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Article
Single Dose Methotrexate as a Primary Treatment of Ectopic Pregnancy
استخدام جرعة عضلية واحدة من دواء ميثوتريكسيت كعلاج اولي للحمل خارج الرحم

Author: Hanan Dh. Al-Jeboury د. حنان ضايع الجبوري
Journal: IRAQI JOURNALOF COMMUNITY MEDICINE المجلة العراقية لطب المجتمع ISSN: 16845382 Year: 2008 Volume: 21 Issue: 3 Pages: 228-236
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Objectives: To determine the efficacy of single-dose intramuscular methotrexate as the primary treatment of ectopic pregnancy.Study design: A hospital based- cohort clinical study.Setting: The study was carried out in the Department of Obstetrics and Gynecology in Al-Yarmouk teaching hospital.Methods: A hospital based- cohort study was done from October 2004 to November 2005 in AL-Yarmook teaching hospital to a total of 82 women referred because of clinical suspicion of ectopic pregnancy. 35 women were excluded because they needed surgical interference, the remaining 47 patients with clinical suspicion of ectopic pregnancy, made using a combination of β-hCG titers with ultrasound. 50 mg intramuscular methotexate regimen was given, β-hCG levels were measured on days 1,4,7 and then weekly . If β-hCG levels were not dropping enough after 1 week, a second dose of methotrexate given. Successful treatment was defined as the resolution of ectopic pregnancy with a single dose without surgical interference. Results: Our over all success rate was 78.7 %( 37/47 women). The median pretreatment serum β-human chorionic gonadotropin level was lower in those women in whom treatment was successful compared with those women with treatment failure (974 vs. 3804 mIU/mL, P<0.05). In our study 37 of 47 patients with ectopic pregnancy the level of β-hCG dropped.Six of 47 patients the dose needed to be repeated for another one week and the level of β-hCG monitored after another one week and was droping; the remaining 4 patients need surgical interference. Conclusion: Single dose of IM methotrexate was associated with a high success rate in selected cases of ectopic pregnancy especially after exclusion of factors which causes treatment failure.Key words: Ectopic pregnancy, Methotrexate

هدف الدراسة: لتحديد فاعلية جرعة عضلية واجدة من دواء ميثوتريكسيت كعلاج اولي للحمل خارج الرحم. تصميم الدراسة: دراسة مستقبلية .مكان الدراسة: اجريت هده الدراسة في قسم النسائيات والتوليد في مستشفى اليرموك التعليمي.طريقة العمل: دراسة تحري اجريت فى مستشفى اليرموك التعليمي قسم النسائية والتوليد للفترة من تشرين اول 2004 الى تشرين ثانى 2005 حيث تم فحص 82 مريضة تعانى من اشتباه حمل خارج الرحم .تم استبعاد 35 مريضة للحاجة الى تداخل جراحى طارئ.تم ادخال 47 مريضة فى البحث حيث تم تشخيص الحالة بواسطة قياس مصل الدم لهرمون الحمل(اج, سي,جي)مع فحص بواسطة جهاز الامواج فوق الصوتيةالمهبلي.استخدم جهاز الامواج فوق الصوتية المهبلي لتشخيص الحالات وتم الاخذ بالاعتبار وجود مايلي :حمل في اول 6 اسابيع ,عدم وجود نبض الجنين,الحمل اقل من 4 سم في الطول .تم اعطاء 50 ملغم عضلي من دواء الميثوتركسيت لكل مريضة ضمن الدراسة بعدها تم قياس نسبة هرمون الحمل في اليوم الاول ,الرابع ,السابع وبعدها اسبوعيا.تم اعطاء جرعة ثانية من العلاج للمرضى الذين لم تتغير نسبة هرمون الحمل لديهم بعد اسبوع من الجرعة الاولى .لنتائج: نجاح العلاج تم تعريفه. باضمحلال الحمل خارج الحمل باستخدام جرعة واحدة من دون الحاجة الى التداخل الجراحى .كان معدل النجاح هو 78.7% (37 مريضة من 47) .وكان معدل هرمون الحمل قبل بدأ العلاج اقل في المرضى الذين استجابوا للعلاج مقارنة بالذين فشل العلاج معهم (974 مقارنة 3804) . 6 مرضى كانوا بحاجة الى جرعة ثانية من دواء الميثوتركسيت لان نسبة هرمون الحمل لم تقل في الاسبوع الاول من الجرعة الاولى .4 مرضى كانوا بحاجة الى تداخل جراحى اثناء فترة مراقبة الهرمون .الاستنتاج: نستنتج من مقارنة النتائج ان جرعة واحدة عضلية من دواء الميثوتركسيت لها الامكانية على رفع معدل نجاح علاج حالات مختارة من حمل خارج الرحم خاصة بعد اخراج العوامل التى تؤدى الى فشل العلاج.


