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Article
Descriptive study of Extragastrointestinal Manifestations of Ulcerative Colitis and their relation to disease activity in 100 Iraqi patients

Author: Khalid A. Al-Khazraji خالد الخزرجي
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2011 Volume: 53 Issue: 1 Pages: 24-28
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Ulcerative colitis is a chronic inflammatory bowel disease (IBD); its extragastrointestinal manifestations vary from one country to another. This study identifies the prevalence of the extragastrointestinal manifestations in a sample of Iraqi patients with ulcerative colitis and their relation to disease activity.Patients and Methods: A descriptive study was conducted on 100 patients with established diagnosis of ulcerative colitis, who attended Baghdad Teaching hospital and Gastroenterology center in Baghdad during the period from May 2009 to January 2010. A direct interview and thorough clinical examination were done to determine the history of the disease, its severity and the presence or absence of the extraintestinal manifestations.Result: The Extragastrointestinal manifestations were observed in 17 patients (17%). The most common EGlMs were the peripheral arthritis and mouth ulcer. The EGlMs were more common in patients with severe disease.Conclusion: The EGlMs of ulcerative are less common in Iraqi patients than in patients from western countries, but their relation with disease activity was relatively similar.Keywords: ulcerative colitis. extragastrointestinal manifestatio


Article
Histochemical and immunohistochemical techniques in ulcerative colitis

Authors: Noel AI-Sakkal نوئيل سليمان الصقال --- Hatim Alnuaimy حاتم النعيمي
Journal: Annals of the College of Medicine Mosul مجلة طب الموصل ISSN: 00271446 23096217 Year: 2008 Volume: 34 Issue: 1 Pages: 28-34
Publisher: Mosul University جامعة الموصل

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Abstract

Objective: To demonstrate the mucin changes in Ulcerative Colitis, to evaluate the benefit of the staining method and to demonstrate the CEA staining pattern in dysplasia complicating ulcerative colitis (U.C).
Methods: Colorectal biopsies were examined for changes of U.C for which a combined PAS/Alcian blue stain was applied. CEA immunohistochemical stain was used for cases of dysplasia complicating ulcerative colitis.
Results: One hundred colorectal biopsies were examined, U.C. was diagnosed in (22%) of cases, the mean age was (36.68) years, (13) were males, and (9) were females. The prevalence of dysplastic changes complicating U.C were detected in (22.7%).The rectum was the most frequent site of dysplasia complicating, U.C.. Two of the cases showed mild dysplastic changes; two showed moderate dysplasia, and only one showed severe dysplasia. The secretory activity of mucin in colorectal mucosa was tow in surface epithelium and varied in the crypts from absent or weak to moderate reduction.
The site of CEA distribution seemed to be affected mainly by degree of dysplasia, it was predominantly along the apical surface of the cells and also in the cytoplasm in case of mild dysplasia, while in moderate dysplasia it was of cytoplasmic distribution, and in severe dysplasia there was intensive cytoplasmic distribution.
Conclusion: There was an increase in relative frequency of U.C.
Immunohistochemical study of CEA localization in dysplastic gland is helpful in detection of early malignant change in U.C.

