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Article
VIDEO CAPSULE ENDOSCOPY

Author: Sarkis K Strak
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2006 Volume: 12 Issue: 1 Pages: 77-80
Publisher: Basrah University جامعة البصرة

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VIDEO CAPSULE ENDOSCOPYThe first rigid endoscope that allowed inspection of the upper gastrointestinal tract under a general anaesthetic was introduced by Bruening in 1907. Forty years later, the first flexible fiber optic instrument allowed procedure to be done under light sedation. A major advance occurred in 1998 when capsule endoscopy was developed in Europe and introduced into clinical practice, which enabled complete visualization of the small intestine. The U.S Food and Drug administration (FDA) approved its use in August 2001. Since then, more than 50000 capsules have been used in more than 50 countries.Historically, the small intestine was considered technically difficult to examine because of its length, location, and tortuosity.Esophago-gastro-duodeuoscopy allows for direct inspection of the duodenum, similarly, incubating the ileocecal valve at colonoscopy or so called terminal ileoscopy can access the very distal portion of the small intestine. Evaluating the more than 20 feet of small bowel that lie beyond the reaches of these instruments has been impeded by difficult technical challenges. Yet, examination of this segment is especially important in evaluating patients with various disorders including gastrointestinal bleeding from an obscure source.Previously the small intestine could be partly assessed by a push enteroscope, which is longer (about 2 meters) than a standard gastroscope and therefore allows examination of up to 80-120 cm beyond the ligament of Treitz, while intraoperative enteroscopy required a general anasethetic and laparotomy where the enteroscope is manually fed though the small intestine and gradually pulled back to allow for close inspection of the mucosa.Barium follow though and enteroclysis allow indirect examination of the small Bowel but have a low diagnosis rate1, relatively insensitive for flat diminutive, infiltrative or inflammatory lesions.Given the limitation of these tests, there has been a surge in investigations on the practical diagnostic ability and clinical utility of capsule endoscopy that allows for direct visualization of the entire small intestine lining2,3.TBas J Surg, March, 12, 2006

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VIDEO --- ENDOSCOPY


Article
KEY FEATURES PROBLEMS: A MORE VALID WRITTEN EXAMINATION TO ASSES ‎

Author: SARKIS K STRAK
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2007 Volume: 13 Issue: 2 Pages: 30-34
Publisher: Basrah University جامعة البصرة

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Article
OBJECTIVE STRUCTURED EXAMINATION AS A TOOL FOR MEDICAL ‎ASSESSMENT‎

Author: SARKIS K STRAK
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2005 Volume: 11 Issue: 2 Pages: 6-8
Publisher: Basrah University جامعة البصرة

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Article
MOSAIC APPEARANCE OF GASTRIC MUCOSA AS A PREDICTOR FOR HELICOBACTER PYLORI INFECTION

Authors: Sarkis K Strak --- Ali Adnan Mohsin
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2013 Volume: 19 Issue: 2 Pages: 26-33
Publisher: Basrah University جامعة البصرة

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Ali Adnan Mohsin* & Sarkis K Strak@*MBChB Registrar, @MBChB, MRCP, FRCP, Professor, Department of Medicine, University of Basrah, Basrah, IRAQ.Abstract Experimental evidence supports a significant association between H. pylori infection and mosaic appearance of gastric mucosa. This study was carried out to find the significance of gastric mosaic mucosal pattern as a predictor of H. pylori related infection. A total of one hundred consecutive patients were selected from those attending endoscopy unit at Al-Sader Teaching Hospital for various dyspeptic symptoms; fifty with mosaic gastric mucosa as patients and fifty with normal gastric mucosa as controls. They were classified according to their ages, gender, and smoking habits. Two endoscopic biopsies from the antrum and corpus were taken from each patient and control and were tested for H. pylori by rapid urease test. Mosaic gastric mucosal pattern was significantly associated with H. pylori infection, as compared with normal mucosa. Age was an important determinant for mosaic mucosal pattern and H. pylori infection, however; gender did not contribute to mosaic mucosal appearances and H. pylori infection, while smoking can contribute to mosaic mucosal appearance but not H. pylori infection. In conclusion, mosaic mucosal pattern is a good indicator in predicting H. pylori related infection.


