Al-Batool Teaching Hospital Research Articles

Role of surfactant therapy in reducing oxygen requirement and mortality among neonates suffering from respiratory distress syndrome: A Prospective study at Al – Batool teaching hospital in Diyala province

Background: Respiratory distress syndrome (RDS) is a major cause of neonatal morbidity and mortality. It is a breathing disorder characterized by a deficiency or inactivity of surfactant in the lungs of preterm and term babies and if not treated, it leads to serious complications like pneumothorax, emphysema, bronchopulmonary dysplasia and death. Objective: To estimate the effect of surfactant therapy on oxygen requirement and neonatal mortality as well as the incidence of RDS in the special care neonatal unit (SCNU) in the AL Batool Teaching Hospital in Diyala Governorate. Patients and Methods: A sample of 2000 patients with signs and symptoms of RDS at the time of presentation was prospectively collected from the 1st of July 2022 until the 1st of March 2023 in SCNU at Al-Batool Teaching Hospital. Gestational age, body weight, the use of oxygen, surfactant therapy, and continuous positive airway pressure (CPAP) were taken into consideration in assessing the outcome of RDS neonates. Results: There was a significant relationship between surfactant administrations, the period of staying on CPAP, and oxygen demand as the p-value was < 0.001 for both. Neonates who received surfactant had a lower mortality rate, with an incidence of 2.5%; the p-value was < 0.001. Incidence of neonatal RDS was 694 (34.7%). Conclusion: Since the incidence of RDS was 34.7%, surfactant therapy should be routine in neonatal special and intensive care units. Proper use of surfactant (proper timing and mode of administration) reduces oxygen demand, the need for CPAP, hospitalization, and mortality among those neonates.

Trimester-Specific Free Thyroid Hormones Levels among Pregnant Women in Nineveh Governorate,Iraq

AbstractThere are numerous physiological changes in thyroid gland functions occur during conception that lead to differ in thyroid hormones levels. Therefore, American Thyroid Association (ATA) guidelines recommended determination of population specific reference serum levels for thyroid hormones in different trimesters. Aim of current study is to establish trimester –specific reference serum levels (TSRSLs) for free triiodothyronine (FT3) and free thyroxine (FT4) in apparently healthy pregnant females in Nineveh governorate, Iraq.Accordingly, a cross-sectional study was carried out from Dec. 2020 to Apr. 2021 in Al-Batool Teaching hospital, Al-khanssa Maternity Teaching Hospital, Al-Noor Primary Health Center (PHC) and Out- patient clinics in Nineveh governorate. A total of 300 pregnant women were enrolled in this study after obtaining oral and written consent, 140 were excluded since they were met one or more of exclusion criteria, other 10 found to be positive anti-thyroid peroxide were also excluded from the study. The remaining 150 pregnant females aged (16-42) years were enrolled in this study, 50 of them were assigned to each trimester.The following parameters FT4 and FT3 were measured for each participants. The result of this study showed the TSRSLs of FT4 were (0.70-1.29, 0.49-1.31 and 0.58-1.28 ng/dl) for the 1st, 2nd and 3rd trim, respectively and for FT3 were ( 2.63-3.96, 2.04-3.3 and 2.11-3.40 pg/ml) for the 1st, 2nd and 3rd trim, respectively. The mean FT4 and FT3 was significantly decreased (P=0.002 and P<0.0001), respectively. from 1st to 3rd trim. The current study are reported the TSRSLs of FT3 and FT4 for the first time in Nineveh governorate. We concluded nearly similar TSRSLs of FT3 and FT4 to that recorded elsewhere

Elective Repeated Cesarean Section (ERCS)