الهدف: توضيح تغيرات المخاط في مرض التهاب القولون التقرحي وتقييم جدوى الطريقة لايضاح المظهر الصبغي لـ CEA في مصاعف الحثل لالتهاب القولون التقرحي.الطرائق: أجرى فحص لخزعات من القولون ومن المستقيم بصدد تغيرات التهاب القولون التقرحي بصبغة (PAS/Alcian) الزرقاء المزدوجة، واجرى صبغ مناعي-نسيجي كيماوي لـ CEA لحالات الحثل المضاعق لالتهاب القولون التقرحي.النتائج: أجري فحص مائة خزعة قولون او مستقيم، وشخص التهاب القولون التقرحي لدى 22% من الحالات معدل العمر كان 36.68 سنة ؛ 13 ذكر و 9 اناث. وجدت التغيرات الحثلية المضاعفة لالتهاب القولون التقرحي لدى 22.7 % وكان المستقيم الموقع الاكثر لحالات الحثل المضاعف لالتهاب القولون التقرحي. اظهرت حالتان تغيرات حثلية خفيفة واثنتان اخريان اظهرتا تغيرات حثلية متوسطة وواحدة فقط اظهر جرت تغيرات حثلية شديدة. كانت فعالية افراز المخاط من النسيج الطلائي للمستقيم والقولون واطئة، مابين معدومة الى واظئة او متوسطة في الخفايا (crypts).ويظهر ان موقع انتشار CEA يتأثر بدرجة الحثل، واكثر ما لوحظ في السطح القمي للخلايا وفي الهيولي في حالات الحثل الخفيف بينما كان منتشرا في الهيولي في الحالات المتوسطة وانتشارا شديدا لوطأة في الهيوليفي الحثل الشديد.الاستنتاج: يظهر وجود زيادة نسبية في تكرار التهاب القولون التقرحي ويستفاد من الدراسة موقع الـ (CEA) بالصبغة المناعية النسيجية الكيماوية للغدد التي فيها مضاف الحثل في كشف التغيرات السرطانية المبكرة في مرض التهاب القولون التقرحي.


Article
Prevalence of autoimmune hemolytic anemia in ulcerative colitis

Author: Khalid A. Al-Khazraji
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2008 Volume: 50 Issue: 3 Pages: 273-281
Publisher: Baghdad University جامعة بغداد

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Abstract

Summary
Background: Ulcerative colitis is a chronic idiopathic inflammatory disorder that affects the
rectum & extends proximally to affect variable extent of the colon. Autoimmune hemolytic
anemia had reported in few cases.
Objective: to determine the prevalence of autoimmune hemolytic anemia in Ulcerative
colitis.
Patient & Methods: Fifty Iraqi patients having Ulcerative colitis attending the GIT Center in
Baghdad during the period from March to August 2004 were interviewed, examined and
diagnosed according to pathological study done for colonic biopsies by the same centre.
Blood was drown for the assessment of complete picture with blood film, reticulocyte
percent, erythrocyte sedimentation rate, Coombs test (direct, indirect), antinuclear antibody,
immunoglobulin assay, serum iron and TIBC in the same laboratory unit.
Results: In our study, 18(36%) patients were anemic, fifteen of them had normal or low
reticulocyte percent with normochromic normocytic RBC in blood film, probable causes of
anemia was either iron deficiency proved by low serum iron and high total iron binding
capacity (TIBC), or anemia of chronic illness. The remaining three of eighteen patients with
reticulocytosis, two of them Coombs test were negative and normal film, but they were
having acute bloody diarrhea which probably was the cause of reticulocytosis.
The third patient was Coombs positive with features of hemolytic anemia in the blood film
(polychromic with spherocytosis), this patient had also a high titer of IGg, LDH, so that this
female had all the evidence of autoimmune hemolytic anemia which is a rare complication of
Ulcerative colitis.
Salfasalazine as a treatment of Ulcerative colitis can cause autoimmune haemolysis, but in
this case the drug had stopped for one month before the development of autoimmune
haemolysis.
In our sample we had five patients with reticuloytosis but normal haemoglobin level and
normal blood film with cooms negative (direct and indirect) those five patients might had
nonimmune causes of hemolytic like G6PD deficiency which need further investigations, or
might had bloody diarrhea which cause elevated reticulocyte as areaction to blood loss, or it
may be due to salazopyrine effect which may lead to increase level of reticulocyte.
Conclusion:Most studies giving range of autoimmune haemolytic anaemia with Ulcerative
colitis between 1%-2%, all these studies showed direct coomb's test positive, and our study
showed 2% incidence. So it is one of the rare manifestations of Ulcerative colitis. It does not
depend much on severity, duration and degree of colonic involvement.


