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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
Autonomic Dysfunction in Interictal Period

Author: *Dr.Bassam Mahmood Flamerz M.B.Ch.B , F.I.B.M.S**Dr.Akram M. Ibrahim Al-Mehdawi,
Journal: Al-Kindy College Medical Journal مجلة كلية الطب الكندي ISSN: 18109543 Year: 2012 Volume: 8 Issue: 1 Pages: 18-23
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: migraine is a chronic neurovascular disorder characterized by intermittent attacks of sever headache with or without aura that can include various combinations of neurological, gastrointestinal tract (G.I.T), and autonomic changes, without evidence of primary structural abnormalities. The Autonomic nervous system involvement suggested by many symptoms and signs including nausea, diarrhea, constipation, coldness in the extremities, paroxysmal tachycardia and chest pain.Objectives: To evaluate autonomic functions in patients with migraine and to clarify the autonomic dysfunction weather its sympathetic, parasympathetic, or combined. Also to assess the severity of this dysfunction and its relation to age, gender and type of migraine.Methods: This study enrolled 60 patients with migraine, 42 females and 18 males with an age range between 14-45 y. with 30 healthy volunteer as control group, The using of a questionnaire paper, autonomic nervous system disability scale and set of autonomic cardiovascular reflexes test were also applied .Results: The migraineurs with disabling attack may be prone to autonomic nervous system hypofunction which may be either a risk factor for migraine headache, or be a consequence of frequent disabling attacks, moreover autonomic nervous system dysfunction and migraine may share a common neural substrate. The Parasympathetic part of autonomic nervous system is affected more than sympathetic according to Ewing classification of autonomic function tests which is significant statistically in comparison to control, and 16(26.7%) of patients showed definite dysautonomia(score >2) while 44(73.3%) of patients were normal. Palpitation and postural dizziness are the most frequent symptoms in patients with migraine . Autonomic dysfunction among migraineurs is not rare also prolong course of illness is strongly correlated with autonomic dysfunction which is affect parasympathetic part more than sympathetic, for this reason the clinician should look carefully for the autonomic symptoms when they assess patient with migraine because most of those symptoms were disablingConclusions: The assessment of autonomic function tests should be a routine work in patient with migraine. The heart rate response to deep breath and valsalva are simple informative and beside to evaluate the parasympathetic part of autonomic nervous systemKey words: migraine, autonomic dysfunction, sympathetic, parasympathetic.


Article
Oxidative Stress Association with Autonomic Dysfunction in Parkinson Patients
ارتباط الإجهاد التأكسدي مع خلل الوظائف التلقائية في مرضى باركنسون

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Abstract

Background: Parkinson’s disease may be caused by oxidative stress within cells due to defective nucleoli. Dopamine producing neurons are particularly sensitive to oxidative stress. The researcher's present evidence showing defective nucleoli within dopamine producing neurons lead to oxidative stress and damageObjective: To assess antioxidant activity in Parkinson patients with autonomic dysfunction.Materials and Methods: samples were collected in Al Kadhimiya Teaching hospital and Baquba teaching hospital in a period lasts from 1st January to 1st November 2013. Antioxidant activity had been tested in 44 Parkinson patients with autonomic dysfunction, 23 Parkinson patients without autonomic dysfunction and 25 healthy matched controls; using (Antioxidant Capacity, Total BioAssay™ Kit ;US Biological company, Catalog No. A2298-43).Results: antioxidant activity showed a reduction in its level in Parkinson patients without autonomic dysfunction (0.75) with further reduction in Parkinson patient with autonomic dysfunction (0.37) compared with the control groups (1.2).Conclusion: Oxidative stress and antioxidants have a role in pathogenesis of Parkinson disease. Both increase oxidative stress (direct) and a reduction in activity of the antioxidants (indirectly) cause loss of neuron and reinforcing damage mechanisms that play a role in autonomic dysfunction in Parkinson Disease.

خلفية الدراسة: قد يكون سبب مرض باركنسون هو الإجهاد التأكسدي في الخلايا بسبب نويات المعيبة. ينتج الدوبامين من الخلايا العصبية الحساسة بشكل خاص للإجهاد التأكسدي. عدد من الباحث بين ان النويات المعيبة خلال فترة انتاج الدوبامين من الخلايا العصبية يؤدي إلى الإجهاد التأكسدي والتلفالهدف من الدراسة: تقييم نشاط مضادات الأكسدة في مرضى الشلل الرعاشي (باركنسون) مع خلل الوظائف التلقائية.المواد والطرق: جمعت العينات من مستشفى الكاظمية التعليمي ومستشفى بعقوبة التعليمي خلال الفترة من 1 كانون الثاني لغاية 1 تشرين الثاني . النشاط المضادة للأكسدة تم اختباره في 44 مريضا باركنسون مع خلل الوظائف التلقائية، 23 مريضا باركنسون دون خلل الوظائف التلقائية و 25 شخص لا تظهر عليهم اعراض المرض بأستخدام عدة القدرة المضادة للأكسدة، حسب الشركة البيولوجية الاحيائية - اميركيا.النتائج: أظهر النشاط المضادة للأكسدة انخفاض مستواه في مرضى الشلل الرعاشي دون خلل الوظائف التلقائية (0.75) مع مزيد من الانخفاض لمرضى الشلل الرعاشي المصحوب بخلل الوظائف التلقائية (0.37) مقارنة مع الاشخاص الذين لا تظهر عليهم اعراض المرض (1.2)الاستنتاجات: تشير البيانات الحالية أن الاكسدة ومضادات الأكسدة قد تلعب دورا هاما في التسبب بمرض الشلل الرعاشي (باركنسون.( قد يسبب ارتفاع الاكسدة الى فقدان الخلايا العصبية اما انخفاض نشاط مضادات الأكسدة مسؤولة بشكل غير مباشر عن فقدان الخلايا العصبية وتعزيز آليات الضرر الذي لعب دورا في خلل الوظائف التلقائية في مرض الشلل الرعاشي (باركنسون).

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