Children's Teaching Hospital Research Articles

Association Between Toxoplasmosis Infection and Human Insulin In Pregnant and Aborted Women

Background : People with compromised immune systems are more likely to get infected with the opportunistic parasite Toxoplasma gondii than healthy individuals. Diabetes and toxoplasmosis are two conditions that are rather prevalent in Iraq. Objective : human insulin was the major objective of this study, along with determining the frequency of anti- T. gondii IgG antibodies in pregnant and abortion. In addition to this, establish a connection of (RBS) and (HbA1c). Methods : The investigation was in Al-Qadisiyah. The term for collecting was from the November 2022 to the end of February 2023. where specimens were collected from the Maternity and Children's Teaching Hospital, 350 serum samples that were collected from pregnant, and abortion women. The healthy samples that served as a control group50 samples,. Both the ELISA technique and the Toxo Rapid Diagnostic Test (Cassette) were used to analyze the samples in order to determine the levels of human insulin present in pregnant and abortion women. Also measures (HbA1c) and (RBS). Results : the Results According Cassette the 350 samples, only 130 (43.3%) positive, whereas 170 (56.7%) negative. Using ELISA, anti-T. gondii IgG was present in 90 (69.2%) of the women from 170 positive cassette. ELISA was also used to assess of human insulin that was present in order to get a better understanding of the role that toxoplasmosis plays in the development of diabetes. Patients with diabetes had considerably higher levels of human insulin (22.83 ± 13.91) when compared to patients with toxoplasmosis alone and healthy controls Conclusion : T. gondii is more prevalent among pregnant women and abortions. Diabetes and toxoplasmosis have been shown to have a close connection, according to research. Our hypothesis is that toxoplasmosis provides the way for diabetes, and diabetes paves the way for toxoplasmosis. Toxoplasmosis is more likely to develop in people with diabetes since the disease lowers the immune response.

Acute kidney injury in neonatal care unite of Babylon teaching hospital for maternity and children

Acute kidney injury in neonatal care unite of Babylon teaching hospital for maternity and children

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

A reappraisal of Gaucher disease patients - Clinical presentation, and diagnosis in rare disease unit of central child teaching hospital in Baghdad province

Introduction and Aim: Gaucher disease (GD) is an autosomal recessive ailment caused due to mutations in the GBA1 gene, encoding for the lysosomal enzyme, glucocerebrosidase. The aim was to evaluate the clinical, biochemical, and molecular parameters associated with this disease, as well as to identify symptoms and covariables thought to be most diagnostic of early GD presentation, allowing for early diagnosis and management. Methodology: This cross-sectional study involved twenty-six patients diagnosed with GD at the Metabolic Department of Central Child Teaching Hospital, Baghdad, Iraq. Diagnosis depended mainly on history and physical examination and confirmed by beta-glucosidase enzyme assay of dry blood spot on filter paper and Lyso-GL-1 level. Amplification-based next generation sequencing approach was used in investigating the GBA1 gene at the molecular level. Results: The mean age of the 26 (17 male and 9 female) patients was 9.13 years, with 100% consanguinity and 50% positive family history. The average number of years from the start of clinical manifestations to the diagnosis' validation was 3.82 years. The original age of presentation was 2.83 years, and the initial age of diagnosis was 6.65 years. Hepatosplenomegaly (85%), pallor (88%), splenomegaly (12%), splenectomy (12%), hemorrhage (19%), bone discomfort (23%), bone breakage (12%), and GD type III (19%) were observed. Among patients 65% exhibited radiological bone abnormalities, 54% had Erlenmeyer flask deformity, and 1.5% had osteopenia and fracture. Studies of GBA1 gene showed the mutation C.[1448T>c ](P.[ Leu483Pro] to be the most common. Hepatosplenomegaly and hematological deficiencies were effectively improved by enzyme replacement therapy. Conclusion: In Gaucher disease, GBA1 gene mutation analysis could provide some predictive information about disease variance as well as severity. PCV%, platelet count, ferritin, and lyso-GL-1 levels could be employed as biomarkers for the diagnosis of GD. ERT proved effective in treating hematological and hepatosplenomegaly abnormalities.