Objective: To investigate the timing of elective repeat cesarean deliveries at Al-Batool Teaching Hospital in Diyala, Iraq. Methods: A retrospective analysis was conducted of 100 women who underwent elective repeat cesarean delivery at 37-40 weeks gestation at Al-Batool Teaching Hospital. Emergency cesarean deliveries were excluded. Results: The majority of elective repeat cesarean deliveries (78%) were performed at 37 weeks gestation. Cesarean deliveries at 38, 39, and 40 weeks accounted for 4%, 2%, and 16% of the sample, respectively. Conclusions: In this cohort, most elective repeat cesarean deliveries were conducted at 37 weeks gestation, rather than the recommended 40 weeks. Delivering earlier than 39-40 weeks in the absence of medical indications reduces the chances of successful vaginal birth after cesarean. These findings suggest that evidence-based protocols were not consistently followed for timing of elective repeat cesarean sections at this institution. Further research is needed to identify barriers to adhering to delivery guidelines and implement quality improvement initiatives to optimize cesarean delivery timing when clinically appropriate.

Congenital Heart Disease In Preterm Infants

Background: Congenital heart defects and preterm birth are two important causes of neonatal and infant mortality. However, the relationship between them has not yet been fully clarified. Objective: To find the association of congenital heart disease with premature delivery. Patients and Methods: The study is an observational cross sectional study, done in Al-Batool teaching hospital for maternity and children from July 2022 to January 2023. A self-prepared questionnaire was used to gather data. Gestational age was calculated mainly on postnatal gestational assessment by Dubowitz/Ballard method by a pediatrician. Echocardiography was done by Echocardiography specialist doctor to identify the presence and types of congenital heart defects. SPSS version 25 was used for statistical analysis. Results: Total number of births (term and preterm) was 1616, congenital heart diseases were detected in 60(3.71%) of them, most of them were isolated heart defect. In preterm babies, the congenital heart diseases were detected in 8% (p value was <0.001), they were of different types as followings: patent ductus arteriosus (n=10,26%), atrial septal defect (n=8,21%), ventricular septal defect (n=7,18%), transposition of the great arteries (n=4,10%), tetralogy of Fallot (n=2,5%), and complex of congenital heart disease (n=7,18%), while in full term babies, the rate of congenital heart diseases was only 1.9%. Conclusion: The incidence of congenital heart disease was higher in preterm than full term delivered babies, mostly in the group of transposition of the great arteries, ventricular septal defect, complex heart defects, followed by atrial septal defect. Keywords: Preterm, delivery, congenital heart disease.

Congenital Heart Disease In Preterm Infants

Background: Congenital heart defects and preterm birth are two important causes of neonatal and infant mortality. However, the relationship between them has not yet been fully clarified.
 Objective: To find the association of congenital heart disease with premature delivery.
 Patients and Methods: The study is an observational cross sectional study, done in Al-Batool teaching hospital for maternity and children from July 2022 to January 2023. A self-prepared questionnaire was used to gather data. Gestational age was calculated mainly on postnatal gestational assessment by Dubowitz/Ballard method by a pediatrician. Echocardiography was done by Echocardiography specialist doctor to identify the presence and types of congenital heart defects. SPSS version 25 was used for statistical analysis.
 Results: Total number of births (term and preterm) was 1616, congenital heart diseases were detected in 60(3.71%) of them, most of them were isolated heart defect. In preterm babies, the congenital heart diseases were detected in 8% (p value was <0.001), they were of different types as followings: patent ductus arteriosus (n=10,26%), atrial septal defect (n=8,21%), ventricular septal defect (n=7,18%), transposition of the great arteries (n=4,10%), tetralogy of Fallot (n=2,5%), and complex of congenital heart disease (n=7,18%), while in full term babies, the rate of congenital heart diseases was only 1.9%.
 Conclusion: The incidence of congenital heart disease was higher in preterm than full term delivered babies, mostly in the group of transposition of the great arteries, ventricular septal defect, complex heart defects, followed by atrial septal defect.

