Issue 1

Assessment of Asthma Severity by History and Lung Function Study in School Age Children

Zuhair M. Al Musawi; Akeel Mahdi; Majeed Matrood; Haidar A. N. Abood

Kerbala Journal of Medicine, Volume 10, Issue 1, Pages 2607-2612

Background: The assessment of childhood asthma severity is important for the diagnosis and determining the initial level or step of the treatment of childhood asthma. It can be performed either by history alone for children less than five years old or by history and pulmonary function test for older children.
Objective: to evaluate and compare the utility of history and lung function test in the assessment of asthma severity in children
Patients and Method: Across-sectional study was conducted in Karbala teaching hospital of pediatrics, during the period from October 1, 2013 - April 30, 2014. The study included 50 children of both genders diagnosed with asthma (diagnosis made by consultant pediatrician). A questionnaire was designed for the assessment of asthma severity by history which included symptoms frequency over the preceding 4 weeks respectively. The lung function test was only done in children 6-year-old and more. All children in our study had performed lung function test.
Results: The mean age of studied group was 9.6 ± 2.5. The result of asthma severity assessment based on history was as follow: 14/50 patients (28%) had intermittent asthma, 36/50 (72%) had persistent asthma of different degrees, mild in 11/50 (22%), moderate in 19/50 (38%) and severe persistent asthma in 6/50 (12%). While according to lung function test, 12/50 patients (24%) had intermittent asthma, 15/50 (30%) had mild persistent, 19/50 (38%) had moderate persistent and the remaining 4/50 patients (8%) had severe persistent asthma. There was no significant statistical difference in severity assessment between the two methods (P > 0.05).
Conclusions: Our study shows good correlation between history and lung function test regarding classification of childhood asthma severity. History is an excellent tool for the assessment of childhood asthma severity when lung functions test is unavailable or difficult to be done in younger children.

The Association between Hyponatremia and Recurrent Febrile Convulsions

Hadeel Rashied; Shamel sharba; Jasim Mohammed Hashim

Kerbala Journal of Medicine, Volume 10, Issue 1, Pages 2613-2619

background: Febrile seizures are common pediatric problem, yet there is a great deal of disagreement about the appropriate diagnostic evaluation of a child with this disorder. Different predisposing factors have been suggested to enhance the susceptibility to febrile seizure and its recurrence. Fever play an important role in causing disturbances in fluid and electrolytes balance, hyponatremia has been thought to enhance the susceptibility to seizures.
Objective: To determine the effect of hyponatremia in recurrent febrile convulsions.
Patients And Methods: A case-control study which carried out in Al- Zahraa teaching hospital in Al-Najaf city during the period between 1st of January to end of October 2015. One hundred fifty children were included in this study. We classified the patients into three groups; group (A) included (50) children presented with fever without seizure, group (B); (50) children presented with simple febrile convulsion, group (C); (50) children presented with recurrent febrile convulsions. Group A conceder as control group. The serum level of Na were estimated in these 3 groups by Na kits.
Results: One hundred fifty children were studied with age range between (6months-6years) old. We compare the S. Na among the three groups;
It is found that male in group A represented 26 (52%) and 24 (48%), 28(56%) in group B and C respectively, while female represented by 24 (48%), 26 (52%), 22 (44%) in groups A, B, C respectively, with p value of 0.726.
There were no significant difference between male and female, in all age groups.Also it is shown that family history of febrile convulsion represented 20%, 50%, 50% in group A, B, C respectively, in family history of recurrent febrile convulsion, represented 4%, 4%, 10%, in group A, B, C respectively, and with family history of epilepsy show group A (0%), group B (4%), group C (0%).
While p value in family history of febrile convulsion (0.002), in family history of recurrent febrile convulsion (0.345), in family history of epilepsy (0.132).
So there were no significant difference in all parameters except family history of febrile convulsion which is significant in all three groups, P value=0.002.
Also the study will show no significant difference in age, white blood cell count, and random blood surge while there is significant difference in temperature.
A significant difference in serum sodium level which is lowest in group C. Regarding Calcium level, there is significant difference between group A and B.
Conclusion:-There is a significant association between recurrent febrile convulsion and lower level of serum sodium, in which serum sodium concentration is lowest in those patient with recurrent febrile convulsion