Article
Partial Mole in Ectopic Pregnancy

Author: Rawaa D. AL-Janabi
Journal: Iraqi Journal of Embryos and Infertility Researches المجلة العراقية لبحوث الأجنة والعقم ISSN: eISSN: 26166984 / pISSN: 22180265 Year: 2016 Volume: 6 Issue: 1 Pages: 8-12
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

Background:Gestational trophoblastic disease is a wide spectrum of abnormal pregnancy that includes: Complete molar pregnancy (CMP), partial molar pregnancies (PMP), invasive mole (IM), chorioncarcinoma (CHC), and placental site trophoblastic tumors (PSTT. Hydatidiform mole is an abnormal gestation characterized by the presence of hydropic changes affecting some or all of the placental villi. Hydatidiform mole arises as a result of the abnormal fertilization of an ovum. Tubal ectopic hydatidiform mole is a rare lesion and few cases have been reported.


Article
Ectopic pregnancy, A Prospective Study In Al-Batool Teaching Hospital In Mosul – Iraq

Author: Ghada Al-Daheen
Journal: Al-Kindy College Medical Journal مجلة كلية الطب الكندي ISSN: 18109543 Year: 2007 Volume: 4 Issue: 1 Pages: 63-69
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Ectopic pregnancy (EP) is the implantation of pregnancy at an extra uterine site. EP accounts for approximately 2 % of reported pregnancy. The largest risk factors are upper genital tract infection due to sexually transmitted diseases (STDs), as well as other risk factors as smoking, the use of intrauterine device, previous tubal or pelvic surgery, history of infertility, and the risk of age and parity. It is difficult to diagnose EP clinically. However diagnostic aids like B-hCG assessment and ultrasound scan has proved to be of great help. The treatment trends for ectopic pregnancy have changed to more conservative procedures like salpingostomy, segmental resection and fimbrial expression.
Methods: From September 2000 to September 2002, a prospective study was conducted to forty patients who were admitted at Al-Batool teaching hospital, as proven or suspected cases of ectopic pregnancy.
Complete assessment of the patients through detailed history and clinical examination was carried out, and accordingly patients were classified into unstable and stable groups.
The investigations has included pregnancy test (PT), ultrasound scan (USS), and laparoscopy.
The operative procedures were either salpingectomy, or conservative surgery in the form of salpingostomy and milking of the tubes.
Histopathological examination confirmed EP in all surgically treated patients.
Results: Forty cases of ectopic pregnancies were collected. 67.5 % were in the age group 26 – 35 year.
Women with higher parity had the highest percent with EP (37.5 %).
Twenty - seven cases (67.5 %) were clinically unstable.
USS was performed for twenty – six (65 %) patients with positive results in all, where twenty – one patients (80.76 %) had an adnexial mass.
Diagnostic laparoscopy was carried out in four cases (10 %) only.
Among the forty cases of EP the findings at laparotomy were as follows:
Tubal abortion was evident in four cases ( 10 % ). Intact ampullary pregnancy in fourteen patients (35 % ), two isthmic gestations (5 %), two ovarian pregnancies ( 5 %) , and one corneal pregnancy( 2.5 %). In seventeen cases (42.5 %) there was ruptured ectopic pregnancy. There was accompanying ovarian cysts in five patients (12.5 %),
The operative procedures included: Salpingectomy in thirty one patients ( 77.5 % ) , salpingostomy in two cases ( 5 % ), milking of the tube in four cases ( 10% ), and conservative removal of the products of conception from the ovarian tissue with adequate haemostasis in the two cases of ovarian pregnancy ( 5 % ).
The route of exploration and management was through opened laparotomy in all. Two cases that were treated through laparoscopy.
Conclusion: Early diagnosis of cases of ectopic pregnancy would reduce the morbidity and even the mortality of ectopic pregnancy. It allows more conservative form of treatment to be applied, and thus giving a better chance for the patient to preserve fertility.
Key word: Ectopic pregnancy, tubal pregnancy, risk factors in ectopic pregnancy