Article
HELICOBACTER PYLORI INFECTION AMONG PATIENTS WITH DIABETES MELLITUS

Authors: Ali K Jumaa --- Sarkis K Strak
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2015 Volume: 21 Issue: 1 Pages: 12-17
Publisher: Basrah University جامعة البصرة

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Helicobacter pylori (H. pylori) is a gram-negative bacterium that specifically colonizes the gastric epithelium causing many complications. The link between H. pylori infection and diabetes mellitus (DM) remains controversial. This study was conducted to determine the frequency of H. pylori infection among a group of subjects with DM and to compare it with that of an age and sex-matched group of non-diabetic subjects. This case control study was conducted in Al-Sadr Teaching Hospital, Basrah, Southern Iraq from January 2013 to September 2014 on 200 subjects aged ≥ 40 years, 100 diabetic and 100 non-diabetic subjects. All subjects were required to submit fresh stool samples which were tested for evidence of H.pylori infection by stool antigen positivity. Helicobacter pylori infection was detected in 43% of diabetic group and 25% of controls, which was found to be statistically significant ( p value=0.007). In conclusion, the present study suggests that diabetic subjects are at more risk for H. pylori infection in comparison to non - diabetic subjects. This association is found to be higher in those with long duration of DM and those with poor glycemic control.


Article
GALLSTONES AMONG PATIENTS WITH TYPE 2 DIABETES MELLITUS

Authors: Munther Jalil Abdul-Abbas --- Sarkis K Strak
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2016 Volume: 22 Issue: 2 Pages: 10-16
Publisher: Basrah University جامعة البصرة

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Abstract The link between gallstones formation and diabetes mellitus remains controversial. The study aims to find the prevalence of gallstones in diabetic patients and its relation with status of control, and duration of diabetes mellitus. A case-control study was conducted in Al-Basrah General Hospital; Basrah city, southern Iraq from January 2015 to September 2015. The study enrolled 100 type 2 diabetic patients with no abdominal pain (60% females, 40% males) as a test group and 100 asymptomatic subjects with no diabetes mellitus (60% females, 40% males) as a control group. Both groups were comparable for gender, age, and body mass index and examined by ultrasound to find gallstones. Blood samples were taken for fasting blood glucose and body mass index was measured. Age, gender, family history of gallstones, and parity for females were recorded in both groups. The tested group was further divided into two subgroups with and without gallstones. The association between duration of diabetes mellitus and hemoglobin A1c level with gallstones was assessed. Gallstones were detected in (28%) of diabetic group and (12%) of controls, which was highly statistically significant (p value=0.005). The prevalence of gallstones was found to be significantly higher among those with more than 10 years of diabetes and poor glycemic control compared with those with less than 5 years and good glycemic control. The study suggested that diabetic patients are at higher risk for gallstones in comparison to non-diabetic patients. Gallstones are found to be higher in those patients with long duration of diabetes mellitus and poor glycemic control.


Article
ISOLATION OF CagA AND VacA GENES FROM H. PYLORI INFECTED PATIENTS WITH VARIOUS GASTRODUODENAL LESIONS 31

Authors: Awatif H Issa --- Sarkis K Strak --- Mohamed H Khudor
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2010 Volume: 16 Issue: 1 Pages: 31
Publisher: Basrah University جامعة البصرة