A Five Years Retrospective Study of Congenital Anomalies at Karbala City, Iraq

Ashwaq Ali Hussein

Kerbala Journal of Medicine, Volume 10, Issue 1, Pages 2620-2627

background: Congenital anomalies are one of the commonest causes of disability in the world but the data from community –based studies originating from developing countries are scanty.
Objectives: To study the frequency and distribution patterns of congenital anomalies in Karbala city, Iraq during five years and to find any related aetiological factor for congenital anomalies occurrence.
Materials & Methods: It is a retrospective study includes all appearant congenital anomalies in newborns during January2011-December2015.
The data were collected from the neonatal care unit admission register & a specific register of recording congenital anomalies according to ICD-10(International classification of diseases &related health problems-10th revision) that’s introduced by WHO.
The data were collected at the Karbala teaching hospital for pediatric where majority of sick newborns care occurs in this city. Variables were represented in a frequency tables & column charts.
Results: The total enrolled cases of congenital anomalies in five years were 327 that’s form 9.19% of total admission to the neonatal care unit in our hospital(3586) ,the highest percentage were anomalies of the cardiovascular system(29.36%) followed by the gastrointestinal system(27,83%) then the musculoskeletal system (13.76%) and the least percentage was of cutaneous system(1.83%).
Individually, there was a fluctuating increment in overall prevalence during the study period, but the highest numbers in 2014 & the least in 2012.
Higher percentages for the urban residency, 18-35 years old maternal group, families of positive consguanity, & multipara’s mothers.
Conclusions& recommendations: preponderance of the malformations of the cardiovascular system despite the underestimation of them due to delayed exhibition of symptoms so there are a great benefit from screening for a hidden congenital heart anomalies., I invite all countries for searching congenital anomalies & I recommend encouragement of higher education researchers to study genetic specialty & preventive health services as our country really required such services in addition to proper preparation of health care staffs.
Keyword: Congenital anomalies, retrospective study, neonatal care unit, Karbala, Iraq

Diagnosis of phenylketonuria in Children with Autistic symptoms

Adel A. Kareem; Husham zuhair Hammoodi; Maher Mahdi Sallih

Kerbala Journal of Medicine, Volume 10, Issue 1, Pages 2628-2633

background: Autism is a behavioral syndrome with still poorly understood etiologies, nevertheless, phenylketonuria (PKU) was frequently associated with autistic symptoms, and the frequency of this association is variably reported
Aim of the study: to bear in mind the diagnosis of phenylketonuria in children presented with autistic symptoms.
Patient and methods: Patients with Autistic disorder was diagnosed according to DSM-5 diagnostic criteria, We describe fourteen patients, eight males and six female, their presentation were autistic behavior with clinical findings included hair hypopigmentation, microcephaly , mousy urine odour and/or positive family history of sibling with same condition,
Result: Autism was present in 14 (26%) of phenylketonuria cases diagnosed with same period; 12 patients had classic PKU and 2 had mild PKU, with average age 5.1 ± 2.696 , all of them are borne to related parent and they have one or more features making PKU index of suspicion.
Conclusion: The present study confirms that PKU is one of the causes of autism. Delay in the diagnosis and management of PKU, may leads to significant incidence autistic features in these patients.

