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Article
The Role of Vaccinia Virus Vaccination in Protection against Molluscum Contagiosum Infection

Author: Wisam Ali Ameen
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2015 Volume: 12 Issue: 2 Pages: 473-478
Publisher: Babylon University جامعة بابل

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Abstract

Molluscum contagiosum virus (MCV) is classified within the Poxvirus family in a specific genus, the molluscipox and has features intermediate between the orthopox and parapox groups. The virus occurs throughout the world, most commonly causing disease in childhood. Infection with MCV is worldwide. Three groups are primarily affected: young children, sexually active adults, and immunosuppressed persons, especially those with HIV infection. Vaccinia virus vaccination protect against smallpox infection. The aim of this across secessional study was to assess the role of vaccinia virus vaccination in the protection against molluscum contagiosum infection. Three hundred patients (165 male, 135 female) with molluscum contagiosum were included in this study their ages ranged from 1 to 80 years with a mean of 28.91 years ±19.53SD. The patients were divided in two groups, the 1st group including the age of the patients less than thirty five years. The 2nd group includes those patients equal and more than thirty five years. Complete history was taken regarding the age and sex and history of the recurrence of the same lesions. Complete physical examination was done including vaccinia vaccine scar, and BCG scar.1st group those patient were their age less than 35 years were 150 patients with mean 8.38 years ±7.97 SD which they already were unvaccinated with vaccinia virus vaccine, while in 2nd group which those patients were their age 35 years and older were also 150 patients with mean 46 years ±7.88SD. 110 (73.33%) patients of these group were unvaccinated with vaccinia virus vaccine, while the others 40 (26.66%) patients of these group were vaccinia virus vaccination scar positive, P value less than 0.001( highly significant).BCG scar was found in 145 (96.66%) patients and the other 5 (3.33%) patients had negative BCG scar in group 1st group, while in 2nd group the BCG scar was found in 98 (65.33%) patients, p value less than 0.0001; confidence interval 95% = ( 0.2245,0.4021) and the other 52(34.66%) patients were had negative BCG scar.History of the recurrence of the lesions were found in 51(34%) patients in the 1st group, while the recurrence of the lesions were found in 41 (27.33%) patients in the 2nd group, p value more than 0.05 not significant, confidence interval 95%= (- 0.0377, 0.1710). The result of the 2nd group was subdivided in to two groups, A and B.Group A those unvaccinated with vaccinia virus vaccine patients with age equal and more than 35 years which were 30 (20%) patients, while group B patients with age equal and more than 35 years with positive vaccinia virus scar which were 11 (7.33%) patients, p value was 0.003 which is significant.According to our knowledge, this study may be the first study in Iraq showed that the vaccinia virus vaccine may have the protective effect in the prevention of molluscum contagiosum and decrease recurrence rate of this infection.

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Article
Gabapentin Therapy for Pruritus in Haemodialysis Patients
دواء الكابابنتين في علاج الحكة الناتجة من الغسل الدموي لمرضى الفشل الكلوي

Authors: Wisam Ali Ameen --- Shukri Faeiz
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2011 Volume: 8 Issue: 2 Pages: 206-212
Publisher: Babylon University جامعة بابل

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Abstract

Background: Itch can be defined subjectively as a poorly localized, non-adapting, usually unpleasant sensation which elicits a desire to scratch . Although specialized nerve endings have been identified for a wide range of stimuli no specific receptor has been identified for itch and it is generally agreed that itch (and pain) are received by unspecialized free nerve endings located close to the dermo-epidermal junction. Generalized severe pruritus occurs in about (30-50 %) of renal failure cases, its one of the dermatological diseases that is difficult to control. Unfortunately, haemodialysis can initiate the symptom as well as improve it. Up to 85% of patients on haemodialysis suffer from itching. Many modalities of treatment are found for those patients, as topical emollients, phototherapy, antihistamine.Aim of study: To assess the effectiveness and safety of gabapentin in treatment of pruritus induced by dialysis.Method: This study was conducted in Merjan teaching hospital Haemodialysis unite .23 patients were included in this study (13 male and 10 female , age more than 18 years) . Haemodialysis was performed twice times per week. All patients had histories of pruritus of more than 6 weeks duration that does not respond to antihistamines and other topical treatments . Any medication with presumed antipruritic effects was discontinued one week before the study. The patients were asked to record the severity of their pruritus on a visual analogue scale twice weekly (at dialysis time). The scale consisted of a 10 cm horizontal line marked from 0 (denoting no itch ) to 10 (denoting worst possible imaginable itch). Patients were assigned to receive 4 weeks of gabapentine therapy followed by 4 weeks of placebo and there was a 2 weeks of washout period between the sequential treatment phases. Gabapentine 100mg or placebo was administered orally twice weekly at the end of haemodialysis sessions.Result: The mean pruritus score before the treatment was 8.43 ± 0.99 with a range from (7-10), after gabapentin therapy the score decreased to 1.26 ± 1 (range : 0-3 ; p-value < 0.0001) while after the end of the resting two weeks (interval period) the score increased to 7.56± 1.55 , increment continued to the end of placebo period (after one month) reached to 8.1 ± 1.01 (range : 6-10 ; p-value = 0.1686).Conclusion: Gabapentin is a safe and effective drug in treatment of pruritus induced by dialysis with little side effects.