Article
ULCERATIVE COLITIS IN YOUNG CHILDREN, A CASE REPORT
التهاب القولون التقرحي في الاطفال الصغار (تقرير حالة)

Authors: Abdul-Kareem M. Ali عبد الكريم محمد علي --- Ahmed H. Alanee احمد هاشم العاني
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2008 Volume: 6 Issue: 2 Pages: 121-123
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

Ulcerative Colitis is one type of the inflammatory bowel diseases that affect the rectum and the colon. The usual age of presentation is at adolescence and adulthood. It is rarely seen during infancy and in young children. Our case, Mohammed, was presented at the age of 18 months with persistent bloody diarrhea that did not respond to the usual antibiotic and anti-parasitic drugs. All the investigations that were done during the period of the illness (more than 9 months) were non conclusive. Then colonoscopy were done which revealed the picture of ulcerative colitis. The patient then was put on oral steroid and salazopyrine with dramatic improvement in the general condition and disappearance of bloody diarrhea. Now the patient is on salazopyrine orally with steroid only in exacerbations.

التهاب القولون التقرحي هو واحد من امراض الامعاء الالتهابية التي تؤثر على المستقيم والقولون يظهر المرض غالبا في سن المراهقة والبلوغ ، ومن النادر اني يظهر المرض عند الرضع وصغار الاطفال حالتنا المرضية (محمد) ظهرت علمات المرض عنده بعمر( 18 شهر) باسهال دموي مستمر لايستجيب للمضادات الحيوية الاعتيادية والادوية المخصصة ضد الطفيليات .كل التحاليل المختبرية التي اجريت خلال فترة المرض المستمرة لاكثر من تسعة شهورغير محددة اومشخصة لمرض معين . وبعد ذلك نواظير القولون اظهرت صورة التهاب القولون التقرحي . ثم وضع المريض على العلاج المخصص لهذا المرض (Oral steroid and salazopyrine) مع حدوث تحسن ملحوظ وكبير في الحالة العامة للمرض واختفاء الاسهال الدموي .وعند حدوث نوبات جديدة للمرض يعطى المريض العلاج ذاته المستعمل عند التشخيص الابتدائي .


Article
Characterization of lymphocyte subsets as a tool of assessment of histological disease activity pattern in ulcerative colitis

Author: Hayder F. Ghazi
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2010 Volume: 52 Issue: 3 Pages: 304-308
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: In Ulcerative colitis (UC), the presence of a persistently elevated number of T cells in the inflamed area with respect to the activity of the disease suggesting bad prognosis. This study was done to evaluate cellular immune response in different disease activity patterns and its possible implication in evaluation of disease activity.Materials and methods: This study included Forty seven archived paraffin-embedded samples of ulcerative colitis; these samples diagnosed and graded for disease activity. Then dual immunofluorescence staining was used for phenotyping of lymphocytic infiltrate (CD3- CD19) and (CD4-CD8). A total and differential T cell as well as plasma cell count was recorded in these UC tissue samples. Non parametric Kruskal-Wallis test was used to compare the median cell counts among different study groups.Results: There is higher lymphocytic infiltrate for all types of cells when UC samples compared with control samples with highly statistical significant difference, T cells represents the major constituents of colonic mucosal infiltrate (86.89%) and about 75.79% were CD4 positive T cells. T-cell subsets and plasma cell have high statistical significant difference (p≤0.001) according to histological grade. Furthermore, with the histological grade the highest association found with T lymphocytes (r=0.944) followed by T helper (r=0.821), T cytotoxic (r=0.653) and B lymphocyte (r=0.237).Conclusions: Qualitative and semi quantitative characterization of lymphocytes subsets was useful in the assessment of different histological grades of UC disease activity.


Article
Development of Modified Release Nicotine Tablet Formulation for Treatment of Ulcerative Colitis

Author: Marwan Y. Al-hurr مروان يحيى الحر
Journal: Iraqi Journal of Pharmaceutical Sciences المجلة العراقية للعلوم الصيدلانية ISSN: 16833597 Year: 2010 Volume: 19 Issue: 2 Pages: 75-81
Publisher: Baghdad University جامعة بغداد

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Abstract

One of the therapeutic effects of nicotine is used as a protective against developing ulcerative colitis . ulcerative colitis is an inflammatory disease of the bowel affecting the superficial lining mucosa in the rectum and large intestine. In this study nicotine tablets were formulated as modified release tablets targeted to the colon. All formulas were studied for drug release , effect of diluent, retardant concentration, avicel grade,and compression force, the selected formula was then further studied for drug release in 3 different pH ( coated tablets) .The kinetic study revealed acceptable shelf life . Finally the selected formula was given to 6 patients in a pre-liminary clinical study which showed that nicotine can stabilize mild to moderate ulcerative colitis attacks.