Active surveillance for carbapenem resistant enterobacteriaceae (CRE) using stool cultures as a method to decrease CRE infections in the pediatric intensive care unit (PICU)

BackgroundThe incidence of Carbapenem Resistant Enterobacteriaceae (CRE) infections is increasing worldwide. Due to dearth of alternative antibiotics, prevention of infection transmission is a part of CRE infection management strategy. Early detection of CRE by active surveillance coupled with contact isolation is much more appropriate compared to contact isolation upon receipt of routine cultures dictated by the patient's clinical condition. ObjectivesTo determine whether active CRE surveillance will decrease CRE infection rates in the Pediatric Intensive Care Unit (PICU). MethodsRetrospective observational study done in the 10-bed PICU of a tertiary care teaching children's hospital from July 2013 to June 2015. Rectal swabs for CRE were sent from all PICU patients except stable post-operative patients. Contact isolation precautions were followed for rectal swab positive patients. CRE colonization and infection rates were calculated and compared. ResultsTotal of 1262 rectal swabs were sent from 1022 patients. CRE colonization rate was 19.5%. Post intervention, ICU acquired CRE colonization decreased by 36% and ICU acquired CRE infection rates decreased by 100%, both showed significant decrease (p ​< ​0.0001). ConclusionActive CRE surveillance and institution of contact isolation in appropriate situations is helpful in decreasing CRE colonization and infection rates in the PICU.

Comparing efficacy and safety of stair step protocols for clomiphene citrate and letrozole in ovulation induction for women with polycystic ovary syndrome (PCOS): a randomized controlled clinical trial.

Polycystic ovary syndrome (PCOS) is characterized by menstrual irregularities, high androgen levels, and ovarian cysts. Clomiphene citrate (Clomid) and letrozole have both been investigated as ovulation induction therapies for PCOS. This interventional study aimed to compare the efficacy and safety of a stairstep practice of letrozole versus clomiphene citrate in women with PCOS. A total of 100 women diagnosed with PCOS and infertility participated in the study, which took place from March 2021 to July 2022 at the Maternity and Children Teaching Hospital in Adiwaniyah Province, Iraq. Participants were randomly assigned to one of two groups (each with 50 women): the first group received clomiphene citrate in a stair step pattern (single dose of 50 mg, 100 mg, and 150 mg) for five days, for a maximum of three cycles; the second group received letrozole in a stair step pattern (single dose of 2.5, 5, and 7.5 mg) for five days, for a maximum of three cycles. Follicle size was monitored using ultrasound to achieve a follicle size >18 mm. The ovulation rate was higher in the letrozole group (86.0%) compared to the clomiphene citrate group (72.0%), although the difference was not statistically significant (p=0.086). The pregnancy rate was slightly higher in the letrozole group (22.0% vs 18.0%), but also not statistically significant (p=0.617). However, the mean time from menstruation to ovulation was significantly shorter in the letrozole group (17.20±1.32 days) compared to the clomiphene citrate group (24.08 ± 1.56 days, p<0.001). There were no significant differences in common side effects between the two groups. Overall, letrozole was found to be as safe as clomiphene citrate but demonstrated a shorter time to ovulation. Further studies with larger sample sizes are necessary to validate these findings and determine their clinical implications.

The Association of Anti-Mullerian Hormone and Infertility Hormonal Imbalance with Polycystic Ovarian Syndrome Among Iraqi Patients.

&lt;b&gt;Background and Objective:&lt;/b&gt; The pathogenesis of PCOS, which affects 5-15% of women of reproductive age, is still poorly understood and which characteristic might be considered essential for its diagnosis is still unknown. This study aimed to determine the significance and relationship between Anti-Mullerian Hormone (AMH) and other infertility hormones in the Polycystic Ovarian Syndrome (PCOS) diagnosis. &lt;b&gt;Materials and Methods:&lt;/b&gt; This study involves 200 women who visited Al-Ramadi Maternity and Child Teaching Hospital in Al-Ramadi, Iraq from October, 2022 to May, 2023. Study participants included 50 women as controls and 150 women with PCOS who were diagnosed using the Rotterdam criteria. The clinical history included oligomenorrhea and BMI. Laboratory investigations included blood tests for FSH, LH, prolactin and AMH levels done for all women who participated in this study. &lt;b&gt;Results:&lt;/b&gt; Age and BMI were comparable for PCOS cases and controls. The AMH levels in women with PCOS increased statistically with severity compared to controls, with the mean AMH level found to be 3.53 ng mL&lt;sup&gt;1&lt;/sup&gt; in controls, whereas it ranged from 6.19 for mild cases to 7.49 for moderate cases to 12.83 for severe cases in PCOS cases. The AMH alone had the highest diagnostic sensitivity (78.6%) and specificity (97.6%) for PCOS at a cut-off of 5.82 ng mL&lt;sup&gt;1&lt;/sup&gt;. All study participants had a positive correlation between AMH and LH (R&lt;sup&gt;2&lt;/sup&gt; = 0.391, p = 0.0031). &lt;b&gt;Conclusion:&lt;/b&gt; The AMH levels were noticeably higher in PCOS patients compared to controls. The AMH could not accurately diagnose PCOS when used as an independent marker. The AMH levels did, however, have good diagnostic potential in combination with current Rotterdam criteria for PCOS diagnosis.