تعرف الحكة على انها شعور داخلي عند المريض يظهر على شكل رغبة خارجية لتخديش الجلد الى حد هذا الوقت لم توجد مستلمات عصبية نهائية متخصصة بالحكة الجلدية على انفراد , لكن النهايات العصبية للحكة تشترك مع النهايات العصبية لمستلمات اخرى في الجلد وهي واقعة على الخط الفاصل بين طبقة البشرة والادمة. 30-50 % من مرضى العجز الكلوي المزمن يعانون من حكة جلدية منتشرة في جميع انحاء الجسم ولسوء الحظ ان الغسل الدموي لعلاج العجز الكلوي المزمن ممكن ان يؤدي الى زيادة الحكة في الجسم بالاضافة الى شفاء او تقليل الحكة. 85% من مرضى الغسل الدموي يعانون من حكة منتشرة في كل اجزاء الجسم .اجريت هذه الدراسة في مستشفى مرجان التعليمي في وحدة الغسل الدموي حيث تم اخذ 23 مريض مصاب بهذا المرض وكان جميع المرضى يغسل لهم مرتين في الأسبوع بالإضافة الى معاناتهم من حكة مزمنه لمدة تزيد عن ستة أسابيع.تم ايقاف كل الادوية الاخرى التي تستعمل في علاج الحكة الجلدية قبل اسبوع من الدخول في هذه الدراسة. طلب من كل مريض تدوين شدة الحكة لديه على مقياس معين مرتين في الاسبوع يتالف هذا المقياس من عشر درجات من صفر (اقل درجة) وتعني لاتوجد حكة و10 (اعلى درجة) وتعني اعلى قيمة للحكة. تم اعطاء المريض عقار الكابابنتين 100 ملغم مرتين في الاسبوع ولدة اربع اسابيع وبعد ذلك تم ايقاف العلاج لمدة اسبوعين (فترة راحة ) ثم اعطي المريض بعد ذلك عقار العلاج المموّه لمدة اربعة اسابيع اخرى النتائج: ان معدل مقياس الحكة قبل اخذ عقار الكابابنتين كان 8.43 ± 0.99 لكن هذه النتيجة قلت الى 1.26 ± 1 بعد اربعة اسابيع , بينما في نهاية فترة الراحة صار معدل مقياس الحكة 7.56 ± 1.55 وهذه النتيجة اخذت بزيادة بعد استعمال علاج العلاج المموّه لمدة اربعة اسابيع لتصبح 8.1 ± 1.01 الاستنتاج: ان عقار الكابابنتين علاج امن وفعال في علاج الحكة الجلدية الناتجة من الغسل الدموي لمرضى العجز الكلوي

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Article
Treatment of Recalcitrant Lichen Planus with Low Molecular Weight Heparin (Enoxaparin): A Case Series Study among Iraqi Patients

Authors: Wisam Ali Ameen --- Zena Saeed Alfadhily
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2011 Volume: 8 Issue: 1 Pages: 93-103
Publisher: Babylon University جامعة بابل