التهاب القولون التقرحي احد التهابات الجهاز الهضمي التي تصيب الطبقة المخاطية السطحية للمستقيم و الامعاء الغليظه ويعتبر النيكوتين عامل حماية ضد تطور هذا المرض. في هذا البحث تم تحضير مضغوطات النيكوتين محورة التحرر موجه الى القولون. وتم دراسة تحررالدواء و تأثير نوع المواد المضافة غير الفعالة و تركيز المواد المثبطه للتحرر للصيغ المحضرة, وتأثير قوة الكبس على تحرر النكوتين. وتم أجراء دراسة اوسع للصيغه المختارة من حيث تحرر النيكوتين في اوساط مختلفة الاس الهيدروجيني و من حيث ثباتها في درجات حرارة مختلفة. وتم ايضا اجراء دراسة سريريه اولية على 6 مرضى للصيغة المختارة حيث أظهرت الدراسة ان النيكوتين يمنع تطور المرض و يزيد من استقرارية هذا المرض في الراحل البسيطة و المعتدلة الشدة.


Article
Co-Expression of Intestinal Lymphocyte Subpopulations in Ulcerative Colitis: An Analysis by Dual- Immunofluorescence Technique

Author: Haider F. Ghazi
Journal: Karbala Journal of Medicine مجلة كربلاء الطبية ISSN: 19905483 Year: 2009 Volume: 2 no.8, 9 Issue: 5 Pages: 725-731
Publisher: Kerbala University جامعة كربلاء

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Abstract

background: Fluoresceins labelled monoclonal antibodies against cell surfaceantigens are able directly to examine the expression of multiple antigens on thesurface of lymphoid cells in Ulcerative colitis lesions.Materials and methods: Using dual-immunofluorescence for investigated thecoexpression of (CD3-CD19 and CD4-CD8) antigens on infiltrated lymphocytes of 47patients with ulcerative colitis and 10 subjects from control group. Total anddifferential T cells as well as plasma cell counts were recorded in all tissue samples.Non parametric Kruskal-Wallis test was used to compare the median cell countsamong different study groups.Results: T lymphocyte, T-cell subtype and plasma cell in UC were high with highlystatistical significant difference when compared with those in normal control subjectsT cell UC (301.39) Controls (35.48), T-helper 2 UC (228.41) Controls (24.75), Thelper1 UC (54.21) Controls (13.45) and plasma cell UC (45.46) Controls (12.94).Recorded values of were different and increased according to modified Geboeshistological grades of disease activity T lymphocytes (r=0.944) followed by T helper2 subtype (r=0.821), T helper 1 (r=0.653) and B lymphocyte (r=0.237).Conclusions: The increased number of lymphocyte subsets was found in the UClesions and correlated with different histological grades of disease activity.


Article
Salivary assessment of Interleukin-6, C-reactive protein and albumin in ulcerative colitis patients in relation to oral findings