Risk Factors for Colonization with S.aureus and Methicillin Resistant Staphylococcus aureus Among Health Care Workers in Al-Batool teaching hospital for maternity and children in Diyala, Iraq

Background: Staphylococcus aureus coloniza-tion for the human nose representing a challenge that requires a cope with host defense and competing resident microor-ganisms. Objective: To evaluate the risk factors for in-fection with S. au-reus and MRSA among health care workers (HCWs) in Al-Batool teaching hospital for maternity and children in Diyala, Iraq. Patients and Methods: A total of 27 swabs were taken from HCWs in Al-Batool teaching hospital for ma-ternity and chil-dren in Diyala, Iraq (ATHMC) Standard microbi-ological proce-dures were used for diagnosis of S. aureus and Methicillin Re-sistant Staphylo-coccus aureus (MRSA). Results: Significant corre-lation was report-ed between age and colonization with S. aureus & MRSA. Inverse correlation was reported between education level and colonization with S. aureus and MRSA. Signifi-cant correlation was reported be-tween acne and colonization with S. aureus. Signifi-cant correlation was reported be-tween sinusitis, years of experi-ence, contact with farm animals and colonization with S. aureus and MRSA. Significant correlation was reported between ward of duty and colonization with MRSA. Conclusion: Colonization with S. aureus and MRSA inversely correlated with younger age group, education level of HCWs. Colonization with S. aureus and MRSA correlated with sinusitis, years of experience (5 -6); contact with farm animals. Colonization with S. aureus correlated with acne. Colonization with MRSA correlated with ward of duty at children care floor.

Risk Factors for Colonization with S.aureus and Methicillin Resistant Staphylococcus aureus Among Health Care Workers in Al-Batool teaching hospital for maternity and children in Diyala, Iraq

Background: Staphylococcus aureus coloniza-tion for the human nose representing a challenge that requires a cope with host defense and competing resident microor-ganisms. Objective: To evaluate the risk factors for in-fection with S. au-reus and MRSA among health care workers (HCWs) in Al-Batool teaching hospital for maternity and children in Diyala, Iraq. Patients and Methods: A total of 27 swabs were taken from HCWs in Al-Batool teaching hospital for ma-ternity and chil-dren in Diyala, Iraq (ATHMC) Standard microbi-ological proce-dures were used for diagnosis of S. aureus and Methicillin Re-sistant Staphylo-coccus aureus (MRSA). Results: Significant corre-lation was report-ed between age and colonization with S. aureus & MRSA. Inverse correlation was reported between education level and colonization with S. aureus and MRSA. Signifi-cant correlation was reported be-tween acne and colonization with S. aureus. Signifi-cant correlation was reported be-tween sinusitis, years of experi-ence, contact with farm animals and colonization with S. aureus and MRSA. Significant correlation was reported between ward of duty and colonization with MRSA. Conclusion: Colonization with S. aureus and MRSA inversely correlated with younger age group, education level of HCWs. Colonization with S. aureus and MRSA correlated with sinusitis, years of experience (5 -6); contact with farm animals. Colonization with S. aureus correlated with acne. Colonization with MRSA correlated with ward of duty at children care floor. Keywords: Health care workers , S.aureus, MRSA ,Risk factors

Anti-Mullerian Hormone Is a Significant Marker for Male Infertility

To evaluate serum anti-Mullerian hormone (AMH) in men with normal, reduced sperm concentration and in azoospermic men as a possible clinical marker of male factor infertility. Prospective study Private clinic of Dr. Yasir Al-Wattar and Al-Batool Teaching Hospital in Mosul. This study was conducted on one hundred male subjects aged less than 50 years for the period from July to November 2011, infertile men were classified according to their sperm count into oligospermics (n=28) and azoospermics(n=47), twenty five men were normal (n=25).Serum concentrations of FSH and Testosterone were measured using ELISA, serum Anti-Mullerian hormone concentrations were measured using AMH/MIS enzyme linked immunosorbant assay kit. Significant differences in serum AMH, FSH and Testosterone concentrations were found between normal, oligospermic & azoospermic men. AMH negatively correlated with FSH in oligospermic and azoospermic men and positively with testosterone in azoospermics and negatively with testosterone in oligospermics. Anti-Mullerian hormone should be evaluated in patients with oligospermia and azoospermia, it may serve as a marker of male infertility.

