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Article
Chronic Obstructive Pulmonary Disease; an Pidemiological Prospective Study

Author: Muhammed .W.Al.Obaidy
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2012 Volume: 11 Issue: supplement Pages: 600-607
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT: BACKGROUND: COPD is preventable and treatable disease state characterized by airflow limitation that is not fully reversible, The airflow limitation is usually progressive and is associated with an abnormal inflammatory response of the lung to noxious particle or gases. Primarily caused by cigarette smoking (1)..COPD is the fourth leading cause of death worldwide and estimated to be the third cause of death by 2020(5 ). OBJECTIVE : *To describe sample of COPD patients by important parameters recommended from GLOBAL INITIATIVE FOR COPD & COPD PROFESSIONAL ORGANIZATION, (wwwgoldcopd.com &www COPD professional .org). * To have an enough idea about the prevalence of disease in Iraqi patients, study risk factors, , methods of diagnosis & management . PATIENTS AND METHODS : A cross sectional study of 200 patients that were recruited from outpatients & inpatients at medical city Those patients diagnosed as COPD according to ; -Age more than 35 years History of cough or productive cough, or. history of shortness of breath with.FEV1/ FVC less than 0.7 & FEV1 is 80% of predicted (MILD COPD) by spirometry Exclude patients-Patients with mixed obstructive & restrictive ventilator defect byspirometry. The study conducted from March 2005- March 2006 (about 1 year). to evaluate & compare the different way of presentation ,diagnosis, management & therapeutic measures. A total number of 200 patients were seen, examine,A send for important (available) tests needed & their medical records . RESULTS: Diseases are more prevalent in male 162 patients (81%) than female 38 patients (19%) & M;F about (4/1).Also COPD are more common in those who lived in rural area 127 patients(63.5%)than those in urban area 73patients(36.5%). show smoking are the most important risk factor in COPD patients recruited in this study about 177 patients( 88.5%) are smokers than 23 patients (11.5%) are never smoke. smokers about 117 patients ( 58.5% ) are current smokers( 94 patients 47% male & 23 patients 11.5% female) than 36 patients (18%) are ex smokers ( 29 patients 14.5% male & 7 patients 3.5% female) than 17 patients(8.5%) are passive smokers ( 12 patients ( 6%) male & 5 patients 2.5% female, than 7 patients ( 3.5%) all of them male are pipe smokers, In analysis cough presentation, we noticed 20 patients (10%) have dry cough and 140 patients (70%) have had productive cough. In those complaints from productive cough show 34 patients (17%) are scanty amount of sputum than 27 patients (13.5%) have moderate, and 79 patients (39.5%) large amount. . CONCLUSION: Cough and age are the most important predictors of the disease..tobacco smoking is the most important risk factors for COPD&smoking cessation is the single most effective important preventive steps cost effective in COPD management... Air pollution either indoor or outdoor plays an important role in development of COPD


Article
A Prevelance of Drug- Resistance in Previously Treated Tuberculous Patients in Baghdad

Author: Muhammed.W. AL-Obaidy
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2013 Volume: 12 Issue: supplement Pages: 626-631
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:BACKGROUND:Multi drug resistant tuberculosis (MDR-TB) is a majorpublic health problem because treatment is complicated;cure -rates are below those for drug-susceptible T.B., and patients may remain infectious for months or years despite receiving the best available therapy. The phenomenon of resistance was detected soon after the introduction of streptomycin for treatment of T.B.OBJECTIVE:To identify prevalence of MDR- TB patients in Baghdad.PATIENT AND METHOD :Across-sectional study, over a period of 1 YEAR (from January to December2012) had been carried out in Baghdad in order to identify the prevalence of drug-resistant tuberculosis in previously treated patients. 168 patients (112male and 56female) sputum smear positive patients were investigated at Chest and Respiratory institute by questionnaire about previous treatment then sent for drug susceptibility testing byegg-based solid medium of Lowenstein.RESULTS:An isolated drug resistance to streptomycin,isoniazid,Rifampicin and Ethambutul of 2.4% , 2.4% , 14.3% and 1.1% respectively. But MDR.TB.Of8.3 %( for more than one drug resistance).CONCLUSION :The high prevalence of M.D.R.T.B. and high prevalence of Rifampicin are the most alarming because of badmedical and social situation in Iraq now.