Article
Serum CA-125 in Ectopic Pregnancy

Authors: Lilyan W. Sersam --- Rasha Shakir Mahmood
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2013 Volume: 12 Issue: 3 Pages: 343-350
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT: BACKGROUND: CA-125 is a glycoprotein, its origin is uncertain during pregnancy. It rises during the first trimester andreturns to a non-pregnancy range in late pregnancy. OBJECTIVE: To compare CA-125 levels between tubal ectopic and normal intrauterine pregnancy, and to find it’susefulness in differentiating intact from ruptured tubal ectopic pregnancy. METHODS: This prospective case-control study was carried out on sixty healthy women with single normalintrauterine pregnancy (NIUP) of 6-10 weeks gestation and sixty women with tubal ectopic pregnancyof same gestational age which were further subdivided into twenty-five women with ruptured tubalectopic pregnancy (REP) and thirty-five women with unruptured tubal ectopic pregnancy (UREP). Thelevels of CA-125 were compared between these groups. RESULTS: The mean level of CA-125 in ruptured ectopic pregnancy group was 49.04±33.63 IU/ml and in unruptured ectopic pregnancy group was 24.3±16.89 IU/ml. The mean level of CA-125 in normalpregnant women (control group) was 53.95±31.2 IU/ml. There was a statistically significant differencebetween mean serum CA-125 levels of ruptured ectopic pregnancy and unruptured ectopic pregnancygroup (p< 0.05), also there was a statistically significant difference between mean of CA-125 level ofunruptured ectopic pregnancy group and control group (p <0.05), while there was no statisticallysignificant difference between ruptured ectopic pregnancy group and control group (p > 0.05).CONCLUSION: CA-125 level is significantly elevated in ruptured tubal ectopic pregnancy than the intact tubal ectopicpregnancy, this increase in CA-125 levels can be used as additional test to identify tubal rupture


Article
SERUM CREATINE KINASE AND ITS ISOENZYME CK-MB IN THE PREDICTION OF TUBAL ECTOPIC PREGNANCY

Author: Hala A Abdullateef هاله عبد القادر عبد اللطيف
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2013 Volume: 11 Issue: 2 Pages: 170-175
Publisher: Al-Nahrain University جامعة النهرين

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Background:Ectopic pregnancy is a major cause of maternal morbidity and mortality. Creatine kinase is an enzyme that its increase reflects tissue injury and could be useful in the diagnosis of tubal pregnancy.Objectives:To evaluate the diagnostic value of total creatine kinase in women with ectopic pregnancy, tubal rupture ectopic pregnancy, spontaneous abortion, and normal pregnancy and to investigate the possible discriminatory ability of creatine kinase-MB for diagnosis of tubal rupture ectopic pregnancy.Methods:Forty women with ectopic pregnancy, 17 with intrauterine abortion and 24 women with normal gestation were studied. The diagnosis of ectopic pregnancy was based on clinical assessment and transvaginal ultrasonography. Serum human chorionic gonadotropin levels were measured by enzyme linked immuno-sorbent assay. Total serum creatine kinase and creatine kinase-MB values were determined by spectrophotometrical analysis.Results:Creatine kinase and creatine kinase-MB levels were significantly higher in tubal ectopic pregnancy compared with both intrauterine abortions and normal gestations. When using creatine kinase-MB of 4.55 IU/ml as a cut-off value for the diagnosis of tubal ectopic pregnancy from control groups, sensitivity 81.64%, specificity 84.3%, positive predictive value 88.5% and negative predictive value 71.4%. Creatine kinase level in the ruptured ectopic pregnancy group was significantly higher than in the unruptured ectopic pregnancy, and normal pregnancy. When using creatine kinase of 29.43 IU/ml as a cut-off value for the diagnosis of ruptured ectopic pregnancy from unruptured groups, sensitivity 92%, specificity 100%, positive predictive value 100%, negative predictive value 96% and efficiency 97.4%.Conclusions:Women with ectopic had a significantly higher levels of creatine kinase-MB compared with women with normal pregnancy or intrauterine abortion and it has a high discriminatory ability for diagnosis of tubal rupture ectopic pregnancy.Keywords:Ectopic pregnancy, creatine kinase-MB


Article
Methotrixate for nonsurgical management of ectopic pregnancy

Author: Ariana Kh. Jawad اريانا كاظم جواد
Journal: Al-Qadisiyah Medical Journal مجلة القادسية الطبية ISSN: 18170153 Year: 2013 Volume: 9 Issue: 16 Pages: 95-108
Publisher: Al-Qadisiyah University جامعة القادسية

