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The Role of Highly Sensitive Troponin I in Diagnosis and Prognosis of Dilated Cardiomyopathy in Pediatric Age Group

Authors: Eman Hassan Al-Hmairy --- Yasar Mohammed Hassan Al-Shamma --- Muntadhar Yahya Al- Muhanna
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2015 Volume: 12 Issue: 3 Pages: 697-705
Publisher: Babylon University جامعة بابل

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Abstract

The aim of this study, is to evaluate the role of highly sensitive serum troponin I in diagnosis and prognosis of children with dilated cardiomyopathy. This study included 48 children with dilated cardiomyopathy with left ventricular dysfunction, that diagnosed clinically by history, clinical examination ,electrocardiography and echocardiography, including 2D-echocardiography, M-mode and Doppler study. Echocardiography regarded as the corner stone in the diagnosis of dilated cardiomyopathy. Those patient were subdivided to 15 children present with acute heart failure (Acute DCM) (8 female and 7 male), and 33 children who are known cases of dilated cardiomyopathy reported in the cardiology out clinic with chronic cardiac dysfunction (18 female and 15 male),both groups followed for one year with regular clinical, laboratory and echocardiographic evaluation during treatment coarse for cardiac dysfunction , another 48 control healthy child with same age groups involved in the study (25 female and 23male), the age of both patient and control groups ranging from 1month- 12 years. All patient had cardiac dysfunction at the time of attendance . We found that most patient with Dilated cardiomyopathy with acute left ventricular dysfunction had high serum level of highly sensitive troponin I at the time of presentation. Those patients with chronic Dilated , usually had serum troponin above the detectable limit and significantly more than control group. During follow up all patient show to decrease their serum troponin I level with improvement of their cardiac function till reaching normal or nearly normal level if Left ventricular function improved toward normal value, while those remain with left ventricular dysfunction for longer period despite treatment shown to have higher troponin level. This negative relationship between highly sensitive troponin I indicates that the highly sensitive troponin I is important for both diagnosis and prognosis of patient with dilated cardiomyopathy.


Article
Interventricular Mechanical Dyssynchrony in Dilated Cardiomyopathy and Its Relation with Left Ventricular Systolic Dysfunction

Author: Ahlam Kadhim Abbood, Haider Jabar Al-Ghizzi1, Wissam S. Tajuldin
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2018 Volume: 15 Issue: 3 Pages: 227-230
Publisher: Babylon University جامعة بابل

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Abstract

Background: Heart failure (HF) is a major problem worldwide, and despite the optimal medical treatment, still it carries high mortality.Ventricular dyssynchrony among patient with HF portends poor prognosis. Aim of the Study: The aim is to evaluate the prevalence ofinterventricular dyssynchrony in patients with dilated cardiomyopathy (DCM) patients and its relation to underlying etiology and the severityof systolic dysfunction. Materials and Methods: Fifty‑eight patients with ischemic and nonischemic cardiomyopathy (ICM and NCM) wereincluded in this study. Inclusion criteria include Type II–IV New York Heart Association patients with ejection fraction (EF) <35%. Mechanicaldyssynchrony (interventricular dyssynchrony) was assessed by pulsed Doppler. Assessment of left ventricular (LV) systolic function was byEF and stroke volume. Evaluation of the prevalence of mechanical indices in DCM and their relation to underlying etiology and severityof LV systolic dysfunction was done. Results: The prevalence of interventricular dyssynchrony was more in NCM than ICM. There was anonsignificant negative correlation between this dyssynchrony and LV systolic parameters. Conclusion: Mechanical dyssynchrony indiceswere affected by the underlying etiology and severity of LV systolic dysfunction associated with the existence of the mechanical dyssynchrony.