Article
The Effect of Cotton Wool Dust on Peak Flow Meter (PEF)of Textile Factory Workers in Mosul

Authors: Kassim .M. Sultan --- Muhammed .W.AL.Obaidy --- Aziz Mohammed
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2013 Volume: 12 Issue: 2 Pages: 230-236
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT : BACKGROUND:Byssinosis is a disease caused by long exposure to cotton, hamp, and flax dust, it differs from occupationalasthma, it needs along period of exposure to develop and the worker gets adaptation on subsequent days afterMonday chest tightness. The over all prevalence of byssinosis was 22.4%.Byssinosis needs at least 10 years to develop,the prevalence and severity increased with increasing duration of exposure to cotton dust. processing of cotton ismore harmful to lungs, and this is due probably to high dust concentration, or the dust contains toxinsand other organic substances which decrease in later manipulations. OBJECTIVE :To find out the prevalence of byssinosis among textile factory workers in mousel.To through alight on the relationship between smoking and byssinosis among workers exposed tocotton wool dust. the relationship between duration of working in a textile factory and occurrenceof byssinosis PATIENT AND METHOD:Two hundred and fifty Mosul Textile factory male workers , occupationally exposed to cottondust, aged (22-65) years were randomly selected and were interviewed to get information aboutage, work duration, smoking habit, and about chronic cough, phlegm, wheeze and chest tightness,and workers were examined clinically, and special considerations attended to the chest. Theworkers involved in this study were in good health at the time of engagement to this work, and anyworker with bronchial asthma, or other chest diseases were excluded. by history .Peakedexpiratory flow (PEF) was carried out for all 250 workers by Right's Peak flow meter(W18416.Harlow, England). RESULT AND DISCUSSION:All of the workers were male their age ranged 22-65 years with mean age of 45.3 years, in thosebetween 31-40 years the incidence was 10.8%, this increased to 49.3% in those whose age wasover 51 years. The mean work duration was 18.2 years, ranged (2-44) years. The prevalence was12.6% in age groups 10-19 year work duration, 47.2% in 20-29 years, and 49.2% in those over 30year work duration. In age group 10-19 years work duration moderate cases of byssinosis was4.7% and no any sever case and mean PEF 106%, while in age group over 30 year work durationthere was 33.3% moderate and 7.9% sever cases of byssinosis and mean PEF 94.9%.increasedprevalence and severity of byssinosis in sections where the dust concentration was high. In theweaving room 12%, were byssinotic, where the dust concentration was lowest, 25%, in spinningroom where the dust concentration was higher, while in ginning room where the dust concentrationis highest the prevalence was 41.8%. . CONCLUSION:We have shown that the prevalence of byssinosis is still high in MousalTexitle factory- Iraq. It isstatistically estimated that the prevalence of byssinosis after 8 years will be 35.2%, the reason forthis may be attributed to bad occupational safety measures..


Article
Prevalence of Latent Tuberculosis in End Stage Renal Disease Patients at Baghdad Teaching Hospital

