ABSTRACT
Background: Ampullary and periampullary tumors are composed of a group of malignant and benign neoplasms arising in the region of the ampulla of Vater and are a major problem to the patients and surgeons and their management remains a big challenge
Objective: Study the age, sex distribution, presentation and management of patients with ampullary and periampullary tumors in Iraq and compare it with other world reports
Patients and Methods: prospective study of 50 patients with ampullary and periampullary tumors carried out in GIT hospital [tertiary center] from January 2013 to March 2015, risk factors, age, sex, clinical presentation, images study, diagnosis and modality of treatments whether curative or palliative are studied
Results: 29 [58%] were males and 21[42%] were females, about the age distribution the mean age was 45 ,about the residency they were mainly from Baghdad in [40%] the presenting symptom was obstructive jaundice in 43 [86%] ,duration of illness [range from 1-2 months] with the mean period 45 days, abdominal ultrasound study reveal distended Gallbladders in 76%, dilated CBD in 82%, dilated pancreatic duct in 56%, Hepatomegaly in 42%, dilated intrahepatic billiary tree in 64%, and liver secondary in 10%, resection surgery was done in 50%, palliative surgery in 12% and endoscopic palliation in 38%
Conclusion: Ampullary and periampullary tumors are relatively common. The mean age is 45 years, lower than the western studies. Sex: male are affected 1.4 times more than female with male: female ratio = 1.38 Abdominal ultrasound is very informative but EUS, CT scan and MRI, MRCP is the cornerstone for the diagnosis, Normal looking papilla does not rule out occult ampullary tumor
Subject(s)
Humans , Male , Middle Aged , Female , Aged , Adult , Common Bile Duct Neoplasms , Prospective Studies , Carcinoma , Tertiary Care Centers , Disease ManagementABSTRACT
The Keap1-Nrf2-ARE pathway is an important antioxidant defense mechanism that protects cells from oxidative stress and the Keap1-Nrf2 protein-protein interaction (PPI) has become an important drug target to upregulate the expression of ARE-controlled cytoprotective oxidative stress response enzymes in the development of therapeutic and preventive agents for a number of diseases and conditions. However, most known Nrf2 activators/ARE inducers are indirect inhibitors of Keap1-Nrf2 PPI and they are electrophilic species that act by modifying the sulfhydryl groups of Keap1׳s cysteine residues. The electrophilicity of these indirect inhibitors may cause "off-target" side effects by reacting with cysteine residues of other important cellular proteins. Efforts have recently been focused on the development of direct inhibitors of Keap1-Nrf2 PPI. This article reviews these recent research efforts including the development of high throughput screening assays, the discovery of peptide and small molecule direct inhibitors, and the biophysical characterization of the binding of these inhibitors to the target Keap1 Kelch domain protein. These non-covalent direct inhibitors of Keap1-Nrf2 PPI could potentially be developed into effective therapeutic or preventive agents for a variety of diseases and conditions.
ABSTRACT
The aim of this study was to find cause effect relationship between diabetes and sensorineural hearing loss. Hearing threshold of 70 diabetic patients and 70 healthy controls were determined using pure tone audiometry at Al Yarmouk Teaching hospital. Their ages ranged between [9-45] years old. The patients were categorized into groups according to their age, the duration of disease, complications, control and type of diabetes. These observations were compared with those from the control subjects using appropriate statistical methods. The results of the study revealed that mean hearing threshold was worse in diabetic patients than control subjects. All age groups with diabetes showed significant low and high frequency hearing loss as compared to those who were well controlled. The threshold was worse in complicated diabetics than in non complicated diabetics. Diabetics with longer duration shows worse threshold than others. However, threshold was better in patients with good control of diabetes and there were no differences in threshold between insulin and non insulin dependent diabetes. It was found that diabetics had a poorer hearing threshold which was seen in all age groups, and there was a relationship between the duration, control and complications of diabetes and the level of hearing loss. No significant difference in hearing loss was found between insulin-dependent and non-insulin dependent diabetics