Chemotherapy and other treatment modalitities in children with Neuroblastoma

Neuroblastoma is the second most common solid tumor in the first decade of life. A retrospective study reviewed (39) children treated for N.B. at Al-Mansour Teaching Hospital for children from Jan. 1st 2001 to Dec. 31st 2006, the clinical data were analyzed. Thirty nine Patients were included (23) males (59%) and (16) females (41%) , the median age at diagnosis was (48) months .The abdomen was the site of initial tumor in 31(79.4%) of patients, hypertension is found in 6 out of eleven cases (54.5%) and hepatomegaly is found in 53.8% of cases . Anemia was recorded in 26(68.4%) of patients Stage IV was the predominant clinico-pathological stage .The median survival was 13.5 months (range 1 month — 45 months). There was significant association between the stage of the disease and event free survival. There was no statistically significant association between the age at diagnosis and the outcome because about 15 cases (38%) of the patients were lost to follow-up .The study recommends the use of the new method for early diagnosis and treatment of the disease like the use of autologous bone marrow transplant and the use of antibodies directed against the tumor cells.

Effect of Obesity on Androgen Receptor and Androgen Levels in the Serum of Women with Infertility in Babylon, Iraq

Background: Infertility is the inability to get pregnant after engaging in unprotected sexual activity for at least a year. Obesity and overweight are terms used to describe abnormal or excessive weight growth that is harmful to one’s health. Objectives: The aim of this study was to measure the androgen receptor (AR), total and free testosterone, and dehydroepiandrosterone sulfates (DHEA-S) levels in the serum of Iraqi women who were having trouble getting pregnant and study the change of these parameters in the case of obesity and infertility. Materials and Methods: The case–control group was made up of 45 additional, presumably healthy women, whereas the sick group was made up of 45 obese infertile women. A study was carried out in the Babylon teaching hospital for maternity and children in Hilla city and private clinics from July to January 2022. An enzyme-linked immunosorbent assay (ELISA) was used to evaluate the serum concentrations of DHEA-S, total testosterone, and free testosterone (ELISA). SPSS software was used to conduct the statistical analysis. Results: A considerable drop in total testosterone and AR levels, infertile women exhibited significantly greater serum levels of free testosterone and DHEA-S than the control group (P &gt; 0.05). Conclusion: Infertile women had considerably lower serum levels of total testosterone and ARs and significantly higher serum levels of free testosterone and DHEA-S. On the basis of the results of this investigation, obesity participates in the pathogenesis of infertility.

Respiratory syncytial virus and its prophylaxis with palivizumab: exploring nurses' knowledge.

Respiratory syncytial virus (RSV) is the most common cause of lower respiratory tract infections in children. Premature infants and infants with underlying health issues are at increased risk of developing severe RSV infection. Prophylactic treatment with palivizumab reduces their risk of hospitalisation. To measure nurses' knowledge of RSV and RSV prophylaxis and explore their perceived potential barriers to palivizumab administration to children in the acute hospital setting. A non-experimental, quantitative fixed study design was adopted. A 17-item online questionnaire was used to survey nurses caring for children under the age of 1 year in an acute children's teaching hospital. Questionnaires were completed by 144 nurses, giving a response rate of 53%. Respondents demonstrated an adequate knowledge of RSV and its prophylaxis but also some knowledge deficits, notably about the eligibility criteria for palivizumab. The most cited perceived potential barriers to palivizumab administration were uncertainty about which infants are eligible for it, forgetting to check whether a patient is due to receive a dose, parental refusal for treatment because their child is ill, and not knowing the contraindications of palivizumab. Front-line hospital staff have a crucial role in identifying infants eligible for prophylactic RSV treatment, in initiating prophylaxis in a timely manner, in avoiding missed or delayed palivizumab doses during infants' hospital stays, and in educating families about the importance of RSV prevention.