Author: Kassim .M. Sultan*, Muhammed .W.AL.Obaidy *, Amer Musa Hasan **
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2016 Volume: 15 Issue: 3 Pages: 321-327
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:BACKGROUND: Tuberculosis (TB) is one of the oldest diseases known to affect humans, it caused by infection with Mycobacterium Tuberculosis (MTB). MTB is most commonly transmitted from a patient with infectious pulmonary TB to other person by droplet nuclei. End Stage Renal Disease (ESRD) patients are exposed to a variety of infections, including TB. The standard test for detecting Latent TB infection (LTBI) is tuberculin skin test (TST).OBJECTIVE: Determination the prevalence of latent tuberculosis among end stage renal disease patients in hemodialysis unit in Baghdad teaching hospital, and assessing its correlations with various conditions.METHODS: A stratified random sampling technique was used to select a sample of 71 patients of ESRD in hemodiaylsis unit in Baghdad teaching hospital. The selected patients were interviewed using a structured pretested questionnaire.Two units of PPD (0.1mL) had been injected intradermally to the volar surface of forearm to be seen within 48-72 hours. The test was considered positive if (>=10mm induration) developed.RESULTS: The study showed the rate of tuberculin reactivity among End Stage Renal Disease (ESRD) patients is 28.57%. About 57.14% of patients were male; mean age of patient was 54.34 ± 15.25 years. The major cause of renal impairment were diabetes mellitus (DM) 52.86%, followed by hypertension 15.71%, duration of dialysis more than 6 months was 46.67% . History of contact with active tuberculosis patient was 62.5%.CONCLUSION: Significant relationship between history of contact with active TB patients, duration of dialysis, and age of patients with TST positivity..


Article
Assessment Severity of Community Acquired Pneumonia
تقيم شدة التهاب ذات الرئة المكتسبة مجتمعيا باستخدام معيار كيرب 65

Authors: Muhammed .W.Al.Obaidy محمد العبيدي --- Ahmed .T. A bdulla --- kassim .M. Sultan قاسم محمد سلطان
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2011 Volume: 53 Issue: 3 Pages: 251-253
Publisher: Baghdad University جامعة بغداد

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Background: Community acquired pneumonia is the most frequent infection-related cause of death. Illness severity might usefully guide a number of management decisions and predict mortality. Confusion, blood urea ,respiratory rate ,blood pressure and age 65 years or older (CURB-65) based largely on clinical assessment.Objective: To evaluate the efficacy of CURB-65 score in assessment severity of community-acquired pneumonia and to predict mortality.Patients and Methods: Fifty patients were enrolled in this prospective study between 1st. of March 2007 and 31st. of January 2008, recruited at Baghdad Teaching Hospital diagnosed as community acquired pneumonia depending on having lower respiratory tract infection symptoms , signs and new infiltrate on the chest radiograph.CURB-65 scoring system was applied and the patients were divided into three groups low risk[CURB-65= (0-1)], intermediate risk [CURB-65= (2)], and high risk [CURB-65= (3-5)] groups . The low risk group was managed at home with oral antibiotics, the intermediate and high risk groups were managed at hospital with intravenous antibiotics. The 30-day mortalities were established.Results: There were 27(54%) females and 23 (46%) males at a median age of 68 year range from(15-90) year Thirty three patients (66%) had their age 65or older, 26 patients (52%) had B.U>7mmol/l, 11patients (22%) had R.R> 30/minute, 3 patients (6%) had systolic B.P<90 mm Hg, 11patients(22%) had diastolic B.P<60 mm Hg and 14 patients (28%) had confusion. Twenty patients (40%) were in the low risk group (CURB-65=0-1), 12 patients (24%) were in the intermediate risk group (CURB-65=2) and 18 patients (36%) were in the high risk group (CURB-65=3-5). The 30 day mortalities were (0%) in the low risk group, (16.5%) in the intermediate risk group and (30%) in the high risk.The overall mortality was 8 (16%) patients.Conclusion: CURB-65 effectively stratified patients regarding the site of medical care, type . route of administration of treatment and predicted mortality.