Article
Status of Some Trace Elementsin Idiopathic and Ischemic Cardiomyopathy and Coronary Artery Disease: Echocardiographic Correlation

Authors: Waleed K. Hussein --- Ali Y. Majid --- Basil O. Saleh
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2010 Volume: 52 Issue: 3 Pages: 331-335
Publisher: Baghdad University جامعة بغداد

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Abstract

Background:The most principal mechanisms of cardiomyopathies are;high preload and afterload and low myocardial contractility, imbalance of trace elements may cause myocardial metabolic dysfunction and may have a role in aetiology of cardiomyopathy, particulary in IDC. Trace elements are being increasingly recognized as essential mediators of the development and progression of heart diseases.
Methods: Study design Multi case-control study and single center estimation of trace elements concentrations in a number of volunteer settings this study was conducted in the Department of Cardiology, Ibn Albitar Hospital, and in the Physiological Chemistry Department of the College of Medicine, Baghdad University, from June 2005 to July 2006. Subjects Twenty-five patients with IDC, 15 patients with ICM, 16 patients with coronary artery disease(CAD) who have normal LV function, and seventeen healthy individuals as controls were included in this study. Investigations included serum estimation of zinc (Zn), copper (Cu), and magnesium (Mg) concentrations in these groups of patients and controls.
Results: The mean (±SD) value of serum zinc was significantly decreased in CAD patients compared with controls (P< 0.003). Serum Cu values (mean±SD) were significantly higher in IDC, ICM and CAD groups than in controls (P< 0.0001, P< 0.002, and P< 0.007, respectively). Serum Mg (mean±SD) value was significantly decreased in ICM patients compared to controls (P<0.007). Furthermore, there was a significant positive correlation between serum Mg levels and the values of LVEF % in IDC patients (r=0.522, P< 0.007).
Conclusion: This study confirmed that heart failure (IDC and ICM) and CAD are associated with serum trace elements (Zn, C u, and Mg) abnormalities.


Article
Thyroid Hormones and Cardiac Dilatation and Dysfunction In Iraqi Patients with Idiopathic Dilated Cardiomyopathy Biochemical and Echocardiographic Study

Author: Basil O.M. Saleh
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2007 Volume: 6 Issue: 1 Pages: 41-44
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Serum thyroid hormone level can provide a quantitative index for evaluating the severity of chronic heart failure.OBJECTIVES:To assess the contributions of thyroid hormones [tri-iodothyronine] (T3) and thyroxine (T4)] to the left ventricular (LV) dilatation and myocardial dysfunction in patients with idiopathic dilated cardiomyopathy (IDC).METHODS:Forty patients with idiopathic dilated cardiomyopathy (IDC) aged 46.20 + 1.90 years, as (mean ± SEM) (11 females and 29 males) were studied. Serum total T3, total T4 and thyroid-stimulating hormone (TSH) were measured in these patients. Echocardiographic parameters including LV systolic diameter, septal thickness systolic diameter, LV diastolic diameter, septal thickness diastolic diameter and LV ejection fraction (LVEF) were also be assessed in all patients.RESULTS:This study showed that the serum T4 values were significantly directly correlated with the values of EF % (r = 0.34; p < 0.035) along with significant inverse relationship between serum levels of T3 and the diameter of LV systole (r = - 0.34; p< 0.032).CONCLUSION:This study revealed an important significant correlation between serum thyroid hormones levels and echocardiographic parameter values that may point to the role of these biochemical factors in the contribution to the LV dilatation and cardiac dysfunction (heart failure) .


Article
Selenium Status and Echocardiographic Parameters in Iraqi Patients with Idiopathic Dilated Cardiomyopathy

Author: Basil O.M. Saleh
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2007 Volume: 6 Issue: 1 Pages: 45-48
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:It has been speculated that trace elements may play a role in the pathogenesis of dilated cardiomyopathy (DCM) .In the present study, we aimed to assess serum concentrations of selenium (Se) in Iraqi patients with idiopathic dilated cardiomyopathy (IDC) and to evaluate the correlation between serum Se concentrations and echocardiographic parameters.METHODS:This study included 28 patients with IDC and 22 healthy controls .Serum level of selenium was measured by atomic absorption spectrophotometry method .Echocardiographic parameters including left ventricular end diastolic diameter (LVEDD), LV end- systolic diameter (LVESD) ,and LV ejection fraction (LVEF) were measured in all patients with IDC in order to evaluate its correlation with serum Se concentrations.RESULTS:Serum concentration of Se in IDC patients was significantly lower than in healthy controls (p<0.001).Relationships of the serum Se levels with echocardiographic and clinical parameters were not statistically significant.CONCLUSION:The present study confirmed that IDC is associated with decreased serum Se concentrations. This change in Se may play an important role in the pathogenesis of myocardial damage in IDC