Study of pyocyanin production and biofilm formation in clinical Pseudomonas aeruginosa

Pseudomonas aeruginosa is an opportunistic pathogen involved in many infections in respiratory system, urinary tract, pneumonia, wounds, and bacteremia. It has many mechanisms and virulence factors such as adaptation and survival in extreme environments. In this study, 32 isolates of P. aeruginosa were collected from Teaching Laboratories in Baqubah General Teaching Hospital and Al-Batool Teaching Hospital, Iraq. The isolates were identified based on morphological and biochemical tests and confirmed by Vitek 2 system. The isolates varied in their antibiotic resistance towered ceftazidime, ceftriaxone, ticarcillin/clavulanic acid, meropenem, aztreonam, imipenem by 100%,100%,100%, 68.75%, 28.12%, and 18.75%, respectively. The biofilm formation test revealed that 43.75% of P. aeruginosa isolates were strongly biofilm forming, 46.8% moderate, and 6.25% were non-biofilm forming. All the tested isolates were able to produce pyocyanin with varied concentration ranged between 17 µg/ml (isolate P2) to 31.5 µg/ml (isolate P7). This study revealed the ability of the clinical P. aeruginosa to produce high amount of pyocyanin which could be used in many applications.

Low birth weight and associated risk factors in neonates

Objective: To determine if there are any maternal factors that might be linked to low birth weight (LBW). Methodology: This cross-sectional study was done at Al-Batool Teaching Hospital from January and March 2022 with 150 mothers who gave birth to babies who lived. Within 24 hours of being born, all babies were weighed. A birth weight of less than 2500 grams was thought to be low. All mothers were interviewed within 24 to 72 hours of giving birth, and the results were recorded. Results: There was significant differences (p<0.05) among socio demographic characteristics of mothers, except residence. There were significant differences (p<0.05) among maternal risk factors, except infant’s sex. There were significant differences (p<0.05) among disorders that associated with mothers. Conclusion: In Diyala province, LBW is linked to maternal socioeconomic status, risk factors, and disorders. Antenatal visits by well-educated and well-off women may decrease LBW.

Konjenital Ağrı Duyarsızlığı ile Anhidrosis Sendromu: Diyala vilayeti / Irak’tan Bir Olgu Sunumu

Congenital insensitivity to pain with anhidrosis syndrome (CIPA); is a rare autosomal recessive disorder presenting with pain insensitivity, sweating inability, and intellectual disability. The incapability to sense pain and temperature often leads to recurrent severe and inadvertent self-inflicted harm; these can result in severe complications, as patients settle slowly from skin and bone harm. We present a case of a four-year-old boy with a diagnosis of CIPA, after repeated visits to the hospital emergency department for repeated chest and both ankle joint infections, which prompted further investigations. Case report A four-year-old boy was admitted to Albatool teaching hospital for maternity and children in Baqubah, Diyala, Iraq because of recurrent chest and both ankle joints infection. He is the second child of consanguineous parents. His six-year-old sister is normal. The mother noticed early after birth that her child was suffering from high fever, he was not responding to pricking and injections, and he never sweats with intolerance to warm weather. Examination revealed mental developmental delay, absent upper and lower canine teeth, napkin and face dermatitis which was intractable to therapy, and deep pus discharging ulcers of both heels. Radiology of feet shows signs of osteomyelitis. There is a history of the same disease in two male cousins who died at age of three and five years respectively, the overall clinical context warranted a clinical suspicion of CIPA. Early diagnosis of this extremely rare disease is very important for the treatment and prevention of complications. Conclusion: This case report shows that a clinician should suspect to investigate for CIPA when managing kids with multiple inadvertent self-inflicted harms, anhidrosis, and pain insensitivity.