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Abstract

Systemic Methotrexate has been widely used to treat ectopic pregnancy.The aim of current study were to evaluate the safety and efficacy of single dose intramuscular methotrexate as a treatment option for early unruptured ectopic pregnancies. From 1st of January 2007 to 1st of January 2009 at Maternity teaching Hospital-Erbil, a case cohort prospective study was conducted on 60 patients with small unruptured ectopic pregnancies treated as in-patients with single dose of Methotrexate therapy.Ectopic pregnancy was diagnosed by both transvaginal ultrasound for the size and volume of the gestational mass and β-HCG measurement. Intramuscular methotrexate 50 mg/m2 was administered on days 1 and Serial ß-hcg was repeated on days 4 and 7, If the β-HCG on day 7was at least 15% lower than that on day 4, the patient was regarded as treatment success, and Follow-up serum ß-HCG was performed weekly until become negative ( value of <15 mIU/ml). while additional doses(second dose) of methotrexate were given on day 7 If the ß-HCG level on day 7 was the same or higher or less than 15% lower than that on day 4. The success rate of systemic methotrexate (single dose) was 75%(n-45), 25%(n=15) exposed to 2 or more doses of methotrexate ,16.6%(n=10) of patients exposed to multidose methotrexate respond to treatment, remain only 8.3%(n=5) not respond to multidose treatment they were treated surgically ,in which 2 cases of them operation done for them on their request after one dose of methotrexate, and other 3 cases were failed to respond to medical treatment after receiving 3 dose of methotrexate. The over all success rate of treatment in our study(medical treatment) was 91%(n=55).Success rate was higher in patients whom with β-HCG was ≤ 1500 mIU .Treatment was well-tolerated; most side effects were reported as mild and transient. All cases respond to methotrexate reported satisfaction with this regimen. Within two years follow up visit 38 cases become pregnant , 2 of them developed recurrent ectopic pregnancy.

عقار الميثوتريكست استخدم بصوره واسعه لعلاج حالات الحمل خارج الرحم تهدف الدراسة لتقييم مدى سلامة وفعالية استحدام عقار الميثوتريكسيت لعلاج حالات الحمل خارج الرحم المبكر وغير المنفجر. دراسه مستقبليه سريريه تضمنت ستون امرأه في مستشفى الولاده في اربيل للفتره من الاول من كانون الثاني 2007 ولغاية الاول من كانون الثاني 2009 وتم التشخيص باستخدام السونار المهبلي وقياس مستوى β-HCG في الدم . اعطي الميثوتريكسيت بالعضله 50 ملغم /متر مربع في اليوم الاول وتم قياس مستوى β-HCG في الدم في اليوم الرابع والسابع وتم اعتبار العلاج ناجح اذا قل المستوى بنسبة 15% وتم المتابعه اسبوعيا الى ان يصل مستوى سالب.تم اعطاء جرعه ثانيه من العقار في اليوم السابع اذا كان مستوى β-HCG اعلى او يساوي او لم يقل عن 15% عن مستوى اليوم الرابع. نسبة النجاح لجرعه واحده من الميثوتريكسيت كانت 75% و16.6% احتاجوا الى جرع متعدده و 8.3%لم يستجيبوا عولجوا جراحيا عقار الميثوتريكسيت بالعضله يعد سليم و فعال ويمثل بديل عن التداخل الجراحي لحالات الحمل الخارج الرحم المبكر


Article
Serum Progesterone &CA125 Levels as an Aid in the Prediction of Ectopic &Intrauterine Pregnancy

