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Article
Cardiovascular Autonomic Nervous System Dysfunction in Iraqi Systemic Lupus Erythematosus Patients

Author: Ziad Shafeek Al-Rawi
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2007 Volume: 6 Issue: 3 Pages: 221-225
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:OBJECTIVE:To assess the incidence, and pattern of autonomic dysfunction in Iraqi systemic lupus erythematosus (SLE) patients and its possible association to patient’s age, duration of disease, SLE activity, drugs used &autonomic nervous system symptoms.PATIENTS AND METHODS:Fifty Iraqi SLE patients and 50 healthy controls were included in this study. Full history was taken and complete clinical examination was done for all individuals in both groups. Disease characteristics [age, sex, duration, SLE disease activity index (SLEDAI), drugs used, and autonomic nervous system symptoms] were also documented. Laboratory analysis included complete blood count, general urine examination, and anti-double stranded deoxyribonucleic acid. Individuals in both groups were assessed for autonomic dysfunction using 5 non-invasive tests: heart rate response to Valsalva maneuver, heart rate response to deep breathing, and heart rate response to immediate standing (30:15 ratios), systolic blood pressure response to standing and diastolic blood pressure response to sustained handgrip. Autonomic dysfunction was categorized as normal, parasympathetic, sympathetic, and mixed pattern according to criteria proposed by Ewing.RESULTS:Forty three (86%) Iraqi SLE patients have autonomic dysfunction compared with 0 % of controls (p=0.00000000001) and the most common autonomic function pattern was the mixed pattern 28(56%) patients. There was no statistical significant association between autonomic function pattern and age group of patients (p=0.536). Also no statistical significant association were observed between autonomic dysfunction; and age, sex, disease duration, disease activity (SLEDAI),autonomic nervous system symptoms or drugs used (chloroquine, prednisolon, azathioprine) (p=0.434, p=0.213, p=0.405, p=0.450, p=0.069, p=0.935, p=0.204, p=0.443 respectively).CONCLUSION:The incidence of autonomic dysfunction in Iraqi SLE patients using non-invasive tests is high (86%) and the most common pattern was the mixed pattern (56%). Also there was no statistical significant association observed between autonomic dysfunction and age, sex, duration, SLE disease activity index (SLEDAI), drugs used, and autonomic nervous system symptoms.


Article
Renal Involvement in 25 Patients with Systemic Sclerosis

Authors: Nizar Abdulateef Jassim --- Ziad Shafeek Al-Rawi --- Ali Abdumajeed Diab --- Ali Nazar Mohammed
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2009 Volume: 8 Issue: 1 Pages: 1-6
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Renal involvement is considered a poor prognostic factor and not frequently a cause of death in patients with scleroderma. Renal involvement can be divided into scleroderma renal crisis and non-renal crisis abnormalities.OBJECTIVE:To evaluate the frequency of renal involvement in 25 Iraqi patients with systemic sclerosis (SSc).METHODS:Twenty five patients with SSc (21 female and 4 male) were included in a case-controlled study. All patients fulfilled the American College of Rheumatology criteria for SSc. All patients were of diffuse type. Other types of SSc were excluded. All patients underwent measurement of blood pressure and investigations had been done for them which included: hemoglobin (Hb), white blood cell (WBC) count, platelet count, erythrocyte sedimentation rate (ESR), blood urea (BU), serum creatinine (SCr), general urine examination (GUE), and rheumatoid factor (RF). Same investigations were done for 25 healthy person (considered as control group).RESULT:All patients (100%) had Raynaud’s phenomenon, 23 patients (29%) had dysphagia, 21 patients (84%) had arthralgia, 10 patients (40%) had telangiectasia and 2 patients (8%) had subcutaneous calcification. Three patients (12%) had moderate hypertension. Fourteen patients (56%) had anemia, 2 patients (8%) had leukocytosis, 6 patients (24%) had elevated ESR, 1 patient (4%) had elevated BU, 1 patient (4%) had albuminuria and 4 patients (16%) had positive RF. Platelet count and SCr were normal in all patients. Only 1 patient (4%) had renal involvement in form of combination of azotemia, albuminuria and hypertension.CONCLUSION:Renal involvement in systemic sclerosis among Iraqi patients is rare.

Keywords

renal --- iraqi --- systemic sclerosis.

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