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Article
Beneficial Effect of Isotretinoin Gel As AdjunctiveTreatment to Oral Azithromycin in the Management of Facial Acne Vulgaris.

Author: Sabeeh A. Al-Mashhadani
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2009 Volume: 8 Issue: 1 Pages: 7-10
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Acne is a multifactorial disease with multiple pathogenic factors, hence combination therapies are needed. Combination therapies using agents with complementary mechanisms of action increasingly are recognized as an effective strategy for treating acne.OBJECTIVE:The rationale of utilizing topical retinoids with azithromycin in treating facial acne vulgaris will be highlighted, particularly in relation to improvement.METHODS:A randomized, clinical trial was carried out at the outpatient Department of Dermatology and Venereology, Baghdad Teaching Hospital between April 2007 and August 2008.A total of 48 patients with moderate to severe papulopustular acne vulgaris were allocated to two groups, azithromycin and azithromycin plus isotretinoin gel, both groups received Azithromycin for two months. Azithromycin 250 mg was prescribed every day for one month and every other day for the following month. Patients in second group were instructed to apply Isotretinoin gel 0.05% once daily over a 3 months treatment period. The clinical assessment was done by counting the number of inflammatory lesions in three occasions: baseline, two months and three months.RESULT:After two months, both groups showed a statistically significant difference from the baseline in reducing inflammatory lesions and improving acne. Adding topical isotretinoin gel produced a higher percentage of reduction in their lesional counts, but differences between the two groups were not statistically significant. After three months, regression in the percentage of reduction of the lesional count from 57.7% to 32.4% in the first group. While in the second group the reduction was maintain in 69.8%.CONCLUSION:Adding topical 0.05 per cent isotretinoin gel to oral azithromycin enhances and maintains the rate of improvement of facial acne vulgaris.


Article
Penile Dermatoses in Out-patient Dermatological Clinic
الحالات الجلدية القضيبية عند مرضى العيادة الخارجية الجلدية

Author: Sabeeh A. Al-Mashhadani د. صبيح عباس حسن المشهداني
Journal: IRAQI JOURNALOF COMMUNITY MEDICINE المجلة العراقية لطب المجتمع ISSN: 16845382 Year: 2006 Volume: 19 Issue: 3 Pages: 268-271
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

AbstractBackground: Penile dermatoses induce a high concern for the patients and inflect a real psychological trauma.Objective: This study was designed to assess the spectrum of penile dermatological conditions.Methods: A total of 90 patients with penile dermatoses were recruited in this study during the period from October2002-2004. History and full clinical assessment were performed Results: The third and the forth decade of life were the commonest age groups affected. Penile dermatoses of infectious causes comprised of forty-nine cases. The percentages of each contagious penile dermatosis from the total recruited patients were as follow: scabies (17.8%), genital warts (15.6%), herpes genitalis (8.8%), molloscum contagiosum (6.6%), candidiasis (2.2%), boil (2.2%) and syphilis (1.1%). Other non-communicable dermatoses were irritant and allergic contact dermatitis (11.1%), fixed drug eruption (11.1%), lichen planus (6.6%), psoriasis (5.7%), vitiligo (5.7%), angiokeratoma (2.2%), lichen nitidus (1.1%), Peyronie´s disease (1.1%), and lichen simplex chronicus (1.1%).Conclusion: A wide spectrum of dermatoses affects the penis, 45.6 % of the lesions were non–infectious. There is a considerable shift of the contagious group toward viral infections rather than bacterial infections and other infestations. Key words: Penile dermatoses, Out-patient

الملخص: أن الأمراض الجلدية التي تصيب العضو الذكري تحدث قلقا عاليا للمرضى وتسبب صدمة نفسية حقيقية.ان هذه الدراسةِ صُمّمتْ لتَقييم طيفِ الإمراض الجلدية القضيبية. أجريت هذه الدراسة على تسعين مريضا مصابا بالامراض الجلدية القضيبية خلال الفترة من تشرين الأول 2002-2004 حيث تم جمع المعلومات المرضية والسريرية للمرضى.بينت النتائج ان هذه الامراض اكثر شييوعا في العقد الثالث والرابع من العمروكانت الحالات التيي سببها معدي هي تسعة واربعون حاله, اما النسب المؤية لكل حالة معدية فكانت 17.8% للجرب,15.6% للثاليل الجنسية,8.8% الحلاء البسيط ,6.6% داء اللؤلؤة المعدي ,2.2% فطر كانددي,2.2% دمامل , 1.1% للسفلس.الحالات غير المعدية كانت 11.1% للتلامس التسحسي والمهيج, 11.1% للطفح الدوائي الثابت, 11.1% للحزاز,5.7% للصدفية, 5.7% للبهاق, 2.2% تقرن دمويي وعائي, 2.2% الحزاز الحبيبي , 1.1% مرض بايروني, 1.1% للحزاز البسيط المزمن.نستنتج من هذه الدراسة بان طيف الامراض الجلدية القضيبية هو طيف واسع وان 45.6% منها هي غير معدية وهناك تغيير واضح في نمط الامراض المعدية حيث زيادة الامراض الفايروسية على حساب مرض الجرب.


