ايمن عبد العظيم دخيل البكاء

Abstract: Background: Beta thalassemia syndromes are a group of hereditary disorders characterized by a genetic deficiency in the synthesis of beta-globin chains. One option for treatment patients with thalassemia major includes chronic and regular transfusion therapy in order to maintain hemoglobin at an adequate level. But, transfusion-related viral infection produces large problems in these patients and may produces significant morbidity and mortality. These viruses may include hepatitis C virus (HCV), hepatitis B virus (HBV), Cytomegalovirus (CMV),and human immune virus (HIV) are common among thalassemic patients. In hepatitis C virus (HCV), many genotypes and subtypes are present , and they are variable in severity ,viral titers, and geographical distribution. Aim: To study the prevalence of hepatitis C virus infection in patients with Beta thalassemia major in AL- Najaf city, and to determine their base line viral titers, their genotypes and the possible relationship between HCV infection in those patients with other risk factors. Patients and methods: This cross-sectional study was conducted at the thalassemia center in AL-Zahraa Teaching Hospital for Maternity and Children in AL- Najaf city, from 1st September 2018 to the end of October 2019. A total of 356 patients pre-diagnosed with B-thalassemia major who’s registered in thalassemia center were surveyed with ELISA test to detect HCV. we did Quantitative Real Time PCR (RT-qPCR) for Beta thalassemia major patients with positive ELISA samples to confirm HCV infection and to quantitate base line viral titer for those patients. Serum samples which showed HCV RNA, and positive Real-Time PCR technique were examined by Reverse Transcription PCR (RT-PCR) to detect Genotypes &their subtypes. Medical records and some data of Beta thalassemia major (B-TM) patients with positive ELISA test for HCV infection were analyzed to study a possible risk factor. Results: This study revealed that (28) patients (7.86 %) were seropositive for HCV from a total number of (356) thalassemia major patients. From those with ELISA positive , only (16) patients (57.14 %) were PCR positive and (12) patients (42.85 %) were negative PCR assay .So the percent of patients with positive PCR from a total number of included thalassemia major patients was (4.49 % ) . Regarding genotypes: genotyp1A ( 81.25% ), genotype 4 ( 12.5% ) and mixed type 1c & 4 (6.25% ).Viral load range from 11 300 to 3 090 000 IU/ML , (mean = 1 236 982.9),( median = 1002500) A significant difference between HCV infected group and those who are not infected in regard to age, ALT and AST ( P -value was 0.0009 ,0.000 and 0.04 respectively ) . Also there is a significant difference between HCV infected group and those who are not infected in regard to splenectomy and number of transfusions (p- value was 0.041 and 0.000 respectively ).A significant difference in regard to age between infected patients with high viral load and infected patients with low viral load groups (p-value =0.007). Conclusion: The percentage of HCV infection among ß-TM patients in our center was16 (4.49 % ) patients. HCV genotype 1a is the commonest genotype in ß-TM patients in our center. The percent of HCV infected patients with genotype 1a with high base line viral load more than infected patients with low viral load. Keyword: ß- thalassemia major, Hepatitis C, Viral Load, Genotypes. DOI: https://doi.org/10.31838/ijpr/2020.SP1.110 Download: Request For Article

Abstract Nephrotic syndrome is a common childhood kidney disorder featured by increase protein excretion urine with low serum albumin with generalized edema and hyperlipidemia. It’s mainly a disease of childhood 15 times more than an adult. The occurrence of Urinary tract infection (UTI) in these patients is increasing, this may be to immunoglobulin loss in urine, defective T cell function, immune-suppressive agents, and relative malnutrition. Aim of the Study: It is to evaluate the occurrence of UTI, its etiological agents, antibiotics sensitivity type, and the effect of UTI on relapse and response to therapy in children with nephrotic syndrome in An Najaf Governorate. Methods: A prospective cross-sectional study of all patients with idiopathic nephrotic syndrome from January 2018 to January 2019 visiting nephrology unit in Al Sader teaching hospital and Al Zahraa teaching hospital. The urine sample was taken by a clean catch method of midstream urine and by urine bag methods for those under 3 years old. The specimens were cultured immediately then examined under the microscope. Results: A 101 patients were studied. The mean age and (S.D) for males was 6.3±2.35years and females with 6.5±1.9years. The age range was 1.5 year to 10 years. There were 44 patients (43.6%) had UTI, 29 patients (65.9%) of them were males and 15 patients (34.1%) females. UTI caused by E. coli. in (25) patients ( 58%) ,Streptococcus (8) patients(16.26%), Staphylococcus aurous (5) patients (11.36%), Proteus (3) patients(6.97%), Pseudomonas (2) patients (4.65%), Klebsiella species (1) patients (2.32%). The E.coli show very good antibiotic sensitivity to cefatriaxion, cefataxime and ciprofloxacin. Each of Proteus, Klebsiella, Pseudomonas spp. show a good sensitivity to cefatriaxion, ciprofloxacin and aminoglycoside while each of Streptococcus SPP and Staphylococcus aureus show good response to ciprofloxacin and moderate sensitivity to the augmentine (combination of amoxicillin and clavulanic acid) and to Septrin (co-trimoxazole) (combinations of Sulfamethoxazole and trimethoprim) and there was high in vitro resistance of these bacteria to ampicillin and nalidixic acid. Conclusion: There is a high occurrence of urinary tract infection in idiopathic nephrotic syndrome children of An Najaf Al Ashraf city and its necessity to diagnose the disease early depending on clinical suspicion and doing the GUE and cultures monthly to avoid delay in diagnosis of infections and their sequels. Keywords: Urinary Tract Infection; Nephrotic Syndrom