Authors: Maha M. Al-Bayati*, --- Manal Madany A. Qader**, --- Jinan Hadi Salma
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2015 Volume: 14 Issue: 1 Pages: 7-13
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:BACKGROUND : Prompt diagnosis of ectopic pregnancy is a difficult dilemma, and reliable predictors for diagnosis and differentiation of ectopic pregnancy from early pregnancy miscarriage are needed.OBJECTIVE: To evaluate the diagnostic value of serum progesterone and CA-125 levels in ectopic pregnancy and early intra uterine miscarriage.Study design: A prospective case control studySetting: The study was carried out in the department of obstetrics and gynecology of AL-Yarmouk teaching hospital (Baghdad – Iraq) from February 2011 to February 2012PATIENTS AND METHODS: This study was carried out on sixty pregnant women in their first trimester. Twenty women diagnosed as unruptured ectopic pregnancy; treated by laparotomy ,twenty women diagnosed as inevitable miscarriage; treated by curettage and twenty women with healthy pregnancy of a comparable gestational age as control group; follow up of this group was done to ascertain uneventful pregnancy with no complications.We compared the serum levels of progesterone and CA-125 in all groups at the time of presentation and 24h after surgical intervention in first and second groups. RESULTS : There was a significant decrease in mean post operative progesterone level in women with ectopic pregnancy and miscarriage groups with significant difference (P<0.0001). The study observed that the mean level of progesterone in women with ectopic group (6.76±3.63 ng/ml) was lower than that in miscarriage group (15.17±6.01 ng/ml) and control group (17.58±4.57 ng/ml) with significant difference (P<0.0001). This study also observed that the mean level of CA-125 in women with miscarriage group (117.07±94.30 U/ml) was higher than that in ectopic group (38.11±28.79 U/ml) and control group (30.51±16.10 U/ml) with statistically significant difference (P<0.0001).There was a significant decrease in mean level of post operative CA-125 in women with ectopic pregnancy and miscarriage groups with significant difference (P<0.0003).CONCLUSION: Combined measurement of both serum progesterone and CA-125 can be sensitive predictors in diagnosis and differentiation of ectopic pregnancy from inevitable miscarriage and normal pregnancy.


Article
Role of Serum Progesterone in the Diagnosis of Ectopic Pregnancy and Missed Abortion

Authors: Abdulrazak H Alnakash --- Zeina Abdulsahib
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2015 Volume: 14 Issue: 1 Pages: 22-27
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:BACKGROUND: diagnosis of early pregnancy failure (ectopic pregnancy and missed abortion) still challenging even by using of serial B-HCG and ultrasound. Serum progesterone hormone level value is regarded as one of the important diagnostic tools in the diagnosis of many obstetrical and gynecological conditions; one of these is early pregnancy failure.OBJECTIVE: To assess the role of serum progesterone level in early diagnosis of ectopic pregnancy and missed abortion.PATIENTS AND METHODS: The study is conducted at Al-Elwiyah Maternity Teaching Hospital throughout the period between (April 2010 –July 2011). Ninety women participated in the study, they are at their early weeks of gestation (6-10) weeks. Their ages were between 18-40 years. thirty of them served as a control group (normal intrauterine pregnancy) and sixty pregnant women included in the study group and subcategorized into 2 groups. thirty women with suspected sub-acute or chronic cases of ectopic pregnancy according to ultrasound and β-HCG results and 30 women served as suspected missed abortion. blood samples were taken from the three groups followed by another blood samples after two-day interval to measure of serum progesterone levels. the results were compared among the three groups at first and second readings. p-value, standard deviation and 95% confidence interval calculated and statistically analyzed.RESULTS: P-value of the serial measurements of serum progesterone levels in two-day interval in the three groups was statistically insignificant. while serum progesterone levels of both ectopic pregnancy and missed abortion were greatly lower than serum progesterone levels of normal intrauterine pregnancy in both first and second readings, with statistically significant deference, P-value is CONCLUSION: Serum progesterone levels has a useful role in diagnosing ectopic pregnancy and missed abortion.


Article
Studying the risk factors for ectopic pregnancy among spontaneous and assisted conception
دراسة عن عوامل الخطورة للحمل خارج الرحم الناتج عن الحمل الطبيعي والحمل المساعد

Authors: فاخر سلمان العاني --- هدى مالك محمد
Journal: Iraqi Journal of Embryos and Infertility Researches المجلة العراقية لبحوث الأجنة والعقم ISSN: eISSN: 26166984 / pISSN: 22180265 Year: 2013 Volume: 3 Issue: 5 Pages: 38-43
Publisher: Al-Nahrain University جامعة النهرين

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ackground:An ectopic pregnancy, or eccyesis, is a complication of pregnancy in which the pregnancy implants outside the uterine cavity. Theoretically, differences between conception via ART and natural conception may affect the risk of ectopic pregnancy. Data on the risk factors for developing ectopic pregnancy after IVF are still inconsistent. There is controversy whether ART increase or decrease the ectopic pregnancy.Objectives:To describe the occurrence or risk factors of ectopic pregnancy following IUI, IVF and spontaneous pregnancyPutlcnts and Methods:The recorded cases of ectopic pregnancy in the period between January 2010 to January 2011 in four teaching hospitals and two private hospitals were surveyed. New cases in the period between July 2011 to July 2012 in two teaching hospitals were also included in this study. The data was collected from medical records and interview.Results:A total of 86676 pregnancies were recorded during the period of the study with, the number of ectopic pregnancy out of total pregnancies in Baghdad was 408 during the period of this study. It was found that the type of conception was significantly associated with infertility (P < 0.001), ovulation induction (P<0.001), dilatation and curettage (P = 0.016), and history of contraception (P =0.002).Conclusion:Although several risk factors for ectopic pregnancy are known, the causes of increasing incidence of ectopic pregnancy remain unknown. The risk factors of ectopic pregnancy following IUI, IVF and spontaneous pregnancy included history of infertility, medication used for ovulation induction, history of contraception, and dilatation curettage as these factors are tightly linked with the types of conception. Increasing knowledge of risk factors for ectopic pregnancy may improve understanding of the causes of infertility.


