه العمريه الاقل من خمسين سنه.مفتاح الكلمات: داء الشقيقه . فوق الخمسين. دون الخمسين


Article
The Relationship of Post-Stroke Aphasia Types with Age, Sex and Stroke Type in a Group of Iraqi Patients

Author: Israa Farhan Salman*, Akram M, Al-Mahdawi** ,Hasan A. Al-Hamadani
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2018 Volume: 17 Issue: 2 Pages: 175-182
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND :Aphasia is a condition of Loss or impairment of the production or comprehension of spoken or written language because of an acquired lesion of the brain. Aphasia is most often caused by stroke. OBJECTIVE:To assess the relationship of post-stroke aphasia types with age, sex and stroke types PATIENTS AND METHODS:A hospital - based cross sectional survey study conducted at Baghdad teaching hospital and Al Imamain Al kadhmain medical city between October 2014 and September 2015. One hundred patients with different types of patients with proved diagnosis of stroke by clinical and radiological assessment in young age group and old one of both genders and both left and right handed were included. Data regarding the clinical and demographic characteristics of the patients were reported including: Age, gender, handedness, stroke types, stroke side, stroke site, and aphasia types.RESULTS:A total of 100 patients with different types of stroke were enrolled in this study. The mean age of the studied group was 62.1 ± 13.2 (range: 37-87) years, moreover, majority of the studied group aged more than 50 years. Females were relatively the dominant than males; 55 (55%) vs. 45 (45%) respectively. Ischemic stroke was the dominant type of stroke among cases it was reported in 76 cases (76%) compared to only 24 (24%) of hemorrhagic type. Global aphasia was found in 32 stroke cases (32%), Broca´s in 17 (17%), Thalamic 17 (17%), Putaminal 11 (11%), Werneck's 11 (11%), Motor transcortical 6 (6%), Conductive and anomia 4 (4%) and the Mixed transcortical in only two cases (2%)CONCLUSION:Post stroke Aphasia was more frequent among stroke patients older than 50 years. Ischemic stroke was the dominant type of stroke. Global aphasia was the dominant subtypes of aphasia among the studied group followed by Broca’s. Thalamic and the other subtypes were less frequent.


Article
Clinico-epidemiological study of childhood stroke in Children Welfare Teaching Hospital/Baghdad

Authors: Husham Z.Hammoodi هشام زهير حمودي --- Lamyaa A.Hammoodi لمياء عبد الكريم حمودي --- Akram M. Al-Mahdawi اكرم المهداوي
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 / 24108057 Year: 2017 Volume: 59 Issue: 1 Pages: 42-46
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: The annual incidence of stroke in children after the newborn period is approximately 2.3 per 100000. Half are ischemic, and half are non-traumaticintracerebral and subarchnoidal hemorrhages.Objectives: To study the etiologic factors, clinical presentation andoutcome of stroke among children admitted to children welfare teaching hospital/Baghdad.Patient and methods: A prospective study was carried out in Children Welfare Teaching Hospital;Children age ranged between 1 month -13 years and was admitted to pediatric neurology ward between 1st of November 2013 and 1st of November 2014. After carful clinical history, physical and neurological examinations, the diagnosis of brain stroke was confirmed in all patients by computerized tomography (CT) and/or magnetic resonance imaging (MRI). Patients included in this study were those diagnosed as having ischemic stroke, hemorrhagic stroke.Results: The total number of cases were 61, 36 were male (59%). The age at onset ranged from 1-156 months. Ischemic stroke constituted 39 patients (63.9%). The most common etiologic factors for the ischemic stroke were protein C deficiency (9, 23.1%). The most common etiologic factor for hemorrhage was bleeding disorders in about 50% of patients. The most common presenting features were hemiplegia, seizure, alteration of consciousness; Cranial nerves palsy is mostly present in the ischemic stroke (14,35.9%) and only in one patient (4.5%) of hemorrhagic stroke.Conclusions: Ischemic stroke is more common than hemorrhagic stroke in pediatric age group. The significant risk factors for ischemic stroke are protein C deficiency, Congenital heart disease(CHD) and positive family history, while vitamin K deficiency, prolong Partial thromboplastin time (PTT) and trauma are significant for hemorrhagic stroke. The most common clinical features of both types of stroke are hemiparesis, siezure and alteration of consciousness.Keywords:Ischemic stroke, Hemorrhagic stroke, Children Welfare Teaching Hospital.