Accuracy of Cervical Intraepithelial Lesion Diagnosis by Visual Cervical Examination with Acetic Acid

Introduction: Using acetic acid to inspect the vaginal canal is a simple screening procedure done with the naked eye. During a speculum examination, the cervical transformation zone is painted with acetic acid 3% to 5% or vinegar. It is a simple, cost-effective screening tool that can be used in poor developing countries with high rates of invasive cervical cancer mortality because acetic acid coagulates nuclear proteins, resulting in white discoloration of the transformation zone in CIN and early invasive cancer. Objective: This study aims to measure the effectiveness of a simple and economical screening test, visual inspection with acetic acid (VIA), for diagnosing cervical intraepithelial lesions in comparison to the gold standard of histopathology using a study population of women attending a gynecology outpatient department. Study Design: The study used a cross-sectional design to validate the findings. Study Area: This study was conducted in the Obstetrics &amp; Gynecology Department, Women and Children Teaching Hospital, Dera Ismail Khan. Study Duration: This study took place between November 2018 and April 2019. Materials and Methods: The study included 414 women with abnormal vaginal bleeding. Under a good light source, a lubricated Cusco's speculum was introduced into the vagina to evaluate the cervix for gross abnormalities. A cotton swab was used to apply 3% acetic acid to the cervix and acetowhite changes were observed for one minute. Positive results were considered when distinct acetowhite areas were detected, while negative results were considered when light, faint, or doubtful aceto-white areas were detected. Results: There was a range of age from 18 to 40 years in this study with a mean age of 30.772 years and a mean weight of 71.644 kilograms. For diagnosis of cervical intraepithelial lesions, acetic acid visual examination has shown a sensitivity of 84.38%, specificity of 97.11%, diagnostic accuracy of 95%, PPV of 84.38%, and NPV of 97.11% (p=0.000). Practical implication: The purpose of this study is to compare the efficacy of a simple and inexpensive screening test, visual inspection with acetic acid (VIA), to the gold standard of histopathology in a study group of women attending a gynecological outpatient service. Cervical cancer is a leading cause of death among women in developing countries, where access to advanced diagnostic tools is limited. If VIA proves to be an effective screening tool, it could be widely implemented in low-resource settings to improve early detection and treatment of cervical cancer. Conclusion: VIA is considered an appropriate screening alternative for a large population. In contrast to cytology-based programs, it is highly sensitive, low-cost, and yields immediate results. Keywords: Cervical Cancer; Visual Inspection with Acetic Acid; Screening

Nutritional status of children and adolescents with Type 1 Diabetes Mellitus in Baghdad: a case-control study.

Diabetes mellitus (DM) is a major life-long non-communicable illness correlated with obesity and chronic undernutrition. It is particularly important to monitor the nutritional status of children with type 1 diabetes mellitus (T1DM), as they are still growing and may be affected by the disease or associated conditions like celiac disease. This study aimed to evaluate the nutritional status of children and adolescents with T1DM in Baghdad city and identify possible risk factors for undernutrition. A single-center, case-control study was conducted in Central Child's Teaching Hospital, Baghdad, Iraq, over 9 months from November 2021 to July 2022. The study included patients with T1DM and healthy controls. Detailed history, clinical examination, and anthropometric measures were performed for all participants in the study. The mean age of the sample was 10.0 ±3.73 years and 8.68±3.1 years in diabetic patients and controls, respectively. Anthropometric measures in patients with type 1 diabetes were significantly lower than those of controls (P<0.001). All patients within the undernourished group were from large-size families compared with 75.76% of the normally nourished group, with a significant difference. The mean age of disease onset in the normal nourished group was 6.61 ± 2.78 years which was significantly earlier than that of the undernourished group (8.83 ± 2.89). Weight-for-age and BMI z-score had a significant negative correlation with HbA1c (r=-0.312, p=0.004, and r=-0.295, p=0.006, respectively). Patients with T1DM had significantly lower anthropometric measures than the normal population. Older children, female gender, large family size, and disease duration are independent predictors of undernutrition in T1DM. BMI and weight-for-age have a significant negative correlation with metabolic control of diabetes represented by HbA1c.