Article
Thermodynamic Investigation of Partially Purified Paraoxonase in the Sera of Healthy Pregnant Women Compared to Women with Pregnancy Complication
دراسة ثرموديناميكية لانزيم الباروكسنيز المنقى جزئيا في امصال الحوامل الاصحاء و الحمل خارج الرحم

Authors: Zaizafoon Nabeel زيزفون نبيل --- Ebaa Zainal اباء زنيل --- Israa Zainal اسراء زينل
Journal: Baghdad Science Journal مجلة بغداد للعلوم ISSN: 20788665 24117986 Year: 2019 Volume: 16 Issue: 4 Pages: 871-877
Publisher: Baghdad University جامعة بغداد

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Abstract

The thermodynamic constanting of “crude and partially purified” Paraxonase(PON) was evaluated in the sera of “healthy and ectopic” pregnant women in order to characterize the reaction of PON with diethyl para-nitro phenyl phosphate as substrate.This study was performed on (17) women with ectopic pregnancy (EP) whose age between (25-55) years and (25) normal pregnant women with a mean age of (25 -55) years as a control group . Samples were collected from the Medical City, AL-Yarmook and Fatema AL-Zahraa hospitals during the period from Sep.2011 to April 2012.The study included the evaluation of “paraxonase activity, specific activity and total protein” in the (crude and partially purified) sera of EP patients & healthy subjects. The results demonstrated that there was significant decline (p≤0.05) in the activity and specific activity of PON and significant increase (p≤0.05) in the protein concentration. The study also included the evaluation of the energetic parameters: the Gibb`s free energy (ΔG) enthalpy change (ΔH), heat of activation,(ΔH*), entropy change(ΔS), temperature coefficient (Q10) and activation energy (Ea) with respect to human PON. The results indicated that there was a dramatic increase in each of the thermodynamic parameters (ΔG,Ea,ΔH,ΔS,ΔH*,Pz,Q10) for purified PON compared with enzyme in crude sera. The results indicated also that there was a dramatic increase in each of the thermodynamic parameters (ΔG, Ea, ΔH,ΔS,ΔH*,Pz,Q10) for purified PON compared with enzyme in crude sera which indicated that the purified PON suffered from the lack metals or substances that help enzyme to over come energy barrier, at the same time the purified PON(the freedom enzyme) had the greatest chance to collide and create of the favorable orientation with substrate.

اجريت هذه الدراسةِ على 17 إمرأةِ حبلى (حمل خارج الرحم) , متوسط اعمارهن (26.14±6.99) سنة و 25 امرأة (حمل طبيعي) بمتوسط اعمار(25.16±5.99) كمجموعة سيطرة, جمعت عينات الامصال من مستشفيات (مدينة الطب, اليرموك و فاطمة الزهراء للفنرة من ايلول 2011 الى نيسان 2012. تضمنت الدراسة تقييم (الفعالية و الفعالية النوعية)لانزيم الباروكسنيز وتقدير تركيز البروتين في امصال(الخام و المنقاة جزئيا في دراسة سابقة) للحوامل (خارج الرحم) ومقارنتها بمجموعة السيطرة ولوحظ وجود نقصان معنوي في تركيز البروتين في امصال المرضى مقارنة بالاصحاء (P≥0.05)في الفعالية والفعالية النوعية للانزيم وزيادة معنوية. P≤0.05)) شملت الدراسة ايضا قياس الدوال الخاصة بالطاقة لتفاعل انزيم الباروكسنيز والتي تضمنت(ΔG, Ea, ΔH, ΔS, ΔH*, Pz, Q10) للمجاميع اعلاه واظهرت النتائج وجود زياده ملحوظه في المتغيرات الحرارية الديناميكية للانزيم المنقى جزئيا مقارنة بالانزيم الخام للمجاميع المدروسة.

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