Authors: Muhassad H. Al-Mudhaffer محسد المظفر --- Sahar H. Abdul-Ghafoor سحر عبد الغفور
Journal: Journal of baghdad college of dentistry مجلة كلية طب الاسنان بغداد ISSN: 16800087 Year: 2013 Volume: 25 Issue: 1 Pages: 105-109
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Ulcerative colitis disease is a chronic inflammatory condition that affects the gastrointestinal tract. Inregulation of this inflammatory process, Interleukin-6, C-reactive proteins and albumin have a major role.Overproduction of IL-6 by immunocompetent cells contributes to activate the liver to produce CRP, transudation ofplasma albumin and development of the inflammatory condition. Elevated levels of IL-6 in saliva could be expected,because the saliva-producing cells are part of the digestive system. The purpose of this study was to assess salivary IL-6, CRP and albumin in ulcerative colitis patients in relation to oral findings.Materials and methods: Forty eight saliva specimens collected from three groups of subjects (sixteen newlydiagnosed UC patients, sixteen UC patients on medication and sixteen healthy subjects). The specimens werecentrifuged and stored at -20°C then three ELISA kits were used for estimating the three variables.Results: There was a significant elevation of salivary IL-6, CRP and albumin level in both newly diagnosed and onmedication groups in comparison to healthy persons. There was a significant elevation differences of salivary IL-6,CRP and albumin level between newly diagnosed and on medication groups. The prevalence of aphthus ulcer washighly significant in the newly diagnosed group in comparison to the other groups. Twenty five percent of patients onmedication complain from candidiasis and only one patients with tempromandibular joints problem (hard clicking).Conclusions: Salivary IL-6, CRP and albumin are elevated simultaneously in UC patients, in both newly diagnosed andon medication groups, but the mean of variables in second group was lower than in the newly diagnosed group.There are no correlation between salivary IL-6, CRP and albumin with oral findings.


Article
Adenosine Deaminase Activity and Peripheral Immune Cells Ratios in a Sample of Inflammatory Bowel Disease Patients

Author: Sahar Manfi Ahmad
Journal: Mustansiriya Medical Journal مجلة المستنصرية الطبية ISSN: 20701128 22274081 Year: 2015 Volume: 14 Issue: 1 Pages: 70-73
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Seventy inflammatory bowel disease (IBD) patients (35 ulcerative colitis; UC and 35 Crohn's disease; CD) and 20 controls were investigated for serum level of adenosine deaminase (ADA) and neutrophil-lymphocyte and monocyte-lymphocyte ratios. The results revealed that the mean of ADA was significantly increased in UC and CD patients (46.72 ± 8.99 and 41.17 ± 5.95 ng/ml, respectively) compared to controls (20.85 ± 2.79 ng/ml), but it was also significantly higher in UC patients than in CD patients. The neutrophil-lymphocyte ratio mean was also significantly increased UC patients (5.83 ± 3.10) as compared to CD patients (3.79 ± 2.02) or controls (1.66 ± 0.22). The ratio was also significantly increased in CD patients compared to controls. A similar pattern was also observed in monocyte-lymphocyte ratio. In conclusion ADA may have a role in the pathogenesis of IBD, especially UC, and consequently the peripheral immune cells might have been affected.


Article
Investigation of Serum TNF-alpha, TRAF-1, andTRAF-2 in Patients Suffer from Ulcerative Colitis
التقصي عن عامل نخر الورم (نوع الفا) والعامل المتعلق بمستقبلات عامل نخرالورم الأول والثاني في مصول المرضى المصابين بالتهاب القولون التقرحي

Authors: Ali Jabbar Eidan --- Mayada Noori Iqbal --- Liwaa Hussein Mahdi
Journal: kufa Journal for Nursing sciences مجلة الكوفة لعلوم التمريض ISSN: 22234055 Year: 2016 Volume: 6 Issue: 1 Pages: 130-138
Publisher: University of Kufa جامعة الكوفة

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Abstract

Background: Ulcerative colitis (UC) is a chronic inflammatory disease of unknown causes. It has involved the inflammatoryprocess of the mucosa and sometimes the submucosa of the large intestinal tract. There are a several theories involve role of the immune mechanisms and cell signals that lead to activation of many intracellular adapter proteins and other markers, which in turn trigger an inflammatory process and death of many colonocytes. Objective:investigation of serum TNF-alpha, TRAF-1 and TRAF-2 levels in active Ulcerative Colitis and also, identified the diagnostic possibility of the studied parameters in diagnosis of UC patients. Material and Method: A case-control study was conducted at the City of Al-Najaf Al-Ashraf using 56 and 30 individuals of both genders for Patients and Control groups with an overall age range of 18-75 years old. All sera with negative Epstein-Barr Virus (EBV) agglutination test of all subjects were monitored for level of Tumor Necrosis Factor-alpha (TNF), TNF Receptor Associated Factor-1 (TRAF-1), and TNF Receptor Associated Factor-2 (TRAF-2), by ELISA Method. All these Data was analyazed by using spss (T-test) program and also, the receiver operate characteristic curve (ROC) was used to identify their possibility of diagnostic value.Results: Serum level of TNF-alpha, TRAF-1 and TRAF-2 were significantly higher in UC patients than those in controls (P values were = 0.000). TNF-alpha, TRAF-1, and TRAF-2 shown to have a display to fabulous value in the differentiation of UC patients and control with the area under the ROC curve (AUR) of 0.698–1.000 (P value < 0.001).Conclusion: In light of the obtained results in current study, we conclude that the serological levels of TNF-alpha, TRAF-1 and TRAF-2 were increased in active UC patients. It seems that the activation of TNF-alpha, TRAF-1, and TRAF-2 may be first events in the development of UC. Recommendation: Additional genetic and immunological markers, including standardized lymphocytes and other assays, are needed. These are to determine the pro-inflammatory cytokines and monitor the progress of the disease in order to detect the suitable time of a possible intervention