الخلاصه :ذات الرئه المكتسبه مجتمعيا واحده من اهم الالتهابات التنفسيه المسببه للوفاه. لذا استحدث هذا المعيار للسرعه تصنيف وتشخيص الالتهابات الصدريه لضمان سرعه التشخيص واعطاء القرار الصائب في العلاج السريع, لتجنب المضاعفات الخطيره للمرض .الغرض من الدراسه: لبيان مدى فاعليه استخدام معيار الكيرب 65 في تقيم وتشخيص شده الاصابه بالتهاب ذات الرئه المكتسبه مجتمعيا لدى المرضى الواصلين الى مدينه الطب – مستشفى بغداد التعليمي.طريقة البحث : تم جمع 50 مريضا مصابين بالتهاب ذات الرئه المكتسبه مجتمعيا( 27 انثى و 23 ذكر ) بمتوسط عمر 68 سنه بين 15-90 سنه , وكانت نسبه الذكور 46% والاناث 54% للفتره من حزيران 2007 الى كانون الثاني 2008.وهي دراسه مسح مقطعي .النتائج: تبين من الدراسه ان 20 حوالي (40%) مريضا كانوا في المتسوى الاقل خطوره الذين لايحتاجون الدخول الى المستشفى فقط اخذ العلاج من العياده الخارجيه.كما تبين ان 12 مريضا (24%) هم بالمستوى المتوسط الذي يتطلب اخذ العلاج والدخول الى المستشفى . كما تبين ان 18 مريضا ( 36%) هم بالمستوى شديد الخطوره الذي يحتاج الدخول الى صاله الانعاش.ان نسبه الوفيات كانت بالمستوى الاول هي صفر وبالمستوى الثاني هي 16.5% اما المستوى الثالث من شده الخطوره كانت نسبه الوفيات هي 30 % .


Article
Relationship Between FEV1& PEF in Patients with Obstructive Airway Diseases

Authors: Muhammed .W.AL.Obaidy --- Kassim Mhamed Sultan* --- Basil Fawzi Jameel ** --- ,Rokan Motasher Fadhil
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2011 Volume: 10 Issue: 2 Pages: 184-190
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:BACKGROUND:Spirometry is the recommended investigation for diagnosis and categorization of the severity of the air flow limitation, however Spirometer is not widely available, while Peak-flow meter is cheap, portable, and easy to operate and maintain, so the PEF is frequently proposed as alternative to FEV1 for this purpose, and widely used in general practice as a surrogate for FEV1 in assessment of airway obstruction diseases.OBJECTIVE:To determine effect of FEV1 & PEF in obstructive airway diseases.PATIENTS AND METHODS:This study was took place between 1st December 2006 and 1st July 2007in Baghdad teaching hospital. A total of 100 patients with history suggestive of obstructive airway diseases (symptoms of cough, wheezes, shortness of breath, and chest tightness), and their pulmonary function test show obstructive pattern (FEV1/FVC <70%) were included. They were (60%) male and (40%) female, and their age ranged from 16 to 82 years.RESULTS:In screening for obstructive airway diseases, there was a significant relationship (P value <0.05) between FEV1% and PEF%, (94%) of patients with obstructive airway disease as assessed byFEV1% (FEV1 %< 80%) had PEF %< 80%.In severity categorization, the PEF% and FEV1% were concordant in only (60%) of patients, with better concordance as severity of obstruction (based on FEV1%) became more. In patients with mild to moderate airway obstruction (FEV1%>40%), PEF% tended to underestimate FEV1%; while in patients with more severe obstruction (FEV1 %< =40%), PEF% tended to overestimate FEV1%. For the entire study population, PEF% underestimated FEV1% by mean of only 0.35%. However, limits of agreement were wide and exceeded-/+ 14.5. In our study 70% of patients had discordance more than 5% apart between PEF% and FEV1%, (which could be considered clinically important error for estimation of severity of airway obstruction), and this discordance more marked in women, short patients, and in patients with mild airway obstruction.CONCLUSION:The PEF% can reliably exclude airway obstruction, when normal value is present. Assumption of parity between PEF% and FEV1% must be avoided especially in categorization of severity of air way obstruction


Article
A Statistical Radiological Analysis in Patients with Sputum Smear Positive Pulmonary Tuberculosis