Article
Homocysteine and Thyroid Hormones in Patients with Familial Dilated Cardiomyopathy

Author: Basil O.M. Saleh
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2007 Volume: 6 Issue: 2 Pages: 88-91
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Familial linkage of primary dilated cardiomyopathy (DCM) occurs more commonly than often is appreciated. In 10-20 percent of patients, a first degree relative also shows evidence of primary DCM suggesting that familial transmission is relatively frequent.METHODS:this study included 7 patients aged 40-70 years (2 females and 5 males) with familial dilated cardiomyopathy (FDCM) and 17 healthy subjects aged 29-60 years (6 females and 11 males). Plasma fasting total homocysteine tHCY, serum folic acid (FA), vitamin B6, total triiodothyronine (T3), and total thyroxine (T4) were measured in these two groups.RESULTS:The mean value of plasma tHCY was significantly higher in patients with FDCM than in control (P<0.001). The mean (±SD) values of serum folic acid and vitamin B6 were significantly decreased in FDCM patients when compared with those of control group (P<0.05, P<0.01, respectively).A significant inverse relationship between plasma tHCY concentration and the values of serum FA was shown in the FDCM patients (r=-0.78, P<0.05). The mean values of serum T3 and T4 were insignificantly decreased in patients with FDCM than in controls.CONCLUSION:The level of plasma tHCY is significantly higher in FDCM patients than in healthy control. This severe hyperhomocyteinemia of FDCM patients may be related to evolution and development of myopathic state in such patients.


Article
Clinical and Doppler Study of Restrictive Filling Pattern in Patients with Dilated Cardiomyopathy

Author: Ali A Mohammed Al Mousawi (FICMS) a Nezar Naser Al Attabi (FICMS) a *Hassan Ali Farhan (FICMS)
Journal: Al-Kindy College Medical Journal مجلة كلية الطب الكندي ISSN: 18109543 Year: 2013 Volume: 9 Issue: 2 Pages: 89-91
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Dilated cardiomyopathy (DCM) is a well-recognized cause of cardiovascular morbidity and mortality.Objectives: To evaluate the prognostic implications of the restrictive left ventricular filling pattern (RFP) in dilated cardiomyopathy.Methods: Patients with DCM admitted to Ibn AL-Bitar Hospital for Cardiac Surgery, Baghdad-Iraq, from May 2006 to August 2008, underwent a full clinical evaluation and Doppler echocardiography study. Patients were classified into three groups: Group I had persistent restrictive filling pattern; Group II had reversible restrictive filling pattern; and Group III had nonrestrictive filling pattern. Results: The current study was conducted on a total number of 80 patients with DCM, fifty (62.5 %) were males and 30(37.5%) were females with a male to female ratio 1.6:1. Patients with restrictive filling pattern (Group I&II) were 51 (63.8%), while patients with nonrestrictive filling pattern (Group III) were 29 (36.2%). During follow up, patients with persistent restrictive filling pattern (30; 37.5%) had higher New York Heart Association (NYHA) class symptoms, low ejection fraction (EF) and higher mortality; 6 (20%) died within the first year, 6 (20%) died in the second year. Clinical improvement was significantly frequent in Group II and III than Group I.Conclusions: In patients with DCM, the persistence of restrictive filling at 3 months is associated with a high mortality the patients with reversible restrictive filling have a high probability of improvement and excellent survival.