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This study aimed to learn the incidence of Helicobacter pylori infection in patients with various gastroduodenal endoscopic lesions and the frequency of virulence H.pylori associated genes CagA and VacA in these patients.One hundred seventy six patients (96 males and 80 females) attending endoscopy units for various dyspeptic symptoms were studied.Antral biopsies were obtained to detect H.pylori by rapid urease test, culturing and histopathologic examination. Twenty five patients with positive H.pyloriisolates who were found to be mannose resistant, were tested for cytotoxic associated (CagA) and vacuolating cytotoxin A (VacA) genes.Among studied patients, positive H.pylori detected by rapid urease test, culturing and histopathologic examination (from 50 patients only) were 113(63%), 127 (71%) and 25 (50%) respectively.Out of 25 patients with positive H.pylori isolates who were found to be mannose resistant, positive genes of either CagA or VacA were detected in 18(72%) patients with positive isolates, while positivity of both genes were detected in 13(52%) patients with positive isolates. Five (45.4%) and 5 (45.4%) out of patients with duodenal ulcers and gastritis respectively were positive for both (CagA) and (VacA) genes.In conclusion, the highest detection rate of H.pylori infection was by bacterial culture. A correlation between CagA and VacA genes and endoscopic lesions of duodenal ulcers and gastritis was found.

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Article
5- EVALUATION OF ENDOSCOPY BASED METHODS (HISTOPATHOLOGY, CYTOLOGY AND UREASE TEST) FOR THE DETECTION OF HELICOBACTER PYLORI

Authors: Sawsan S Al-Haroon --- Sarkis K Strak --- Rafid Adil Abood
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2009 Volume: 15 Issue: 1 Pages: 21-24
Publisher: Basrah University جامعة البصرة

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This study aimed to assess the accuracy of histopathology, brush cytology, andurease test in the diagnosis of Helicobacter pylori and to evaluate the effect of testduration on the sensitivity and specificity of positive urease test for the detection of H.pylori.Fifty patients [25 patients with gastritis group A and 25 patients with duodenal ulcergroup B] selected from those attending endoscopy unit for dyspeptic symptoms, wereenrolled in the study. Four endoscopic biopsies were taken from each patient. Onebiopsy from each of antrum and body were obtained for urease test (Urease test wasread at 30 min, 1, 4 and 24 hour after biopsy insertion into the reagent), and onebiopsy from each of antrum and body were used for histopathological examination.Antral brush cytology was taken also from each patient. The patients were consideredH. pylori positive when minimum concordances of 2 out of 3 tests (Histopathology,brush cytology, and urease test) were positive.Fourteen patients were positive for H. pylori in group A, in comparison to seventeenpatients in group B. The sensitivities of the histopathological examination, brushcytology, and urease test at 24 hours in group (A) were 58%, 79%, and 93%respectively. Corresponding figures for the specificity were 100%, 91%, and 46%respectively. While in group (B) the sensitivities were 82%, 82%, and 100% and thespecificities were 100%, 100%, and 88% respectively.It is concluded that among the invasive methods, the association of the urease testwith brush cytology constituted the best choice for confirming the diagnosis of H.pylori, due to the high sensitivity of the urease test and high specificity of brushcytology.


Article
ENDOSCOPIC BIOPSIES VERSUS BRUSHING ‎CYTOLOGY IN THE DIAGNOSIS OF VARIOUS GASTRO ‎INTESTINAL LESIONS WITH SPECIAL REFERENCE TO ‎GASTRIC TUMOURS

Authors: Jasim M Al-Diab --- Fatah Abdul Sahib --- Sarkis K Strak
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2005 Volume: 11 Issue: 2 Pages: 50-54
Publisher: Basrah University جامعة البصرة

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This study aimed to correlate the diagnostic efficiency of brushing cytology versus endoscopic biopsies ‎in the diagnosis of various gastro-intestinal lesions with especial reference to gastric tumours.‎‎ Eighty three patients who had visible mucosal lesions were studied. All lesions were brushed and ‎biopsied and were read blindly by one pathologist‏ ‏‎.‎The sensetivety and positive predictive values for brushing cytology were 91.3% and 84.6% respectively, ‎while specificity and negative predictive value were 93.3% and 96.5%‎‏ ‏respectively. The cumulative ‎diagnostic yield for both test was 92.7%‎‏.‏‎ ‎‏ ‏‎ We concluded that brush cytology is a convenient, safe & accurate technique for the diagnosis of ‎various gastro intestinal lesions which should be used concurrently with endoscopic biopsies