Role of Neurosonography in the Management of Neonatal Intracranial Lesions

Zuhair Mahdi Al-Musawi; Mariam Zuhair Al-Musawi

Kerbala Journal of Medicine, Volume 10, Issue 1, Pages 2634-2640

ackground: Neurosonography is an important test in the diagnosis of hemorrhage and other acquired and congenital brain pathology of the newborn, despite the advances in computed tomography (CT) and magnetic resonance imaging (MRI), ultrasound is still the only modality able to image the brain at the bedside, which can be vitally important in the case of the critically ill infant. Whereas CT and MRI require sedation for optimal imaging, US can be done without incurring the risks associated with sedation. Also of benefit to the newborn is that ultrasound is easily reproducible and does not produce any ionizing radiation.
Aim of the study:
1. To analyze prospectively the value of neurosonography versus CT scan for the assessment of suspected intracranial lesions.
2. To evaluate the significance of CT imaging after brain ultrasound and whether it change the patient management.
Methods: This is a cross sectional descriptive study in which a forty two full-term neonates were prospectively studied in Kerbela teaching hospital for children between April 2015, and September 2016. Brain ultrasound was done for them for various presentations (seizure, big head, small head, birth asphyxia, bulging fontanel, declining hemoglobin, central apnea/bradycardia, and lethargy)
Then CT scan requested for them by radiologist, pediatrician or neurosurgeon.
Results: There were 26 male and 16 female neonates.
The main findings on US were
Hydrocephaly (14), Intracranial bleeding (9), Cystic lesions (8), Brain edema (6), Normal (5)
In the present study, 14 cases of hydrocephalus were diagnosed by US, and were confirmed by CT scan of brain, the results were completely similar in 6/14 of cases, and were partially concordant in the remaining 8 cases.
Regarding intracranial hemorrhage in 6 of 9 cases, there is complete concordance between ultrasound and CT findings while there is partial concordance in the remaining 3 cases.
For cystic brain lesion, in 6 of 8 cases there is no concordance between the findings, one of 8 showed complete concordance while the last one showed partial concordance.
In brain edema, 6 detected by ultrasound, 5 of them confirmed by CT scan, while the 6th were normal.
In the present study 5 cases appeared normal by ultrasound and CT.
Conclusions: Transfontanellar ultrasound is the first step when performing an intracranial evaluation in neonates as it is informative, bed side, cheep and available

Clinicopathological Spectrum of Renal Biopsies in Children a Multicenter Study in Baghdad-Iraq

Mohamed Saad Fadhil

Kerbala Journal of Medicine, Volume 10, Issue 1, Pages 2641-2649

background: Renal biopsy is a very important diagnostic tool for many kidney diseases which play important role in the diagnosis, management and prognosis of kidney diseases.
Aim of study: To study the indications, histopathological findings, and complications of renal biopsies in multicenter in Baghdad-Iraq.
Materials and Methods: In this retrospective and descriptive study, we included renal biopsies done in multicenter in Baghdad-Iraq, from 1st of January 2014 to 31 of December 2016, which was 120 patients up to 17 years of age
Results: Out of 120 patients, 68 cases (56.6%) were males, and 52 cases (43.3%) were females, steroid resistant nephrotic syndrome was the main indication of renal biopsy 42% followed by acute glomerulonephritis 19% and then evidence of systemic lupus erythematosus 15%, minimal change nephrotic syndrome was the most common primary kidney disease 39% followed by focal segmental glomerulosclerosis 31%. And lupus nephritis was the most common secondary kidney disease 83%, hematuria and mild pain at site of biopsy was the most common complications of renal biopsy 31.4% and 40% respectively.
Conclusion: Renal biopsy is useful in diagnosis, assess level of chronicity, management, and prognosis of kidney diseases. Steroid resistant nephrotic syndrome remain the most common indication for renal biopsy, minimal change disease and focal segmental glomerulosclerosis is the most common histopathological lesions in primary kidney diseases, lupus nephritis is the most common secondary kidney diseases. Renal biopsy under ultrasound guidance is safe with self-limited complications in form of hematuria and mild pain at site of biopsy.

The Utility of Platelet Indices in Differentiating between Hyper-productive and Hypo-productive Thrombocytopenia in Children