Failure to thrive and it's Risk factors among children under 5 years old in Al-Batool Teaching Hospital in Baquba city

Background: Failure to thrive (FTT) indicates insufficient weight gain or absence of an appropriate physical growth,it is a sign not a disease ,commonly seen by the primary health care physicians. It might be due to organic or non-organic causes and it is usually of a multifactorial etiology.
 Objective: To detect the prevalence of failure to thrive and risk factors in pediatric age group - under 5 year old in Al-Batool teaching hospital in Baquba city through 2020-2021.
 Patients and Methods: This study was across sectional study that took place In Al-Batool Teaching Hospital for maternity and children,in Baquba Distract-Diyala province, Iraq.during the period from 1st of February 2020-31st of July 2021. Throughout this study Two hundred and fifty (250) child were randomly selected under -5years old . Informations were collected from the patients files including age,current weight,birth weight,type of feeding,weaning,history of prematurity, history of chronic diseases and socioeconomic conditions.
 Results: Showed that children below 12 months were (45.2%), males (51.6%)and females (48.4%). male:female ratio was 1:1 ,majority of children were from Bohris . medium socioeconomic level was the largest with (61.6%). regarding mother education,mothers who have secondary education represent the largest level with (45.6%),children with bottle feeding were the largest with (45.0%),premature birth represent (2.0%),children with chronic diseases (14.0%),children with UTI (32.0%). Children with (FTT)were(23.2%),while (76.8%) were of normal growth. Regarding age groups most of the affected children were below 24 months of age with (36.5%) (P value was 0.0001) which is considered to be a significant. Males with (FTT) (24.8%) ,while Females (21.5%). (Pvaluewas0.534) which is considered to be of no significance. Regarding children with (FTT) and low socioeconomic level it was (68.8%) (p value was 0.0001)which is considered to be a significant. Children with (FTT) and illutrate mother was(60.0%) (p value was 0.0001)which is considered to be a significant. children with breastfeeding showed no (FTT) ,while those with bottle feeding was (37.0%) (P value was 0.0001 ) which is considered to be a significant. children with (FTT) and UTI (58.8%)(P value was 0.0001)which is considered to be a significant.
 Conclusion: This study concluded that failure to thrive is strongly correlated with poverty, mothers education ,chronic diseases, premature birth and type of feeding.failure to thrive showed no correlation with gender .

Failure to thrive and it's Risk factors among children under 5 years old in Al-Batool Teaching Hospital in Baquba city

Background: Failure to thrive (FTT) indicates insufficient weight gain or absence of an appropriate physical growth,it is a sign not a disease ,commonly seen by the primary health care physicians. It might be due to organic or non-organic causes and it is usually of a multifactorial etiologyز Objective: To detect the prevalence of failure to thrive and risk factors in pediatric age group - under 5 year old in Al-Batool teaching hospital in Baquba city through 2020-2021ز Patients and Methods: This study was across sectional study that took place In Al-Batool Teaching Hospital for maternity and children,in Baquba Distract-Diyala province, Iraq.during the period from 1st of February 2020-31st of July 2021. Throughout this study Two hundred and fifty (250) child were randomly selected under -5years old . Informations were collected from the patients files including age,current weight,birth weight,type of feeding,weaning,history of prematurity, history of chronic diseases and socioeconomic conditions. Results: Showed that children below 12 months were (45.2%), males (51.6%)and females (48.4%). male:female ratio was 1:1 ,majority of children were from Bohris . medium socioeconomic level was the largest with (61.6%). regarding mother education,mothers who have secondary education represent the largest level with (45.6%),children with bottle feeding were the largest with (45.0%),premature birth represent (2.0%),children with chronic diseases (14.0%),children with UTI (32.0%). Children with (FTT)were(23.2%),while (76.8%) were of normal growth. Regarding age groups most of the affected children were below 24 months of age with (36.5%) (P value was 0.0001) which is considered to be a significant. Males with (FTT) (24.8%) ,while Females (21.5%). (Pvaluewas0.534) which is considered to be of no significance. Regarding children with (FTT) and low socioeconomic level it was (68.8%) (p value was 0.0001)which is considered to be a significant. Children with (FTT) and illutrate mother was(60.0%) (p value was 0.0001)which is considered to be a significant. children with breastfeeding showed no (FTT) ,while those with bottle feeding was (37.0%) (P value was 0.0001 ) which is considered to be a significant. children with (FTT) and UTI (58.8%)(P value was 0.0001)which is considered to be a significant. Conclusion: This study concluded that failure to thrive is strongly correlated with poverty, mothers education ,chronic diseases, premature birth and type of feeding.failure to thrive showed no correlation with gender . Keywords: Failure to thrive, Risk Factors, Children