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Abstract

Lichen planus (LP) is a unique, common, pruritic, inflammatory disease of the skin, mucous membranes and hair follicles. The exact pathogenesis of LP is unknown, but it is evident that immunologic mechanisms almost certainly mediate the development of LP. Cell mediated immunity plays the major role in triggering the clinical expression of the disease. Both CD4 and CD8 T-cells are found in lesional skin of LP. Low dose, low molecular weight heparin (enoxaparin) has been proven effective in various types of Lp. Enoxaparin has been shown to inhibit the expression of heparanase enzyme that is produced by CD4 lymphocytes (this enzyme is crucial in T-cell migration to target tissue). The Aim: is to evaluate the efficacy of low-dose enoxaparin in treatment of Iraqi patient with recalcitrant LP that is unresponsive to traditional courses of topical and systemic steroid therapy. Methods: Fifteen patients with recalcitrant LP were included in this study Enoxaparin was given to each patient in a dose of 3mg subcutaneous injection every week for a period of 20 weeks. Assessment of response to treatment was done for each patient every two weeks by assessment of the severity of itching and reduction in the number of lesions. VAS score used to assess improvement of itching. Patients divided into 3 groups (mild LP, moderate LP, and severe LP) according to the number of lesions at initial presentation. Response to treatment classified for 4 grades (no response, mild response, moderate response, dramatic response). Results: There was dramatic reduction in VAS score in 13 patients of the 15 patients (86.6%). This reduction is considered statistically significant in the end of the 1st month of treatment (p-value 0.0002). The number of patients that respond to therapy in the end of treatment course was 12 patients (80%), this include all grades of improvement (mild 26.6%, moderate 20%, and dramatic 33.33%). patients with mild type LP showed a response of (83.33%) which is higher than the response rate of moderate type LP (71.42%). Conclusions: Enoxaparin is effective, safe, simple and good alternative therapy for acute and chronic recalcitrant lichen planus, specially those who complain from severe itching, those who use prolonged courses of steroid therapy without benefit and those with hypertrophic type LP.

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Article
Treatment of low serum ferritin in females with alopecia by oral iron.

Authors: Wisam Ali Ameen --- Hassanain H. Al-Charrakh
Journal: Iraq Joural of Hematology المجلة العراقية لامراض الدم ISSN: 20728069/25432702 Year: 2015 Volume: 4 Issue: 1 Pages: 126-136
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Background: Hair loss affects over 25% of women in developed countries. Three hairdisorders, androgenetic alopecia, telogen effluvium and alopecia areata which account formost cases of nonscarring alopecia in women. Iron deficiency has been reported in themajority of women presenting with diffuse hair loss. Iron has important function in oxidationreductionreactions, collagen synthesis, and as a co-factor for enzymes.Objectives: To assess the percentage of the low serum ferritin hair loss females and theirresponse to oral iron replacement therapy.Materials and methods: a prospective cohort study conducted in at Marjan teaching hospitalfrom August 2013 to January 2015. It included 72 female complained from diffuse hair losswere enrolled in this study. Full history was taken from all patients and physical examinationswere done both general examination and local examination of the scalp including pull test.Patients were sent to complete blood examinations, serum ferritin. Patients divided in to threegroups according to their response to treatment. Before the treatment the severity of hair losswas assess by VAS.Results: Fifty two patients met criteria of inclusion. Their serum ferritin levels range between(1.4-14.4) with mean 6.16±3.30 their hemoglobin levels were (8.3-13.4) with mean ±SD11.98±1.22. Group I patients included 27 patients (51.9%), their severity of hair loss beforetreatment was assess by VAS which was 9.18±0.84, after two week of treatment the scorebecome 7.33±1.03, P value is < 0.0001; confidence interval 95% = ( 1.477 to 2.277). in groupII patients which included 12 patients (23%), their severity of hair loss before treatment wasassess by VAS which was 9.33±0.49, after two week of treatment the score become 9.08±0.66,P value is 0.081 considered not significant; confidence interval 95% = (-0.037 to 0.537). Theother thirteen patients (25%) represented the third group. All the patients in this group didn’tshow any response to treatmentConclusion: Measurement of serum ferritin level should be done to all patients with chronictelogen effluvium before starting other anti-hair loss modalities. Iron replacement is a safedrug with a few side effects and indicated to all females with low serum ferritin level.