Zuhair Mahdi Al-Musawi; Mohaimen Abdulmilk Al-Kabi

Kerbala Journal of Medicine, Volume 10, Issue 1, Pages 2650-2655

background: Thrombocytopenia refers to a reduction in platelet count to <150 × 109/L. It may occur due to decreased production) hypoproductive thrombocytopenia) such as aplastic anemia (AA) and acute leukemia (AL), or increased destruction of normally synthesized platelets (hyperproductive thrombocytopenia) such as immune thrombocytopenic purpura (ITP).
Platelet indices, namely plateletcrit (PCT), mean platelet volume (MPV), platelet distribution width (PDW), platelet –large cell ratio (P-LCR) and immature platelet fraction (IPF) .Platelet Volume Indices (PVIs) are a group of parameters which are inexpensive to measure and are derived from routine blood counts.
Objective In this study, we aimed to assess the sensitivity and specificity of these indices and set cutoff values that aid in diagnosis of thrombocytopenia causes.
Patients and Methods: We recruited 90 individuals as thrombocytopenic patients, who were divided into two groups: group I (n= 40) included newly diagnosed immune thrombocytopenic purpura (ITP) patients (hyperproductive thrombocytopenia), whereas group II(n = 50) included hypoproductive thrombocytopenia patients. The MPV and PDW were derived from automated cell counter. A comparison of the sensitivity and specificity for MPV and PDW in both conditions (hypo and hyper-production thrombocytopenia) were evaluated.
Results: All platelet indices were significantly higher in ITP than in ( AA and AL), and platelet indices showed sufficient sensitivity and specificity ; the best cutoff value for MPV was greater than 10.6 fl and for PDW was greater than 16fl, with a sensitivity(90,95) and specificity(86,80) respectively.. The area under the curve (AUC) of the receiver operating characteristics curve of platelet indices was large enough to enable the diagnosis of ITP. the PDW had the larger AUCs(0.938)than MPV where AUCs (0.900) , which means that these values are very reliable for ITP.
Conclusion: Platelet volume indices can differentiate with some certainty ITP from AL and AA, and helps pediatricians to avoid the invasive bone marrow aspiration which need expert hematologist for its interpretation.

Pathological Analysis of Thyroglossal Duct Cyst in Children

Aseel Hameed A. Al-Khalifah

Kerbala Journal of Medicine, Volume 10, Issue 1, Pages 2656-2662

Background: Thyroglossal duct cysts (TGDCs) are the most common form of congenital neck cyst, accounting for up to 70% of such lesions. There has been no consensus on which factors predict outcome of thyroglossal duct cyst excision.
Objective: To evaluate the relevance of symptomatology, age at presentation and the histopathology of TGDCs.
Methods: Retrospective review of patients with TGDC at Al-Hissain medical city. Data collected included patient’s age, gender, clinical presentation, presence or absence of preoperative infection, size and location of the lesion,
Results: Thirty –one patients were identified (71% female and 29% male). Age of presentation was bimodal and ranged from few months to 17 years. The most common presenting symptom was the presence of an asymptomatic midline neck mass (71%). A history of preoperative TGDC infection was present in 3% of patients ≤2 years of age and in 10% of patients ≥5 years of age.
Conclusions: The finding of a midline neck mass is the most common presentation of TGDCs in toddlers, whereas infection is the most common presenting symptoms in school-aged children. Complete and precise clinical information is a prerequisite in order for pathologists to make accurate diagnoses of congenital cervical cysts.

Hemophagocytic lymphohistiocytosis (HLH)

Ameer Muhsin Al-lawendy; Qahtan Mohammed Ali Al-obaidy

Kerbala Journal of Medicine, Volume 10, Issue 1, Pages 2663-2667

Hemophagocytic lymphohistiocytosis (HLH This aggressive and potentially life-threatening disease most often affects infants from birth to 18 months of age, but cases in older children and adults have been reported. We describe a 14-year-old boy whom (HLH) developed. He suffered from fever with disturbed level of conciseness. Physical examination revealed drowsy but easily arousal, pallor, no cyanosis, no jaundice, faint macular rash, soft distended abdomen, and hepatomegaly. Laboratory findings were abnormal liver function, coagulopathies, hypertriglyceridemia, high renal indices, urinalysis show hematuria and proteinuria, anemia, thrombocytopenia, high serum ferritin level and abnormal bone marrow findings.

Atypical presentation of Castleman’s Disease as nephrotic syndrome

Layla Qasim Hiris Ali; Qasim Rahi Essa; Bushra Jaleel Saleh

Kerbala Journal of Medicine, Volume 10, Issue 1, Pages 2668-2673

Castleman’s disease is an uncommon and poorly understood disorder of atypical lymphoproliferative disorder of unknown etiology atypical. Renal manifestations, such as proteinuria, hematuria, and renal dysfunction, are common in Castleman’s disease; however, a nephrotic syndrome rarely occurs.
We have encountered an unusual case of Castleman’s disease characterized by nephrotic syndrome because of glomerulopathy mimicking membranoproliferative glomerulonephritis.
The diagnoses were confirmed by cervical lymph node and renal biopsy.