Authors: Waleed Latif Hussein --- Basil Fawzi Jameel --- Muhammed .W.AL.Obaidy --- Adnan M. AL,Jubouri
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2016 Volume: 15 Issue: 2 Pages: 148-157
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:BACK GROUND:Tuberculosis (TB) a multi-systemic disease with various presentations and manifestations; is due to infection with the acid fast bacillus mycobacterium. Disease occurs in only (10%) of infected individuals, it is associated with overcrowding and immune-compromised statesOBJECTIVE:To identity the main findings in plain chest X-ray and CT-scan of the chest of pulmonary tuberculosis patients with sputum smear positive in relation to certain factors and clinical conditions including : gender, age , smoking , alcohol- consumption , co-morbid diseases e.g. diabetes mellitus and steroid medication for more than 4 weeks .PATIENT AND METHOD:Across sectional study of randomly collected (100) patients all were new cases of pulmonary tuberculosis disease with sputum smear positive, A plain chest radiography was done to all of them , and a randomly chosen (30) patients (out of the same sample of the study) were examined also by ( high resolution CT-scan ) of the chest to compare the radiological findings.The sample of patients collected consisted of (68)males and (32) females , aged between (12 -82) years.The study was done in the specialized chest and respiratory diseases center in Baghdad during the period from first of March 2012 ,to the end of August 2012.RESULTS:100patients with sputum smear positive – pulmonary tuberculosis disease were collected, 68 patients (68%) were males and 32 patients (32%) females. From our study97 patients(97%)of total number presented with positive radiological findings whether by plain chest X-ray and /or CT-scan of chest, And 3 patients(3%) of the sample studied were with normal both plain chest X-ray and CT-scan of chest.The radiological findings of all of the patients studied were as :Infiltrative lesion48 patients( 48% )Cavitary lesion(: 37%)Consolidation ( 32%)Pleural effusion (17%)Miliary shadowing( 1%)Clear radiological was found that 28 patients (28%) had radiological abnormalities in the right side of the chest and 25 patients were with left sided radiographic abnormality, while bilateral chest radiological finding had been shown in44 patients (44%).CONCLUSION:The CT- scan of chest is more sensitive than plain chest X-ray for evaluation of abnormal or obscured radiological findings. There is no specific pattern for radiological finding in the chestthe direct sputum examination is remained the 'gold standard' for the diagnosis of pulmonary tuberculosis.


Article
Rate of Tuberculin Reactivity Among Health Care Workers in Ibn-Zuhur and Ibn-Alkhateeb Hospitals

Author: Kassim .M. Sultan**, Muhammed .W.AL.Obaidy **, Ismael Ibraheem M.ALZubaidi*
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2015 Volume: 14 Issue: 3 Pages: 436-442
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:BACKGROUND: Tuberculosis is one of the oldest diseases known to affect humans, it caused by infection with Mycobacterium Tuberculosis, which is part of a complex organisms including M.bovis ( reservior Cattle ) and M.africanum ( reservior human ). Mycobacterium Tuberculosis is most commonly transmitted from a patient with infectious pulmonary TB to other person by droplet nuclei which are aerosolized by coughing, sneezing or speaking. Health care workers are exposed to a variety of infections, including TB. the standard test for detecting Latent TB infection is tuberculin skin test (Mantoux test) using purified protein derivatives of Mycobacterium Tuberculosis.OBJECTIVE: Is to estimate the rate of TB transmission from patients with active disease to the Health care workers, and also to study the relation of different variables to the transmission risk including (Gender, Vaccination, and Duration of contact or occupation duration). SUBJECT AND METHODS: Cross sectional descriptive study done in Ibn-Zuhur hospital and Ibn-alkhateeb hospital between April and May 2013 .One hundred and two Health care workers were included in this study (50) HCWs from Ibn-zuhur hospital and (52) Health care workers from Ibn-Alkhateeb hospital. 5 units of PPD (0.1mL) had been injected intradermally to the volar surface of forearm to be seen within 48-72 hours. The test was considered positive if (>=10mm induration) developed.RESULTS:The study shows the rate of tuberculin reactivity among health care workers 25.5% (26/102) a significant relationship between duration of work in hospital and tuberculin reactivity among HCWs. (50) HCWs from Ibn-zuhur hospital their age ranging between 24-48 years mean 36 year, 34 (68%) were male and 16 (32%) female and (52) HCWs from Ibn-Alkhateeb hospital their age ranging between 21-43 years mean 32 year, 42 (81%) were male and 10 (19%) female.in Ibn-zuhur hospital 32%(16/50) Ward nursing staff (5-10) years' work duration shows the higher rate (38.5%) followed by Laboratory staff ( 5-10) years (28.57%) and then doctors < 5 years' work (25%) ,service workers (2-5) years' work shows (22.22 %).While in Ibn-Alkhateeb hospital 19% (10/52) ward nursing staff (5-10) years' work duration shows the higher rate 27% followed by Laboratory staff (20%) and then service workers (2-5) years' work shows (12.5%) while doctors < 5 years work duration shows (8.5%).CONCLUSION: Health care workers have high rate of latent TB infection. Their positivity correlated with the duration of their jobs. Health care workers with negative tuberculin skin test should be immunized with BCG vaccine..