خلفيةالبحث:التهاب القولون التقرحي (UC) هو مرض مزمن مجهول السبب يتصف بالتهاب الغشاء المخاطي وأحيانا التهاب الطبقة تحت المخاطية من الأمعاء الغليظة. هناك عدة نظريات تنطوي على دور آليات المناعة وإشارات الخلية التي تؤدي إلى تفعيل العديد من البروتينات المتحولة داخل الخلايا وعلامات أخرى، وهذا بدوره يقدح عملية الالتهاب وموت الكثير من خلايا القولون.الهدف: التقصي عن مستوى عامل نخر الورم نوع الفا والعامل المتعلق بمستقبلات نخر الورم الأول والثاني في مصول المرضى المصابين بالتهاب القولون التقرحي وكذلك معرفة دور تلك العوامل في تشخيص المرض.المنهجية:في دراسة مقارنة أجريت في مدينة النجف الأشرف باستخدام 56 و 30 شخصا من كلا الجنسين للمرضى الصابين بالتهاب القولون التقرحي ومجموعة التحكم مع الفئة العمرية 18-75 سنة. تم جمع الأمصال من كل المجاميع بعد التأكد من الاختبار السلبي لفيروس ابشتاين بار (EBV). وقد تم قياس مستوى نخر الورم عامل ألفا TNF-alpha والعامل المتعلق بمستقبلات نخر الورم الأول والثاني (TRAF-1)، (TRAF -2) باستخدام تقنية الامتزاز الأنزيمي (ELISA). وباستخدام برنامج الـSPSSتم تحليل البيانات واجراء اختبار Tوكذلك، تم استخدام منحنى الميزة (ROC) لتحديد القيمة التشخيصية لتلك العوامل المدروسة.النتائج:ان مستوى المصل للعامل TNF-ألفا، وTRAF-1 وTRAF-2 أعلى بكثير في المرضى الذين يعانون من التهاب القولون التقرحي مما هو عليه في مجموعة السيطرة (مستوى المعنوية لكل العوامل المدروسة يساوي 0,000) وتبين أن العوامل المدروسة تملك قيمة تشخيصية ممتازة للتشخيص المرض حسب المنطقة تحت منحى الميزة من 0،698-1،000 وبمستوى معنوية اقل من 0,001 (P value <0.001).الاستنتاج: في ضوء النتائج التي تم الحصول عليها في الدراسة الحالية، نخلص إلى أن هناك زيادة في مستويات كل من العاملTNF-ألفا، وTRAF-1 وTRAF-2 في المرضى الذين يعانون من القولون التقرحي. ويبدو أن تفعيل TNF-ألفا، TRAF-1، وTRAF-2 قد تكون الأحداث الأولى في التسبب في المرض .التوصيات:لغرض تحديد السيتوكينات الموالية للالتهابات ومراقبة تطور المرض ومن اجل تحديد التوقيت المناسب للتدخل في المرض يجب قياس معلمات مناعية ووراثية أخرى، بما في ذلك خلايا-T وأختيارات أخرى.

Keywords

TNF-alpha --- TRAF-1 --- TRAF-2 --- Ulcerative Colitis --- UC --- IBD

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