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

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
Topical Treatment of Melasma with Lactic Acid Cream: a Comparative Study with Glycolic Acid Cream

Author: Ali F.Al-Saadi* ,Khalifa E. Sharquie**, Sabeeh A. Al-Mashhadani **
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2017 Volume: 16 Issue: 3 Pages: 229-234
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Melasma is a major cosmetic problem affecting young people mainly females. There are many modalities of topical therapy but usually end with relapse.OBJECTIVE: To evaluate the efficacy and safety of 6% lactic acid cream in comparison with glycolic acid cream 6% and 12% in the treatment of melasma.PATIENTS & METHODS: This is a COHORT comparative therapeutic trial conducted in the Department of Dermatology-Baghdad Teaching Hospital.Sixty patients with melasma were included in this study. They were divided into three groups; each one consisted of twenty patients. Group one treated with 6% lactic acid cream, group two with 6% glycolic acid cream, group three with 12% glycolic acid cream. Patients were evaluated clinically using wood’s light & melasma area severity index score before and after therapy. Follow up was done regularly every two weeks for two months to assess the improvement and side effects. Also patients were seen monthly for 3 months after the end of treatment to see any relapse. All patients were instructed to apply the cream once at night for two months with broad spectrum sun block SPF > 30 before sun exposure. RESULTS: In group one of the study using lactic acid cream 6%, 14 patients completed the study; their ages ranged from 26-42 years, with a mean 31.9 SD 4.1 years, twelve patients (86%) were females and 2 (14%) males. The result showed that the average score before treatment was 11.45  2.9 while after treatment score changed to 5.312.71; so the improvement was 6.14, this represented a (54%) decrease and was statistically significant (p value<0.0005). No important side effects were recorded during the treatment or follow up. In group two of the study using 6% glycolic acid cream, 13 patients completed the treatment; their ages ranged from 17- 40 years with a mean 27.5  SD 6.8 years, all patients (100%) were females. The result revealed the mean of score before treatment was 10.56  2.77 while after treatment score became 8.36  2.85. So the average decrease was2.2 which represented (21%) decrease and it was statistically significant (p value<0.0005). No important side effects were recorded during the treatment or follow up. While In group 3 of the study using 12% glycolic acid cream,15 patients completed the study; their ages 22 to 40 years with a mean of 31.8  SD 5.3 years. Thirteen (87%) patients were females and 2 (13%) males. The result showed that the mean before treatment was 12.54  3, 4 while after treatment score changed to 6.06  2.38. So the average decrease was 6.48; this represented 52% decrease and was statistically significant (p value <0.0005). No important side effects were recorded during the treatment or follow up. The three agents were statistically significant for the treatment of melasma and there were no significant difference between 6% lactic acid cream and 12% glycolic acid cream (p value= 0.654). But there were significant difference between 6% glycolic acid cream and the others.CONCLUSION: Lactic acid cream 6% is a new, non costly, alternative effective, safe agent and as effective as 12% glycolic acid cream for the treatment of melasma.

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Article
Treatment of Vitiligo Patients with Narrow Band Ultraviolet Light -B and Associated Predictive Factors (A Prospective Interventional Therapeutic Study)