Article
Spiro metric Tests and Thyroid Hormone Concentrations in sample of Iraqi Patients with Chronic Obstructive Pulmonary Disease
دراسة العلاقة ما بين اختبار قياس التنفس وتراكيز هورمونات الغدة الدرقية لدى مجموعة من مرضى الانسداد الرئوي المزمن العراقيين

Authors: Muhanned A. Weheeb مهند عيال وهيب --- Kassim M. Sultan قاسم محمد سلطان --- Muhammed W. Al.Obaidy محمد وهيب
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2014 Volume: 56 Issue: 3 Pages: 273-282
Publisher: Baghdad University جامعة بغداد

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Background: Chronic obstructive pulmonary disease (COPD) is a preventable disease with some significant extra pulmonary effects that may contribute to the severity in individual patients.. The systemic manifestations of COPD include a number of endocrine disorders , such as those involving the pituitary, the thyroid , the gonads, the adrenals and the pancreas. The mechanisms by which COPD alters endocrine function are incompletely understood but likely involve hypoxemia , hypercapnia , systemic inflammation and glucocorticoid administration. Objective: To evaluate the relationship between pulmonary function tests and thyroid gland function in patient with chronic obstructive pulmonary disease (COPD).Subjects and Methods: Cross sectional study was done in Baghdad teaching hospital from April 2012 to October 2012 in respiratory outpatient. Thirty eight patients were included in the study (36 male and 2 females) who had stable COPD , thyroid function tests and FEV1% were done to all of them. Patients were classified into four groups according to GOLD criteria: mild COPD ( > 80) FEV1% , moderate (80 – 50)%, severe ( 50 – 30)% and very severe < 30%. Results: one patient has decreased level of TSH , one patient has decreased T3 hormone and one patient has increased free T3 hormone level, all other patient had normal thyroid hormones levels. The results of study showed no significant changes in thyroid hormones concentrations with COPD and its severity. Conclusion: We found no significant changes in thyroid hormones in patients with COPD, and any changes that occur in TFT in these patients are may be due to other causes than COPD.Keyword: COPD, : Chronic Obstructive Pulmonary Disease. TSH:Thyroid function test

