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Modulation of some cardiovascular risks factors with different doses of Quercetin in patient with rheumatoid arthritis treated with Azathioprine
تعديل بعض عوامل الخطورة للجهاز القلبي الوعائي باستخدام جرع مختلفة من عقار الكورستين في مرضى التهاب المفاصل المعالجين بعقار ازاثوبرن

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Abstract

Abstract: Cardiovascular diseases are increasingly recognized contributors to increased morbidity and mortality in rheumatoid arthritis (RA). Attention to this feature of RA has been drawn by recognition of the key role played by inflammation in atherogenesis. This may be related to an atherogenic lipid profile and endothelial dysfunction. Conventional treatments of RA patient does not greatly affect those risk factors . Moreover , they may aggravate them and carry a potential adverse effects. Quercetin is a versatile flavonoid and has several biological activities that can abolish most of the undesirable effects of the inflammatory process associated with RA. It has well known anti-inflammatory, anti-oxidant and cardioprotective properties. In this work we investigated the effect quercetin on lipid profile and sICAM-1 in 160 RA patient treated with azathioprine for 8 weeks. Patient are divided into 4 groups each group was treated either with azathioprine ( Aza.) combined with different doses of quercetin(500, 1000, 1500mg/day) . In addition, 30 apparently healthy volunteers were participated and served as control group. Blood samples of the patients taken at zero time and after 8 weeks , converted to serum and analyzed for ICAM-1 and lipid profile Results shows a significant ( P>0.05) reduction in serum level of sICAM -1 in all doses tried in this study . Significant reduction in both total cholesterol ( TC) and low density lipoprotein cholesterol (LDL-c) specially at a dose of 1500mg/day quercetin . High density lipoprotein cholesterol had increased in all doses quercetin as well as azathioprine only treated group. The atherogenic index TC/HDL-c ratio had improved in all groups with no significant effect on triglycerides. From this study we conclude that although the treatment of RA patient with azathioprine improve some cardiovascular risk factors specially lipid profile , the addition of quercetin to such patients greatly and significantly improve lipid profile and reduce the level of ICAM-1 which are important risk factors for atherogenesis . It has also concluded that 1500mg/day of quercetin gave an attractive results compared with other doses used in the study.

الخلاصة: تعبر الأمراض القلبية الوعائية المساهم الرئيسي لزيادة الأضرار ونسبة الوفيات الناتجة عن التهاب المفاصل الرثوي. إن الانتباه لهذه الخاصية جاء نتيجة معرفة الدور الرئيسي الذي يلعبه الالتهاب في عملية تكون الجلطات.وهذا يعود لزيادة نسبة الدهون المجلطة والاختلال بوظيفة الخلايا المبطنة للأوعية.إن العلاجات الاعتيادية المعروفة لالتهاب المفاصل الرثوي لم توثر كثيرا على هذه العوامل وإنها قد تزيد من خطورتها أو تؤدي إلى أثار جانبية عكسية.يعتبر الكويرسيتين من الفلافونويدات الرائدة حيث يمتلك العديد من الفعاليات الحياتية التي تبطل اغلب التأثيرات الضارة التي تصاحب العملية الالتهابية.كما يمتلك فعاليات مضادة للالتهاب و مضادة للأكسدة وحامية للقلب. في هذا العمل تم دراسة تأثير الكويرسيتين على صورة الدهون والجزيئات اللاصقة للخلايا في 160 مريض بالتهاب المفاصل الرثوي والمعالجين بالازاثايوبرين. حيث قسم المرضى إلى أربعة مجاميع عولجت المجموعة الأولى بالازاثايوبرين فقط فيما عولجت بقية المجاميع بالازاثايوبرين مضافا إليه جرعة مختلفة من الكويرسيتين . هذا بالإضافة إلى الاستعانة ب 30 متطوع صحيح واعتبروا كمجموعة سيطرة. حللت عينات المرضى في بداية الدراسة أي قبل العلاج وبعد 8 أسابيع من العلاج.تم قياس الكولسترول الكلي وعالي الكثافة والدهون الثلاثية وتم حساب الدهون واطئة الكثافة ومعامل التجلط بصورة غير مباشرة . لوحظ ان المعالجة بالكويرسيتين أدت إلى تغير معنوي بمستوى الجزيئات اللاصقة للخلايا كما أدت الجرعات العالية إلى قلة معنوية في الدهون واطئة الكثافة فيما أدت جميع الجرعات المستخدمة إلى زيادة معنوية في الدهون عالية الكثافة مما انعكس إيجابا على تقليل معمل التجلط. نستنتج من هذا العمل إن الكويرسيتين يمتلك تأثيرات ايجابية في تحسين العوامل التي تزيد من نسبة حصول الأمراض الوعائية القلبية وقد تبين إن أفضل جرعة كانت 1500 ملي غرام في اليوم الواحد.