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Article
Gastrointestinal tract cancer in Basrah: time, place and histopathological characteristics
سرطان القناة الهضمية في البصرة: الخصائص الزمانية والمكانية والنسجية

Author: Seenaa S. Meziad1, Omran S. Habib2 & Sarkis K. Strak
Journal: The Medical Journal of Basrah University المجلة الطبية لجامعة البصرة ISSN: 02530759 Year: 2014 Volume: 32 Issue: 2 Pages: 55-62
Publisher: Basrah University جامعة البصرة

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Background: This is a cancer registry- based study carried out in Basrah to analyze the pattern of gastrointestinal tract malignant diseases over a period of seven years (2005-2011 inclusive). The study is in line with the work of Basrah Cancer Research Group to quantify cancer in Basrah governorate.Objectives: To describe the time trend, spatial distribution and histopathological types of gastrointestinal tract cancers in Basrah governorate over the years 2005-2011.Methods: The data used in the study were based on all new malignant cases which were diagnosed, treated and registered in Basrah cancer registration units. A total of 1601 new cases could be identified. Of these 1123 cases were from the inhabitants of Basrah governorate. The rest were from other Iraqi governorates.Results: Analysis of cases from Basrah indicated an overall annual incidence rate of gastrointestinal malignant diseases of 6.87 per 100000 population with very little variation with the passage of time from 2005 to 2011. Great variation in the district specific incidence rates was found with Basrah city centre and Shatt Al-Arab districts having the highest incidence rates (8.28 and 8.62 per 100000 population. Other districts have lower incidence rates: north of Basrah (5.59), West of Basrah (4.24) and south of Basrah (4.53). Histopathologically, four types represented 94.2% of total registered cases. Adenocarcinoma was the commonest cancer representing 71.8% followed by Squamous cell carcinoma (12.8%), Non-Hodgkins lymphoma (7.6%) and undifferentiated carcinoma (3.0%).Conclusions: Gastrointestinal tract cancer represented one of the major cancer groups in Basrah and deserves more care regarding prevention, early detection and treatment and research. Key words: Cancer, Basrah, Incidence, Time trend, place distribution

خلفية الدراسة: هذه دراسة مبنية على البيانات المتوفرة في التسجيل السرطاني في البصرة أجريت لتحليل نمط سرطان القناة الهضمية في محافظة البصرة للسنوات 2005-2011 وهي جزء من مشروع مجموعة البصرة لأبحاث السرطان لقياس السرطان.الأهداف: وصف النمط الزماني والمكاني والنسجي لسرطان القناة الهضمية في محافظة البصرة للسنوات 2005-2011.الطرائق: اعتمدت الدراسة على البيانات المتوفرة في وحدات التسجيل السرطاني في البصرة والتي تخص الحالات الجديدة لسرطان القناة الهضمية. بلغ مجموع الإصابات المسجلة في البصرة للسنوات أعلاه 1601 منها 1123 حالة من سكنة محافظة البصرة.النتائج: بلغ معدل نسبة الإصابة السنوية لسرطان القناة الهضمية في البصرة لكل 100000 نسمة مع نسبة تغاير طفيفة مع مرور السنوات. أما التغاير المكاني فكان واضحا حيث كانت أعلى نسبة إصابة سنوية في مركز مدينة البصرة وفي منطقة شط العرب. أما أوطأ نسبة إصابة فكانت في منطقتي غرب البصرة (الزبير) وجنوب البصرة (أبو الخصيب والفاو). أما من حيث التنوع النسجي فكانت أربعة أنواع هي السائدة وهي السرطان الغددي والطلائي واللمفاوي وغير المتميز ومثلت نسبة تقارب ال95% من مجموع الإصابات.الاستنتاج: يمثل سرطان القناة الهضمية احد الأنواع المهمة في البصرة الا إن الطراز الزماني لا ينذر بتفاقم هذا النوع في المستقبل المنظور عدا سرطان الأمعاء الغليظة.

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