الهدف: لتقييم العلاقة بين وظائف الرئة واختبارات الغدة الدرقية في مرضى الانسداد الرئوي المزمن (COPD) المواضيع والأساليب دراسة مقطعية عرضية في مستشفى بغداد التعليمي من أبريل 2012 إلى أكتوبر 2012 في العياده الخارجية لامراض الجهاز التنفسي. أدرج ثمانية وثلاثين مريض في الدراسة (36 من الذكور والإناث 2) حيث كان مرض الانسداد الرئوي مستقرا لجميع المرضى، واجريت اختبارات وظائف الغدة الدرقية و نسبة FEV1٪ لجميع المرضى. تم تصنيف المرضى إلى أربع مجموعات وفقا لمعايير GOLD: COPD خفيف (> 80) FEV1٪، متوسطة (80 - 50)٪، شديدة (50 - 30)٪ و قاسية جدا <30٪ .النتائج: وقد اظهرت النتائج وجود مريض واحد قد انخفض لديه مستوى TSH، ومريض واحد انخفض لديه هرمون T3 , ومريض واحد فقط قد ازداد لديه مستوى هرمون T3 الحر، بقية نتائج اختبرات هرمونات الغدة الدرقية كانت طبيعية لجميع المرضى. اي ان نتائج الدراسة لم تظهر أي تغييرات كبيرة في تركيزات هرمونات الغدة الدرقية ومرض الانسداد الرئوي المزمن و حدته.الاستنتاج: لم نجد أي تغييرات كبيرة في هرمونات الغدة الدرقية في المرضى الذين يعانون من مرض الانسداد الرئوي المزمن، وأية تغييرات تحدث في وظائف الغدة الدرقية في هؤلاء المرضى قد يكون راجعا إلى أسباب أخرى غير مرض الانسداد الرئوي المزمن.مفاتيح الكلمات: انسداد القصبات الرئوي المزمن. تراكيز هرمونات الغده الدرقية.


Article
Comparison of Asthma Control Test (ACT) with (GINA) guidelines in the Assessment of Asthma Control and determine if can use Asthmda Control Test ACT as alternative to Gina guidelines in control asthma
دراسة مقارنة اختبار فحص السيطرةِ على الربو مع البروتوكولات ألعالميه للربو(جينا) في تقييمِ السيطرةِ على الربو وإيجاد إذا يُمْكِنُ أَنْ نستعملَ اختبار فحص السيطرةِ على الربو كبديل أداة إلى البروتوكولات ألعالميه للربو(جينا).

Authors: Kassim M. Sultan قاسم محمد سلطان --- Ahmed H. Jamer احمد حسن جبر --- Muhammed W.Al.Obaidy محمد وهيب
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2016 Volume: 58 Issue: 1 Pages: 1-7
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: The gold standard in assessing asthma control is the Global Initiative for Asthma (GINA) criteria. And because of the difficulties of access to pulmonary functions tests, The ACT has the added advantage that it does not require lung function assessment.Objectives: The aim of this study is to assess asthma control through ACT score and GINA guideline, and to determine if the ACT can be as useful as the GINA-guidelines criteria in assessing asthma control in Iraq.Patient and method: Cross sectional study with comparing ACT vs. GINA guideline in control of asthma level. This study was conducted at Respiratory consultation unit of the Iraqi National center of early detection of Cancer, Baghdad-Iraq, The study was conducted during the period from 1stNovember 2012 to 1stJuly 2013. A total of 71 adult asthmatic patients who were attended to the respiratory consultant unit were asked to participate and were enrolled in this study regardless their age or gender. Their asthma diagnosed and proved clinically by a combination of history, clinical finding In addition objective measurements using spirometry(FEV1) measured by the reversibility test which is defined as(an increment of>12% or 200 ml of FEV1 after 20 minutes of administration of inhaled short acting B2-agonist)Result: There were 71 patients enrolled in this study, of them 66 (92.96%) had an ACT score of ≤ 19 ((26)(39.4%) are male),(40)(60.6%) are female ,and 5 patients (7.04%) had an ACT score of > 19 (only(1)(20.0%) is male and and(4)(80.0%) are female. It had been found the number of male is( 27)and(26)(39.4%)out of them had an ACT<19and only(1)(20.0%) had ACT>19 and number of female is(44),(40)(60.6%)out of them had ACT<19 and(4)(80.0%)had ACT>19. No significant differences had been found in between those patients with ≤19 ACT score vs. those with > 19, regarding the age and gender, in both comparison P>0.05 it had been found that good agreement present between ACT and GINA, 92.9%.ACT agreed the GINA in (37 patients with uncontrolled asthma, 24 patients with partially controlled and 5 patients with controlled).Conclusion: ACT can serve as an alternative diagnostic tool in assessing asthma control even without an aid of a spirometer or a peak flow meter. An ACT score of more than 19 can classify patient as controlled asthmatic while an ACT score < 19 can classify the patient as uncontrolled and partially controlled asthmatics.Keyword: (ACT): Asthma Control Test.(GINA) Global initiative for asthma