Article
Anti-Myelin Associated Glycoprotein Antibody and Relapsing Remitting Multiple Sclerosis among A Sample of Iraqi Patients

Authors: Dr.Kareem M. Al-Tameemi, د. كريم التميمي --- Dr. Anmar U. Hatam, د. انمارحاتم --- Dr. Akram M. Al-Mahdawi, د. اكرم المهداوي
Journal: Karbala Journal of Medicine مجلة كربلاء الطبية ISSN: 19905483 Year: 2012 Volume: 5 no 1 Issue: 11 Pages: 1194-1199
Publisher: Kerbala University جامعة كربلاء

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Abstract

ackground:Multiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system affecting nearly 2 million people worldwide. The pathogenesis of MS is at best incompletely understood. There are several proposed mechanisms that may be important in the production of MS plaques: autoimmunity, infection, bystander demyelination and heredity. Deviation of immune responses plays a central role in the pathogenesis of MS. Auto antibodies to many myelin constituents is present in MS. These antibodies may be an autoimmune reaction to an “MS antigens” or simply part of a generalized “non-sense” antibody response. In either case, the antibodies may affect the pathology of MS.Objective: To study the association between Anti-myelin associated glycoprotein (anti –MAG) antibody and relapsing remitting multiple sclerosis in Iraq.Method: 105 patients with relapsing remitting multiple sclerosis and 85 patients with other neurological diseases (OND) as control group were recruited in this study. The cases were collected from Baghdad teaching hospital, MS center, Baghdad, Iraq at the period from April 2009 to February 2010. The sera of all patents were tested for MAG- antibodies.Results: The present study showed increase in the percent of patients with positive anti-MAG antibody in patients with relapsing remitting multiple sclerosis than the control group( 7.6% in the patients group viz 3.5% in the control group) but with no statistical significance. Also among patients group we try to study the relationship between severity of the disease measured by expanded disability status scale (EDSS) and positive serum anti-MAG antibody and we found no significant statistical association.Conclusion: There is a higher percent of patients with positive anti-MAG antibody in the serum of patients with relapsing remitting multiple sclerosis than the control group.


Article
OBSERVING THE OUTCOME OF USING NEUROAID [MLC 601] ON A SAMPLE OF IRAQI STROKE PATIENTS

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Background:Stroke is one of the major causes of morbidity and mortality throughout the world, and carries greater economic costs. [MLC 601] originates from Traditional Chinese Medicine approved in 7 countries as drug that can aids post-stroke recovery.Objective:To assess [MLC 601] efficacy in improving outcomes of Iraqi patients’ stroke.Methods:Two hundreds ischemic stroke patients and 17 intracerebral hemorrhage patients were participated in this study; they took [MLC601] at the onset of their disease for 3 months and were assessed monthly for the motor power using modified Rankin scale mRs scale, speech, and visual field assessments.Results:mRs grade [4-5] were changed from (zero out of 159) at onset to (89 out of 55) at first month and to 98 out of 134 ischemic stroke patients after 3 months; also mRs grade [4-5] were changed from (1 out of 17) at onset to (12 out of 17) at first month and to 12 out of 17 intracerebral hemorrhage patients after 3 months. In 44% of the enrolled patients with aphasia were improved. Visual field assessments showed improvement in 43% of the patients with homonymous heminopia after 3 months [MLC 601] treatment.Conclusion:[MLC 601] is associated with improvement in all post stroke disabilities and placebo controlled trial is crucial to assess the benefit of it.Key worlds:Stroke, intracerebral hemorrhage, MLC 601, NeuroAid

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