Article
The Outcome of Dilated Cardiomyopathy in Pediatric Age Group After One Year Treatment for Acute and Chronic LV Dysfunction

Authors: Yesar Mohammed Hassan Al- Shamma --- Muntadhar Yahya Al- Muhanna
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2015 Volume: 12 Issue: 3 Pages: 706-710
Publisher: Babylon University جامعة بابل

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Abstract

Dilated cardiomyopathy (DCM) means congestive heart failure as a result of dilation and systolic dysfunction of cardiac ventricles (mainly the left ventricle). It is a common type of cardiac muscle disease in pediatric age group. Many children with DCM are without symptoms, but known patients with DCM may present with acute heart failure, others may be developed ventricular abnormal rhythm and atrioventricular block, syncopal attack and sudden death . Dilated cardiomyopathy (DCM) in pediatric age group has a worse prognosis, the survival rate was 41% at 1 year and 20% at 3 years.The participants belongs to both 48 patients)15 patients with acute DCM , mean age (10.24±11.38 months; 8 females and 7 males) and 33 patients with chronic DCM (mean age (10.46±10.72 months;18females and 15 males) were selected and examined in the cardiology clinic of Karbala pediatric teaching hospital between April 2013 and October 2014. 2- D echocardiography, M- mode for assessment of cardiac function ( Ejection fraction (EF).At the time of attendance , all the patients with acute DCM (NO.=15) had low EF, with treatment , there was improvement in the EF during the period of treatment and follow up, after 1 year 66.7% of patients had normal EF.Also, all patients with chronic DCM (NO.=33) had low EF, with treatment , there was improvement in EF, after 1 year 60.6% of patients had normal EF. At the time of attendance , all the patients with acute and chronic DCM had low EF, with treatment, there was improvement in the EF during the period of treatment and follow up, after 1 year of treatment and follow up.


Article
AMIODARONE - INDUCED THYROIDITIS IN A POST-CARDIAC TRANCEPLANT PATIENT - CASE REPORT
التهاب الغدة الدرقية نتيجة استعمال الامايودارون بعد اج ا رء عملية زرع القلب – اشهار حالة

Authors: HATEM AL-FARHAN حاتم الفرحان --- AFTAB A. SIDDIQUI افتاب صديقو --- YASSER W. SHAREF ياسر شريف --- ADIL F. AL LAWATI عادل اللاواتي
Journal: Duhok Medical Journal مجلة دهوك الطبية ISSN: ISSN: 20717334 (online)/ ISSN: 20717326 (Print) Year: 2012 Volume: 6 Issue: 1 Pages: 59-63
Publisher: University of Dohuk جامعة دهوك

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Abstract

Amiodarone is a class III antiarrhythmic medication that is widely used for the treatment of various arrhythmias and is useful in non-ischaemic dilated cardiomyopathy. It is well known that amiodarone can alter the biochemical status of the thyroid gland. Amiodarone-induced thyroidits is more common than amiodarone-induced hypothyroidism. It is estimated that 23% of patients receiving amiodarone may develop amiodarone-induced thyroidits. We arereporting a case of a young lady with familial dilated cardiomyopathy who was on amiodarone that was stopped in July 2007, yet she developed clinical signs and biochemical evidence of amiodarone-induced thyroidits few months after her cardiac transplantation despite stopping amiodarone. She was managed conservatively jointly with the endocrinologist and her thyroid function test returned back to normal eventually.

Non-) الامايودارون هو أحد الادوية التي تستعمل في علاج عدم انتظام ضربات القلب كما هو مفيد في علاج مرض و من المعروف بأن هذا الدواء يودي الى خلل في وظائف الغدة الدرقية. و .(ischemic dilated cardiomyopathy يذكر بأن التهاب الغدة الدرقية نتيجة استعمال هذا الدواء هو أكثر شيوعا من نقص هورمون الغدة الدرقية نتيجة استعمال و التي كانت تستعمل الدواء (Familial dilated cardiomyopathy) الدواء. و قد قمنا برصد حالة شابة مصابة ب الى حين توقف الدواء في تموز 2007 . رغم عدم استعمال الدواء فقد ظهرت لدى المريضة العلامات السريرية و البايوكيمياوية لالتهاب الغدة الدرقية نتيجة استعمال هذا الدواء عدة أشهر بعد اج ا رء عملية زرع القلب. تم علاج المريضة تحفظيا حيث تم ارجاع وظائف الغدة الدرقية الى حالتها الطبيعية.