Abdominal Migraine among Children in Diyala Province

Background: Abdominal migraine is characterized by frequent, paroxysmal, and acute attacks of abdominal pain. There are many hypotheses which contribute to its pathophysiology, but abnormal gastric motility can play a role in the disease's pathogens. Abdominal migraine affects 0.2% to 4.1% of children. Diagnosis of abdominal migraine depends on history and physical examination, radiological and laboratory tests which help to exclude other causes of abdominal pain. Treatment is focused on non-pharmacological and pharmacological therapy. Objective: To identify abdominal migraine among children in Diyala province and summarize the relationship between abdominal migraine and other disorders. Patients and Methods: A cross-sectional study was carried out in Al-Batool teaching hospital in Diyala Province for 8 months from 1st November 2020 till 30th June 2021. The target population was the children who were attending pediatric consultant clinics who were examined and recorded according to Rome Ⅳ Criteria for diagnosis of abdominal migraine. A total of 300 children were included in the study. The information was taken from mothers of children using a questionnaire that was used for the study of abdominal migraine. All data were collected by introducing and analyzing information by using computer (Microsoft Excel 2010 software for windows). Statistical analysis was done by number and percentage as description. Results: The results of demographic data were conducted on 300 child their ages ranged between 3-15 years presented with paroxysmal abdominal pain associated with at least two of following features as anorexia, nausea, vomiting, headache , palpitation , decrease school performance and pallor . Peak percentage of abdominal migraine was seen in age between 6-9years (54.7%). Females affected nearly equal to males, females were (51.6%) and males were (48.3%). Regarding the location of abdominal pain, it occurred mainly in periumbilical site (80%). In children with abdominal migraine, there was history of migraine headache and motion sickness in first-degree relatives. There were many triggering factors for abdominal migraine such as foods like sweets, chinese food, carbonated drinks which were found in (90.3%) of children and watching TV, mobile,and electronic games for long time in (96.7%) of children. The duration of symptoms less than 6 months was seen in (13.3%) of children while the duration of symptoms in between 6-12 months was seen in (60%) of children while the duration of symptoms above one year was seen in (26.7%) of children . Conclusion: Abdominal migraine was mostly seen in school age children. Family education about the causes ,trigger factors and management of disease is important. Keywords: Abdominal migraine, abdominal pain , children

MOLECULAR STUDY OF BLASTOCYSTIS HOMINIS ISOLATED FROM DIFFERENT REGIONS OF DIYALA GOVERNORATE.

The aim: To detect the infection rate of Blastocystis hominis in children less than 10 years old with diarrhea in Diyalaby polymerase chain reaction (PCR) method, to determine the subtype of Blastocystis hominis by sequencing the product of the positive result, and to determine the association between Blastocystis hominis infection and different factors such as gender, age, the level of mother education and the presence or absence animals in their houses. Materials and methods: A cross-sectional study was conducted on children with diarrhea at Al-Batool Teaching Hospital in Diyala governorate, during the period from November 2020 to April 2021, a total of 100 children 55 males and 45 females, then, stool samples were collected and examined by conventional polymerase chain reaction. Results: The rate of infection with the parasite Blastocystis hominis was 8%, 8 out of 100. The infection was higher among females 62.5% than to males 37.5%, while the positive result was higher in the age group less than two years 75%, the highest percentage occur with patient whose mothers were incomplete primary and primary education was reached 37.5% and 25%; respectively and the study showed the highest percentage was with those who kept animals at homes was 75%. Conclusions: According to the genetic analysis of the sequence of eight samples that were positive for Blastocystis hominis parasite using the conventional polymerase chain reaction and they were back to the subtypes 3.