Author: Hayder R. Al-Hamamy* , Sabeeh A. Al-Mashhadani **, Manar G. Aziz
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2018 Volume: 17 Issue: 1 Pages: 13-21
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND: Vitiligo is a common dermatological disease with a great psychological impact on the life of individual. Narrow band ultraviolet B phototherapy has been used successfully for the treatment of vitiligo with variable results.OBJECTIVE: To assess the response to NB UVB and to identify factors that could predict the response to therapy.Patients and methods: This study is an interventional prospective therapeutic study, had been conducted in the Department of Dermatology and Venereology - Baghdad Teaching Hospital extending from October 2013 to October 2014. Thirty two patients with vitiligo were included in the study , the ages ranged from 8- 35 (18.84±7.86) years, 22 (68.8%) females and 10 (31.2%) males, the body surface area of vitiligo ranged from 2- 60%( 23.8 ± 16.66 ), full history and physical examination , assessment of skin phenotype , daily life quality index before and after completing the 48 sessions. Narrow band phototherapy was given twice weekly, recording of the body surface area of vitiligo was done before the treatment and every 16 sessions till the end of 48 sessions. Documentation of the first response session for every patient, calculation of the total percent of reduction , the main predictive factors and the development of any side effect had been recorded.RESULTS: First response session ranged from 3- 20 (10th ± 4.37) ,the response of patients according to the degree of regimentation was as the following: 3 (9.37%) patients had excellent response, 6 (18.75%) patients had good response , 14 (43.75%) patients had moderate response and 9 (28.12%) patients had poor response. The age of patients and negative hair involvement had a statistically significant correlation to the total percent of reduction. The face was the area of maximum response , The side effects were tolerable and no patient discontinued the treatment due to the side effects. Daily life quality index showed a statistically significant reduction at the end of treatment.CONCLUSION: Narrow band is an effective treatment for vitiligo with few side effects. Age of the patients and absence of hair involvement are favorable predictive features. The face was the area of maximum response.


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.


Article
Zinc Sulphate 5%Mouthwash is an Effective Therapeutic and Prophylactic Agent in Treatment of Recurrent Aphthous Ulcer (Single blind placebo controlled therapeutic study)
محلول الزنك 5%غسل فموي عقار مؤثر علاجي ووقائي لتقرح الفم المتكرر دراسه احاديه معميه

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Abstract

Background: Recurrent aphthous ulcer (RAU) is a common disease where its exact etiology and pathogenesis are not known. There is no uniformly effective therapy for this disease. Recent study showed that oral zinc sulphate has effective therapeutic and prophylactic role in management of this disease.Objective: To evaluate the therapeutic, prophylactic efficacy and safety of 5% zinc sulphate mouthwash in the management of patients with RAU.Patients and Methods: This is single blind placebo controlled therapeutic study where 40 patients with early onset oral aphthosis were recruited in this work those who attended Baghdad Teaching Hospital-Department of Dermatology between April 2005- April 2006. Patients were divided into two groups: Group A (20 patients) were instructed to use 5% zinc sulphate mouthwash, 5 ml twice daily for three months, while 20 patients in Group B used placebo in a form of distilled water mouthwash and in a similar way to zinc sulphate mouthwash. A short term assessment of each patient of both groups was done to evaluate the therapeutic effect of the drug by using oral clinical manifestation index (OCMI and the mean size of the largest diameter of ulcers. A long term assessment was done for each patient to evaluate the prophylactic effect of the drug by using (OCMI) before, after 1, 2 and 3 months of therapy. Results: The patient included in this study 19 males (47.5%) and 21 females (52.5%), female to male ratio was 1.1: 1. Their ages ranged between 20-60 (29.6 ± 9.6 ) years. The mean of OCMI in Group A started to decline directly after 4 days of therapy and went to its lower level after 8 days of therapy, and it was statistically significant (P value <0.05). The change in the mean of OCMI of Group B after 4 and 8 days of therapy was also statistically significant (P value <0.05). The response rate (percentage of change in the mean) after 4 days of therapy in Group A was 22.65% and in Group B was 6.44%, while the response rate after 8 days of therapy in Group A was 66.33% and in Group B was 44.98%. The difference in the response rates after 4 and 8 days between Group 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, and it was statistically significant (P value <0.05). The change in the 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 44.30% and in Group B was 15.08%, while the response rate after 8 days of therapy in Group A was 83.54% and in Group B was 55.36%. The difference in the response rates after 4 and 8 days between Group A and B was statistically significant (P-value <0.05). So the therapeutic effect of zinc sulphate mouth wash was statistically more significant than placebo effect. No significant side effects were noticed apart from mild irritation in two patients using zinc sulphate. Zinc sulphate mouth wash showed statistically significant prophylactic effect in comparison to placebo after 1, 2 & 3 months from starting therapy using the oral clinical manifestation index. Conclusions: Zinc sulphate 5% mouthwash is a new, safe effective therapeutic and prophylactic remedy in management of RAU. The mechanism of action could be related to its immunomodulatory, antimicrobial, antioxidant actions and effects on wound healing

Keywords

zinc sulphate --- RAU --- mouthwash.

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