Article
Quercetin role in moderating the side effects of chemical drug Doxorubicin in Troponin level and some cardiac enzymes in local male rabbits
دور مادة كوركتين في تلطيف الآثار الجانبية للعقار الكيماوي دوكسوروبسين في مستوى تروبونين وبعض الإنزيمات القلبية في ذكور الأرانب المحلية

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Abstract

The study aim to detect the treatment effect of Quercetin in mitigation the toxic effect of Doxorubicin drug in heart function in 32 local male rabbits divided randomly into four equal groups treated for 28 days as follow; Control group given daily distilled water orally and injected with 4ml normal saline weekly. First treatment group given orally 10mg/kg Quercetin daily and injected with 4ml normal saline weekly. Second treatment group injected with 4mg/kg doxorubicin weekly and given daily distilled water orally. The third treatment group given 10mg/kg Quercetin daily and injected with 4mg/kg doxorubicin weekly. Results showed a significant (P<0.05) increase of Troponin, CK-MB and LDH levels in second group treated with doxorubicin only compared with normal levels of these parameters in control group, conversely there is positive interrelating non significant (P>0.05) among control group and other groups which treated with Quercetin, first as well as third groups in which Quercetin reduces all parameters significantly (P<0.05). In conclusion; The Quercetin has important role in reduced negative side effects of Doxorubicin in heart function.

تهدف الدراسة الى تحديد التأثير العلاجي لمادة Quercetin في تلطيف التأثيرات السمية لعقار Doxorubicin في وظيفة القلب. أجريت التجربة في البيت الحيواني التابع لكلية التربية/جامعة القادسية واستمرت لمدة 28 يوما استخدم فيها 32 من ذكور الأرانب المحلية وزعت عشوائيا إلى أربعة مجاميع متساوية تم معاملتها على النحو التالي: مجموعة السيطرة جرعت بالماء المقطر يوميا وحقنت أسبوعيا 4ml من المحلول الفسيولوجي ، مجموعة المعاملة الأولى جرعت بمادة Quercetin بتركيز 10mg/kg يوميا وحقنت أسبوعيا 4ml من المحلول الفسيولوجي ، مجموعة المعاملة الثانية حقنت الحيوانات أسبوعيا بعقار Doxorubicin بتركيز 4mg/kg وكان الحقن متزامن مع تجريع الحيوانات 4ml من الماء المقطر يوميا ، مجموعة المعاملة الثالثة جرعت الحيوانات بمادة Quercetin بتركيز 10mg/kg يوميا مصحوبا بحقن الحيوانات بعقار Doxorubicin بتركيز 4mg/kg أسبوعيا. أظهرت نتائج التحليل الإحصائي حصول ارتفاع معنوي (P<0.05) في مستوى Troponin, CK-MB, LDH في مجموعة المعاملة الثانية وذلك عند مقارنة نتائج هذه المجموعة مع المستوى الطبيعي لهذه المعايير الذي ظهر في نتائج مجموعة السيطرة ، بالمقابل لوحظ وجود تقارب ايجابي واضح وصل إلى درجة انعدام المعنوية (P>0.05) في مستوى هذه المعايير ما بين مجموعة السيطرة وبين المجاميع التي تم معاملتها بالمادة النباتية الفعالة Quercetin وهي مجموعة المعاملة الأولى وكذلك مجموعة المعاملة الثالثة ففي المجموعة الثالثة خفضت مادة Quercetin مستوى المعايير المدروسة معنويا (P<0.05) مقارنة بمجموعة المعاملة الثانية ، كما اظهر الفحص النسجي للمقاطع المأخوذة من حيوانات المعاملة الثانية وجود تحلل واضح في الألياف العضلية القلبية مع وجود تنخر شديد في الألياف وغياب واضح للتخطيط العرضي في معظم مناطق النسيج فضلا عن وجود تفجج وتباعد شديد بين الألياف العضلية القلبية في حين لم تشاهد معظم هذه التأثيرات السلبية في مجموعة المعاملة الثالثة رغم كون عقار Doxorubicin جزء من معاملتها. نستنتج مما تقدم أن مادةQuercetin لها دور مهم في تقليل التأثيرات السلبية لعقار Doxorubicin في وظيفة القلب وتقليل الأضرار النسجية السلبية للعقار في عضلة القلب.

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