الخلفية :أن المعيار الأساسي في تَقييم سيطرةِ الربو هي البروتوكولات العالميةُ للربو (جينا). وبسبب صعوباتِ الوصولِ إلى إختباراتِ الوظائفِ الرئويةِ من قبل المريض، فان فحص السيطرة على الربو لَهُ الفائدةُ الإضافيةُ التي هي لا تَتطلّبُ الحصول على وظائف الرئه.طريقة العمل:دراسة متوقّعة بمُقَارَنَة فحص السيطرة على الربو مقابل البروتوكولات العالميةُ للربو (جينا)للسيطرة على مستوى الربو. هذه الدراسةِ أجريتْ في وحدةِ الإستشاريةِ التنفسيةِ في المركزِ الوطنيِ العراقيِ للكشفِ المبكّرِ عنالسرطانِ، بغداد/العراق، الدراسة أجريتْ في الفترة من1 تشرين الثاني 2012إلى 1تموز2013. تم اجراء الدراسة على 71 مريضامن عمر 15سنة فما فوق راجعوا وحدةَ الاستشارةِ التنفسيةِ. تم تشخيص الربو وأثبتَ سريرياً مِن خلال التاريخ المرضي، إضافة إلى الإعراض السريرية، واستخدام فحص وظائف الرئة (سرعه جريان الزفير الأقصى عند الثانية الأولى) عن طريق الاختبار الانعكاسي ا لذي يعَرَّفُ(بزيادة> 12 % أَو 200 ملي لتر بعد 20 دقيقةِ مِنْ استنشاق التمثيل القصيرِ المُسْتَنْشقِ (B2 agonist)النتائج :تم تسجيل واحد وسبعون مريضَا في هذه الدراسةِ، منهم 66 (92.96 %) كَانَت عِنْدَهُم نتيجة ACTاقل من 19 و5 مرضى (7.04 %) كَانتَ عِنْدَهُمْ نتيجةُ ACTاكثر من 19، و كَانَ عددَ الذكورهو (27) منهم(26) (39.4 %) كَانَ عِنْدَهُ ACT<19 وفقط (1) (20.0 %) كَانَ عِنْدَهُ ACT> 19 وعدد الأناث (44)، منهم(40) (60.6 %) كَانَ عِنْدَهُ ACT<19 و(4) (80.0 %) كَانَ عِنْدَهُ ACT> 19. لا اختلافات هامّةَ قَدْ وُجِدتْ في المرضى بخصوص العُمر والجنس، في كلتا المقارنة P.value> 0.05وهدا يدل على الاتفاق بشكل ملحوظ بين فحص اختبار السيطرة على الربو وبروتوكولات جينا، (92.9 % )كانت نسبة الاتفاقية بينهم في (37 مريض غير مسيطر على الربو، 24 مريض مسيطر عليهِ جزئياً و5 مرضى مسيطر عليهِ).الاستنتاج: فحص اختبار السيطرة على الربو يُمْكِنُ أَنْ يَعْملَ كأداةِ تشخيصيةِ بديلةِ في تَقييم السيطرةِ على الربو حتى بدون مساعدةِ جهاز وظائف الرئة.وان نتيجة فحص اختبار الربو أكثر من 19 يُمْكِنُ أَنْ يُصنّفَ المريضَ مصاب بالرَّبوِ مسيطر عليه بينما نتيجة فحص اختبار الربو اقل من19 يُمْكِنُ أَنْ يُصنّفَ المريضَ مصاب بالرَّبو لا يمكن السيطرة عليه ومسيطر عليه جزئياً.مفتاح الكلمات: اختبار السيطرة على الربو ACT، البروتوكولات العالمية للربو (جينا) GINA

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