صامت الياس قاسم المولى

ABSTRACT Background: Structural changes of airways can be detected by high-resolution computerized tomography (HRCT) in asthmatics especially those with persistent asthma. The aim of this study was to detect these airways changes and their relationship with the duration and severity of the disease. Methods: This cross-sectional study enrolled 80 patients with persistent asthma. The patients were classified into two groups; severe and non-severe persistent asthma. HRCT scan was done for all patients, and radiological changes were classified into reversible (mucoid impaction, consolidation and lobar collapse) and irreversible changes (bronchiectasis, bronchial wall-thickening and emphysema). The Statistical Package for Social Sciences (SPSS, version 18) was used for data entry and analysis with appropriate statistical tests. P value of less than 0.05 was considered statistically significant. Conclusion: In this study, 28 patients out of 80 patients (35%) had severe and 52 patients (65%) had non-severe persistent asthma. Irreversible changes were detected in 100% of patients with severe, and 57.7% of patients with non-severe persistent asthma, (P = 0.0001). Reversible changes were found in 42.9% of patients with severe and 42.3% of patients with non-severe persistent asthma (p=0.9732). In asthmatic patients, radiological changes on HRCT scan correlates directly with the severity and the duration of the disease. Key wards: Asthma, high resolution computed tomography, reversible and irreversible changes.

Background: Leptin hormone mediates cardio metabolic risk but it’s role in the pathogenesis of heart failure remains uncertain. In patients with dilated cardiomyopathy an elevated leptin level have been reported and used as a biomarker for the progression of heart failure. Although leptin contribution and progression of obesity-related heart failure with preserved ejection fraction is expected, however, there is no clinical evidence that supports the role of leptin in this phenotype of heart failure. Aim of the study: To evaluate the presence of association between different leptin levels and cardiac function in a sample of Iraqi population and the possibility of using this hormone as surrogate for diagnosis for future heart disease or target for therapy. Methods: In this observational cohort study, we evaluated 88 participants with cardiovascular diseases who were attending Al-Najaf cardiac centre(mean age of 59.42 years, 52% females) who underwent routine echocardiography to evaluate their cardiac function and had their circulating leptin measured and classified as high and low variance groups. We used multivariable linear regression, adjusting for known correlates (including weight), to relate leptin concentrations to various types of heart failure. Results: Patients with family history of cardiovascular disease had higher serum leptin concentrations (p-value 0.0015), also higher leptin levels was observed in males with low risk waist-hip ratio group (P value 0.054) and smoker patients (p value 0.0001). Heart failure was not significantly associated with circulating leptin level changes. Conclusion: In our sample of Iraqi population complaining of cardiovascular diseases (CVD), systolic and diastolic cardiac dysfunctions were not associated with higher or lower circulating concentrations of leptin hormone. Although there was no direct correlation between different leptin levels and abnormal cardiac function, there was indirect correlation through the association of high leptin levels and risk factors of cardiovascular disease like smoking and family history of CVD .These observations need to be reevaluated in other ethnic groups of this population. Keywords: Leptin, heart failure, Iraqi population.

ABSTRACT Background: The clinical significance of coronary Myocardial Bridge (MB) anatomical characteristics is controversial in the literature. It is not clear whether MB has a benign or malignant clinical outcome. Objectives: To investigate the possible relationship between MB characteristics (depth, length and volume index) with ECG markers [T Peak-to-End interval (Tp-e), transmural dispersion of repolarization and Index of Cardiac Electrical Balance (iCEB)] and changes (ST-T and S/R ratio changes in V1 and aVL leads). Patients and Methods: Forty-one patients who were diagnosed as having MB at multi-detector CT exam were enrolled in the study. Results: MB depth and volume index were associated with notched QRS (p = 0.001 and 0.003 respectively) in the whole sample. The association of notched QRS with MB depth and volume index was more significant in patients with coronary atherosclerosis (p = 0.001 and 0.01 respectively). There was a statistically significant association between MB length (p = 0.006) and volume index (p = 0.001) with an increased S/R ratio in aVL lead in patients free from coronary atherosclerosis. No statistically significant association was observed between MB anatomical characteristics with ECG markers of increased arrhythmia (p > 0.01), including TDR, Tp-e and iCEB. Conclusion: MB depth and volume index showed a statistically significant association with notched QRS, particularly in patients with coronary atherosclerosis.