Healthcare Professionals’ Adherence to Contact Precautions at a Maternal and Child Teaching Hospital

Healthcare Professionals’ Adherence to Contact Precautions at a Maternal and Child Teaching Hospital

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.

Structure, Process, and Outcome Evaluation of Hospitals about Neonatal Screening Program in Karbala in 2022

Background: The newborn screening program has been evaluated in several parts of the world, with varying outcomes (1). In terms of incidence, severity, age of onset, and diagnostic and therapeutic techniques, they vary greatly. The program screens a group of conditions that causes major metabolic abnormalities in newborns, resulting in irreversible damage and illness. There is a treatment for some of them that, if given soon after birth, can prevent such damage. Many countries have suggested, developed, and implemented population-based newborn screening for these illnesses, although at differing rates and using various criteria(2). Materials and Methods: This evaluation study was conducted between the first of September 2021 and the end of June 2022. This research was carried out in the Holy Karbala Governorate, to assess a pilot program implemented by the Governorate Directorate of Health in Karbala Children's Teaching Hospital and Al-Hindiya General Hospital. A checklist has been used to evaluate hospitals after reviewing the “National Guideline of Newborn Screening for Care Providers in Primary Health Care Centers in Iraq”. The list was built and developed by the researchers. Results: It was documented that the program worked in only one hospital, where the trained medical staff. However, there was untrained health staff available, in addition to the lack of the program’s needs for laboratory testing follow-up, food, and milk needed for the program patients. Conclusion: Although, this program could contribute to “reducing the rate of under-five mortality by two-thirds”, the necessary tools to meet these objectives were not found in the hospitals.

The Role of Liver Function Tests in Monitoring the effect of Enzyme Replacement Therapy in Children with Gaucher Disease

Background: Gaucher disease (GD) is an autosomal recessive hereditary disease. The etiology, pathophysiology, diagnosis, and prognosis of GD in children might all be affected by a variety of biomarkers. The majority of them are linked to abnormalities caused by this lysosomal storage disorder, which is caused by a deficiency of the glucocerebrosidase enzyme that affects numerous organs including the liver, spleen, and bones. Objectives: to investigate the relevance of liver function tests in the assessment of treatment response in children with Gaucher's disease who are undergoing enzyme replacement therapy in a follow-up manner. Methods: A case-control study was performed on 67 children (girls and boys) with GD who were recruited from the Children Welfare Hospital Consultation Clinic, the Gastroenterology and Hepatology Teaching Hospital, and the Central Child's Teaching Hospital. The levels of ALT, AST, total bilirubin (TB), and total protein (TP) were assessed in the samples of 67 Gaucher children, who were classified as recently diagnosed untreated patients (n=9), patients who received ERT for 3-6 months (n=18), 6-12 months (n=20), and patients who received ERT for more than one year (n=20), and compared to twenty newly comparable age-matched controls. The practical part of the study was conducted at research laboratories in the College of Pharmacy, Al-Maaql University and the Department of Pharmacy, Al-Turath University College during the period from December 2020 to March 2021. Results: The results showed that total protein levels in patients were significantly lower than in age-matched control group. The negative significant correlations between the levels of AST, ALT, and TB with the period of receiving treatment and the positive significant correlations between the levels of total protein and the period of receiving treatment indicated that the studied parameters were significantly associated with the period of receiving ERT. The effect of ERT was also indicated by the results of the ANOVA test, which revealed significant variations in the levels of ALT, AST, total bilirubin, and total protein across the patient subgroups. Conclusions: ALT, AST, total bilirubin, and total protein have been shown to have diagnostic significance in newly diagnosed untreated children with a wide range of treatment responses, limiting their utility in treatment monitoring.