Clinical and Social Findings of Childhood Epilepsy

Background: Seizures are defined as a transient occurrence of signs and symptoms due to the abnormal, excessive, or synchronous neuronal activity in the brain characterized by abrupt and involuntary skeletal muscle activity. Seizure is related to specific risk factors like positive family history, fever, infections, neurological comorbidity, premature birth, mother’s alcohol abuse, and smoking in pregnancy. Epilepsy is the most frequent chronic neurologic condition in children. Studies have suggested declining incidence rates of childhood epilepsy in high-income countries during the last decades. Objective: To describe the clinical features and social findings of epilepsy in children, and to evaluate some risk factors associated with control of epilepsy. Patients and Methods: This cross-sectional study was conducted in the pediatric department of Albatool teaching hospital in Diyala province, Iraq. A total of 100 children were included in the study from February 2020 to May 2020. All children diagnosed with epilepsy in this study. Results: One hundred children with epilepsy, their mean age was 5.96± 3.33 years (range 1-14 years). Of the 48(48%) children were male and 52(52%). Of the total patients, 79% were free from seizure on AED, 21% of them were refractory to treatment.Patients without developmental delay (88.7%, p=0.012) can be controlled by AED. Patients who had idiopathic seizures (87.5%, p=0.04) can be controlled by AED. Patients who had seizure attacks can be controlled by AED more than patients who had weekly or monthly seizure attacks (97.4%) (p<0.001). Patients who had been treated by monotherapy (94.7%, p=0.012) can be controlled more than patients who were treated by multidrug therapy. Affected social interaction and need more supervision were factors that detected more in patients with refractory epilepsy, p=0.04, 0.01 respectively. While there was no association between frightened other people and epilepsy control. Conclusion: Most of the patients are characterized by: treatment approach monotherapy, less affected by social interaction and need less supervision. Patients with refractory epilepsy had opposite factors. Keywords: Epilepsy, Albatool teaching hospital.

Barriers to Antenatal Care Use among Pregnant Women

Background: Antenatal care is the routine health program of pregnant women to reduce the risk of stillbirths andpregnancy complications and give women a positive pregnancy experience.Objectives: This study aims to assess the utilization ratio of antenatal care services and to identify current barriersto proper utilization of antenatal care services in Mosul city.Subjects and Methods: A descriptive study was carried out during the period from 26 September, 2019 to 1stApril 2020. The study has been conducted among three hospitals in Mosul city namely: Al- khansaa teachinghospital, Al- salam teaching hospital and Al-batool teaching hospital. The target population was pregnant womenwho attend maternity and child care unit. The study sample consists of 3000 pregnant women. Data collection toolwas composed of (2) main parts. The first one was for socio demographic data about the pregnant woman. Thesecond part was for gynecological, obstetric and antenatal care characteristics. It was constructed through use of(2) option- type (yes-no). Content validity was determined by presenting the items to a panel of scientific experts.Results: Women with greater obstacles (mean=4.5) were found to be less likely than those with less barriers(N=60, mean=5.6) to receive prenatal care. There was a significant difference in prenatal care attendance betweenpregnant women who had no prior children (nulliparous) and pregnant women who had at least one prior child(multiparous) If t = 1.2, then the significance level is 0.05.Recommendations: The study recommends establishing several antenatal care clinics in different areas of Mosulcity to improve medical and nursing staff caring attitude in addition to increasing people’s awareness throughhealth education about the importance of conducting antenatal care visits since the beginning of pregnancy.

Epidemiological Study of Anemia in Diyala Province / Iraq

Background: More than one billion people worldwide are affected with anemia. Studies have shown that nutritional deficiency, particularly a decrease in iron-rich food consumed, seems to be the most common cause of anemia. Objective: To study some demographic characteristics of anemia in children of different residencies of Diyala governorate/ Iraq. Patients and Methods: A cross-sectional descriptive study piloted in Al-Batool Teaching hospital in Baqubah / Diyala- Iraq from February 1st to Sept 30th 2019. Children was categorized according to the residency into two groups (rural & urban regions), anemia was sorted according to WHO classification: normal Hb 11 gm/dL, mild anemia 10- 10.9 gm/dL, moderate 7- 9.9 gm/ dL, and severe anemia Hb < 7 gm/dl. Results: One hundred seventeen children aged 6 months – 9 years were included in the study; 58.1% males and 41.9% females, 104 children 88.9% were less than 3.5 years, and 13 (11.1% ) children of 3.5 years and more. Sixteen children 13.7% were having normal Hb level and the remaining was anemic as follow: 35.9% mild anemia, 46.1% moderate anemia, 4.3% severe anemia, p-value 0.000. It was found that 57.3% of children belongs to family lived in urban areas, while 50 (42.7%) of them live in rural areas. The number of children who had moderate anemia was more in rural areas, p-value 0.008. Conclusion: Most of the studied children had a moderate degree of anemia and this might be due to many factors, including a residency in rural areas. Keywords: Anemia,Children, Diyala , Iraq