Keywords

ferritin --- female --- hair loss


Article
Effectiveness of Ketotifen in Treating Uremic Pruritus

Authors: Ali Jaber Al-Mamoori --- Wisam Ali Ameen --- Basim A. Abd
Journal: Journal of University of Babylon مجلة جامعة بابل ISSN: 19920652 23128135 Year: 2017 Volume: 25 Issue: 2 Pages: 761-769
Publisher: Babylon University جامعة بابل

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Abstract

Introduction Among the commonest distressing complaints in patients with chronic kidney disease, is itching. We conducted a prospective study to assess the efficacy of ketotifen, a putative.mast.cell.stabilizer, in patients with uremic itch refractory to traditional.treatment.Materials and Methods A double-blind.randomized.trial with a crossover.design was applied on 25 patients .In all of these patients,causes of itching other than uremia had been excluded. We divided the patients into two groups A and B ; they received either oral ketotifen, 1 mg, twice a day for 2 week or placebo for the same period . After A one week period of washout, each group was conversely treated. The response was assessed by the patients subjectively by a questionnaire to assess their itching is either totally relieved ,partially relieved, or still the same (no effect).Results nine patients (36%) reported totally relieved itching with ketotifen and none (0%) with placebo (P =.003). Partial relieve was reported in 15 (60%) and 16 (64 %), respectively. One patient (4%) with ketotifen and nine patients (36%) with placebo showed no change in their symptoms.. Eleven patients (44%) suffered from drowsiness that decreased spontaeously in all them after average 5 days. Conclusions in this study,we postulate that ketotifen, a putative.mast.cell.stabilizer, can be employed to relieve pruritus refractory to other traditional therapies in chronic kidney disease patients who were on maintenence hemodialysis. A moderate dose of ketotifen was effective while safe despite its major side effect, drowsiness, which was transient and could be well accepted by uremic subjects.

المقدمة من بين الشكاوى الأكثر إضرارا لدى المرضى الذين يعانون من مرضى الفشل الكلوى المزمن، هو الحكة.أجرينا دراسة مستقبلية لتقييم فعالية كيتوتيفين,وهو مثبت مفترض للخلية البدينة ، في المرضى الذين يعانون من حكة والغير مستجيبين إلى العلاجات التقليدية.المواد وطرق العمل تم تطبيق دراسة عشوائية مزدوج التعمية على 25 مريضا. في كل من هؤلاء المرضى، تم استبعاد أسباب الحكة الأخرى فيما عدا الفشل الكلوى المزمن. تم تقسيم المرضى إلى مجموعتين A و B وتم اعطاء إما كيتوتيفن عن طريق الفم، 1 ملغ، مرتين في اليوم لمدة 2 أسبوع أو علاج وهمي لنفس الفترة. بعد فترة أسبوع واحد من سحب العلاج، عولجت كل مجموعة على العكس. تم تقييم الاستجابة من قبل المرضى انفسهم عن طريق الاستبيان كما يلي: هم إما إستجابة تامة، اوجزئية، أو لا تزال الحكة هي نفسها (أي لا يوجد تأثير).النتائج تسعة مرضى (36٪) ذكروا إستجابة تامة للحكة مع الكيتوتيفين و لا يوجد مريض (0٪) استجاب مع الدواء الوهمي (P = .003). تم تسجيل عن تخفيف جزئي في الحكة 15 (60٪) مع الكيتوتيفين و 16 (64٪) مع الدواء الوهمي تم تسجيل. مريض واحد (4٪) مع كيتوتيفين وتسعة مرضى (36٪) مع العلاج الوهمي لا يظهر أي تغيير في أعراضهم .. أحد عشر مريضا (44٪) عانوا من النعاس الذي انخفض بشكل تلقائي في كل منهم بعد متوسط 5 أيام .الاستنتاجات في هذه الدراسة، نحن نفترض ان كيتوتيفين,وهو مثبت مفترض للخلية البدينة يمكن استخدامه لتخفيف الحكة الغير مستجيبة إلى العلاجات التقليدية الأخرى في المرضى الذين يعانون من فشل الكلى المزمن الذين يعتمدون على الغسيل الكلوي. جرعة معتدلة من الكيتوتيفين فعالة في حين آمنة على الرغم من تأثيره الجانبي الرئيسي، و هوالنعاس، وهو عابر ويمكن أن يكون مقبول بشكل جيد من قبل مرضى الفشل الكلوي المزمن .

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