Clinical Presentations of Idiopathic Thrombocytopenic Purpura

Back Ground: ITP is the most common cause of thrombocytopenia in children and is a result of immunologically mediated increased platelet destruction, which is usually acute and self-limiting but may be a recurrent or chronic disorder. Aim of Study: Assessment of clinical manifestation of ITP in children. Patient and Methods: A prospective study was performed on 60 patients diagnosed as idiopathic thrombocytopenic purpura admitted to central child teaching hospital from 1st of January to 3o September 2011. Diagnosis was based on clinical and laboratory tests including bone marrow aspiration. Results: The age ranged from 6 months to 13 years and majority of cases were between 1-5 years, 68.3 % were males and 31.7 % were females, male to female ratio 2.1 : 1 . History of upper respiratory tract infection preceded the onset of illness in 71.7 % of patients. Where the Duration between Preceding URTI and ITP Up to 1 week in 30.2 % and &gt; 1 week in 79.8 % Concerning the distribution of cases according to the season of the year: One case (1.7%) found during January, four cases (6.7%) during February, six cases (10.0%) during March, five cases (8.3%) during April, ten cases (16.7%) during May, eight cases (13.3%) during June, 14 cases (23.3%) during July , five cases (8.3%) during August, and seven cases (11. 7%) during September. This distribution was significant (P less than 0.05). The commonest presentation was cutaneous bleeding in 60 %, Mucous Membrane bleeding 1.7 %, both 38.3 % , Splenomegaly with bleeding 6.7 % , Hepatomegaly with bleeding 8.3 %, Lymphadeno-pathy with bleeding 5 % . In 69 % of cases the initial platelet count was less than 20.000 /mm³. 37.9 % had anemia. Bone marrow examination done in 56 case and all were normal. In this study, one case die due to intracranial hemo – rrhage . we didn’t include the management because the patients receive different types of treatments ( mostly by steroid , some by IVIG and anti-D ) , most of patients examined by bone marrow aspiration which was normal , and also we didn’t include the follow up because of most of the patients didn’t come for follow up. Conclusion: The disease is self-limited , most cases at age of 1-5 years , male affected more than female , most cases preceded by upper respiratory tract infections , most cases presented by skin bleeding.

Role of Carotid Ultrasound in the Evaluation of Atherosclerotic Changes in Beta Thalassemia Major Patients

Background: Iron overload in beta thalassemia patients may lead to the alteration of arterial structures together with hyperlipidemia and other risk factors that may lead to the atherosclerotic changes and thickening of carotid arteries. Carotid ultrasound is easy, noninvasive, and rapid test that can detect atherosclerotic changes by the assessment of carotid intima-media thickness, which is a structural marker of atherosclerosis, and it correlates well with vascular risk factors and its relation with stroke and coronary artery disease. Aim: The aim was to evaluate the role of carotid ultrasound in the assessment of atherosclerotic changes in iron-overloaded beta thalassemia major patients. Patients and Methods: This is a case–control study done in Babylon Gynecology and Children Teaching Hospital from July 1 to December 31, 2018 on 60 patients with beta thalassemia major and 30 normal children as a control group. Their age ranges from 3 to 14 years old. Carotid ultrasound examination was done on all patients and the control group. Results: In this study, carotid intima-media thickness was significantly higher in patients than in controls (P &lt; 0.001). Carotid intima-media thickness significantly increases in patients with beta thalassemia major with increasing duration of blood transfusion (P &lt; 0.001), with increasing serum ferritin (P = 0.004), and with increasing serum cholesterol (P &lt; 0.001). The study also showed no correlation between body mass index and blood pressure with carotid intima-media thickness. Conclusion: Carotid ultrasound is useful in the assessment of carotid intima-media thickness, which is a marker of atherosclerosis and has a strong positive correlation with markers of iron overload and hyperlipidemia.

Impact of hemoglobinopathies upon behaviors of adolescents

Background: Hemoglobinopathies are the most common life threatening, monogenic disorders in the world. The most common causes of hemoglobinopathies are sickle cell disease and thalassemia. Objectives: The purpose of this study is to investigate Impact of Hemoglobinopathies upon Behaviors of Adolescents in Karbala City/ Iraq. Methods: The cross-sectional study with quantitative approach was carried out on 200 participants who were attending hereditary blood disease center in Karbala teaching hospital for children. The questionnaire's dependability was established through a pilot study, and it was subsequently presented to experts for validation. The information was collected through the use of interview techniques and evaluated using descriptive and inferential statistical analysis. Results: Findings demonstrated that the (49%) of Hemoglobinopathies adolescents were poor health behavior, no-significant differences in health behavior with regards hemoglobinopathies adolescents gender, and Findings demonstrated there were significant differences health behavior with regards disease related relative among hemoglobinopathies adolescents (p&lt;0.05). Conclusion: Age , gender, and disease relative have been influencing on quality of life and health behaviors of adolescent with hemoglobinopathies