Characteristics of Febrile Convulsions and The Association Between Ketonuria and Febrile Convulsions

Background: Febrile seizures are common and mostly benign. There is growing evidence that ketone bodies derived from fatty acid oxidation during fasting or consumption of high-fat diets can exert broad neuroprotective effects, including anti-convulsant effects. Objective: To determine the characteristics of febrile convulsions and the relationship between ketonuria and febrile convulsions. Patients and Methods: A cross-sectional comparative study was done between May 2018 – December 2019 at Al-Batool teaching hospital. The data included 100 children aged between (6- 60 months) admitted to the emergency unit, 50 % of them were having a febrile convulsion, while the others were presented with fever without a seizure. Blood samples were measured for serum glucose and urine samples were taken for level of ketone bodies (KB) and analyzed by reagent strip test. Statistical analysis was done by using SPSS version 21, level of association between variables was tested by Chi-square at 0.05. Results: Febrile convulsions occur equally in males and females and more likely in children less than 18 months of age (P value=0.157). Causes of fever in children with febrile convulsion were mostly respiratory causes (p value=0. 000). The incidence of hypoglycemia and ketonuria were slightly more common in the non-convulsive group of the study to be statistically insignificant (p- values were 0.169 and 0.275, respectively). Conclusion: The febrile convulsions affect equally males and females and the major cause of fever was respiratory infections. There is no significant relationship between ketonuria and the occurrence of febrile convulsions. Keywords: Febrile convulsion; Ketonuria; Children

Environmental Factors Associated With Type 1 Diabetes Mellitus

Background: Type 1diabetes (T1D) is immune-mediated disease that presented as a consequence of the gradual destruction of the insulin- producing beta cells, which in results total beta-cell loss and complete dependence on exogenous insulin. Objective: To explore the potential environmental risk factors associated with the development of T1D among children. Patients and Methods: This case-control study was conducted in the pediatric department of Albatool teaching hospital in Diyala province, Iraq. A hundred children diagnosed with diabetes mellitus type1 (cases) and hundred children (controls) without diabetes during the period between February 2020 to May 2020. Data collection was done through interviewing parents’ or the caregivers of children directly using a questionnaire that was used before for study T1D. the target population was the children attending the outpatient clinic of the endocrine pediatric department of Albatool teaching hospital. A total of 200 children were included in the study. Computer software SPSS (Version 25) and Microsoft Excel (2016) were used to carry out the statistical analysis of data. Results: The results show Children who had insufficient family income had the highest risk for developing T1D (p<0.001), and children born to low educated parents, especially illiterate parents, had a risk to develop T1D (p< 0.001), followed by children whose parent had a history of consanguinity had a high risk for developing T1D (p=0.004). Children born to older mothers had a higher risk for developing T1D (p=0.04). Children with cesarean section delivery had more risk to develop T1D (p <0.000), followed by children a history of early onset of weaning had more risk to develop T1D (p= 0.001). Children had a history of bottle feeding had more risk to develop T1D (p= 0.004). Conclusion: The following factors were associated with significant risk for developing type 1 DM in children: Insufficient family income, low educated parents especially illiterate parents, history of consanguinity. Maternal factors, including older mothers, mothers with a previous history of abortion and infection, and a history of abnormal weight gain. Child factors include, including a history of hospital delivery, a low birth weight, an early onset of weaning, and bottle-feeding. Keywords: Diabetes Mellitus; children; Diyala