Article
The Study of Oral Findings, Oxidative Stress and Antioxidant Vitamin E in Serum and Saliva of Crohn's Patients on Azathioprine Monotherapy and those on Combination of Anti-TNF-α Plus Azathioprine

Authors: Zainab Kh. Abbas --- Taghreed F. Zaidan
Journal: Journal of baghdad college of dentistry مجلة كلية طب الاسنان بغداد ISSN: 16800087 Year: 2018 Volume: 30 Issue: 1 Pages: 39-45
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Crohn's disease (CD) is an immunological disorder associated with chronic inflammatory process of several unspecific regions of gastrointestinal tract but frequently detected in the terminal Ilium and proximal colon or both. This disease frequently presented with various oral manifestations as a consequence of inflammatory process of the disease, nutritional deficiency or medications side effects. Several therapeutic approaches have been developed for CD management that are targeting the inflammatory process and directed at controlling the host immune response. Immunosuppressants such as Azathioprine and anti-TNF α agents as well as the combination of them have been widely used as an effective therapeutic modality with a better chance of achieving clinical remission and decrease the risk of future complications.Subjects, Materials, and Methods: Seventy-five subjects were incorporated in this study; fifty subjects presented with moderate to severe CD that were subdivided into two subgroups treated with different therapeutic modalities( Azathioprine monotherapy and Combination of anti TNF-α biological agent (Infliximab) plus Azathioprine), while other twenty-five were age and gender matched healthy control subjects. Body mass index (BMI) of all participants was determined by weight (kg) high (m2). Oral cavity of each patient was examined for the presence of oral manifestations. Blood and saliva samples were gained from each subject enrolled in this study and salivary flow rate (mlmin) was measured for those participants, then these samples were centrifuged and the supernatants frizzed for subsequent oxidative stress and antioxidants biomarkers assessment.Results: The means of BMI and salivary flow rate were significantly higher in combination treated group than Azathioprine treated group. Fungal infection was the main oral findings that observed among Crohn's patients on combination therapy compared with those on Azathioprine monotherapy. Assessment of oxidative stress and antioxidant activity revealed that the means of serum and saliva Malondialdehyde (MDA) were highly significantly higher in Azathioprine treated group than combination treated group, while Vitamin E (VE) level showed significant reduction in Azathioprine Crohn's group as compared to combination treated group. Significant negative linear correlation was found between MDA level in serum and saliva with duration of treatment, while highly significant positive correlation was detected between VE levels and duration of treatment.Conclusions: Oxidative stress was increased with reduced antioxidant level in both groups of Crohn's patients. Treatment with Combination therapy approved to be effective in controlling oxidative tissue damage and enhanced antioxidants system in Crohn's patients better than Azathioprine monotherapy. Fungal infection was the most predominant oral manifestations among Crohn's patients on combination therapy as a result of concomitant immunosuppressive effect that accounted for reduced immune response to opportunistic infections

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