ABSTRACT Background: Angiotensin Converting Enzyme Inhibitors (ACEI) commonly cause cough as a main side effect, and whether or not they cause a more substantial effect on the respiratory function remains uncertain. Aims: to assess the pulmonary function status in patients who are taking ACEI with or without cough, during the treatment time & one month after cessation of therapy. Methods: This study was conducted in Al-Sader teaching hospital in Annajaf and Al-Hamza general hospital in Diwanyia from October 2015 till October 2016. One hundred and twenty subjects were assessed and divided in the following groups: G1: 30 hypertensive patients treated with ACEI who developed cough as a side effect of ACE inhibitors, G2: 30 hypertensive patients on ACEI without cough, G3: 30 hypertensive patients treated with antihypertensive drugs other than ACEI, G4: 30 subjects without history of hypertension used as control group. Spirometric tests and blood biochemistry tests were performed for all participants at baseline and were repeated for G1 one month after discontinuation of ACE inhibitors therapy. Results: Statistical analysis of the results reveals that the FEV1, FEV%, PEF were significantly lower in G1 than G2, G3 and G4 (p<0.05) and that FVC in G1 was significantly lower than G4 (p<0.05). Following the discontinuation of ACEI therapy , spirometry was repeated and the results show that there were significant increment in FEV1, FVC, FEV% and PEF for G1 after ACEI cessation (p<0.05). Conclusions: It is not only the cough that is caused by ACEI medication in those susceptible patients but also airway hype responsiveness and some effect of ACEI may persist after one month of stopping medications. Keyword:Angiotensin,spirometriy

Abstract Background: Chronic obstructive pulmonary disease (COPD) is manifested mainly as two main clinical phenotypes chronic bronchitis and emphysema. It is characterized by the presence of poorly reversible airflow obstruction; the presence of other histopathological changes may contribute to the poor response to treatment in many patients. Aim of study: To detect additional changes that involves the lung tissue such as interstitial lung fibrosis in COPD patient. Patients and Methods: This cross-sectional study was carried out on (16) male patients diagnosed with COPD. All patients were during the stable state, and investigated by spirometry and HRCT. Results: Eight patients had emphysema, four had emphysema and lung fibrosis, two had traction bronchiectasis, one with apical fibrosis and another with possible lung neoplasm, four patients (out of seven) who had obstructive and restrictive pattern on spirometry had interstitial changes compared to two (out of nine of those with obstructive pattern only. Conclusions and Recommendations: HRCT scan is an important diagnostic tool to detect other pulmonary changes that can occur in patients with COPD. Larger studies are needed and obtaining histopathological assessment for these patients. Keywords: COPD, HRCT, respiratory condition

Abstract Diabetes mellitus is chronic metabolic disorder which causes many complications. These are subdivided into microvascular complication affecting retina, kidney and peripheral nerves and macrovascular complications (atherosclerosis) affecting the major arterial systems including coronary arteries. Abnormal lipid metabolism is common in DM and it play an important role in the macrovascular complications. In this case control study 150 diabetic patients on different regimens of treatment were investigated for hyperlipidemia and compared to each other and to 50 apparently healthy control. Comparison of each group of diabetic patients with the control group was as follow; regarding total cholesterol there was no significant difference, higlyceride was significantly higher in group 2 (mixed insulin and oral hypoglycemic therapy), and group 3 (oral hypoglycemic drugs therapy) (P<0.001) in comparison with control group, while in group I (only insulin therapy) it was lower than the control group, but the difference was siatistically not significant, HDL was significantly lower in all groups in comparison with control group and the least value of HDL was found in group 3 (P<0.001). Regarding LDL there was no significant difference in comparison with the control group, while VLDL was higher in group 2 and 3 than the control group and the difference was significant (P<0.001). Comparison of the measured parameters among three groups of diabetic patients was as follow; regarding total cholesterol and LDL there was no significant difference among these three groups. Triglycerides and VLDL were significantly lower in group 1 (P<0.001), while HDL was significantly lower in group 3 (P< 0.001). Cholesterol, triglycerides and VLDL were significantly higher in females in group 2 (P<0.05). Regarding HDL and LDL no significant difference was found between males and females. In group I triglyceride was higher in those with 5 - l0 years treatment, while in group 2 & 3 there was no significant difference in measured parameters regarding the duration of treatment.