Background: Acute idiopathic thrombocytopenic purpura(I.T.P) is a bleeding disorder in which the immune system for unknown reason produce antibodies against platelets, which are necessary for normal blood clotting resulting in decrease number of circulating platelets, manifested itself by bleeding tendency, easy brusing or extravasation of blood from capillaries in the skin and mucous membrane . Objective: to choose the most appropriate therapy for acute idiopathic thrombocytopenic purpura management . Methods : 65 patients were enrolled in this retrospective study, who were admitted to AL-Zahraa teaching hospital from January 2000 to January 2010 . Relevant information were collected according to preceding data collection sheet that include age, sex, initial hemoglobin and platelets count, treatment given, response to therapy…These patients subdivided into 3 groups according to initial drug used for their management either prednisolone, I.V.immunoglobulin-G, or anti-D. The response was analyzed according to rapid rise of platelets number in the pre-treatment state. chronic cases of I.T.P were excluded from this study . Results: All patients were aged from 2-12 years with peaks of 2-5 years. Sex ratio (female\male) of 1:1.7 .Our study showed that out of 65 patients, 37(57%) of them were assigned as group 1 who received prednisolone as a conventional therapy ,the response was noted in 31( 86.5%) after few days of treatment. Regarding group 2 patients received I.V immunoglobulin-G, the response of platelets rise was noted in 16( 89%) of cases out of 18 patients . While(10) patients in group 3 who received anti-D as main line of treatment to Rh-positive individuals, the response is observed in only 6( 60%) of cases . Conclusion: Regarding various treatment modalities of idiopathic thrombocytopenic purpura ,it has been noted that oral prednisolone is the best, single, readily available, inexpensive drug that can be taken orally and as outpatient . Recommendation:The availability of other treatment options such as I.V-immunoglobulin-G should be adopted in our hospitals in cases of life- threatening illness as it induces more rapid rise in platelets in comparison with other drugs.

Background: Iron is an essential micronutrient that plays a significant role in critical cellular functions in all organ systems in all species. Iron is particularly vital for early brain growth and function in humans since it supports neuronal and glial energy metabolism, neurotransmitter synthesis and myelination. Methods: 93 infants born through normal vaginal and cesarean delivery, enrolled in this study. According to maternal iron supplementation the sample divided in to two groups: iron supplemented group or a non-iron supplemented group. Women in the iron supplemented group consumed daily prenatal supplements. At the time of delivery, 5-ml of blood was obtained from the umbilical cord after early ligation of the cord, for each sample (Hb), (MCV), (RDW), (CBI) and (TIBC) was measured. Maternal age, Gestational age, parity birth weight, and baby sex were also recorded. Results: The mean of neonatal birth weight was higher in iron supplemented group (2589.29±638.74gm) than that in non- iron supplemented group (2150.94±601.48), (P<0.01). The Cord Blood Markers of the newborns (Hb, MCV ,CBI, TIBC) shows higher values in iron-supplemented group than that in non-iron supplemented group, (P<0.05). The cord blood markers of SGA newborns (Hb, MCV, CBI, TICB) were more than that in AGA newborns (P<0.01). Conclusions: Maternal iron supplementation during pregnancy significantly increases neonatal birth weight. Most the cord blood hematological markers of neonate have higher value in iron-supplemented mothers than that in non-iron supplemented mothers which indicated better iron status. Keywords: neonatal birth weight, iron supplementation, iron status, maternal anemia

Abstract Background: Acute infectious gastroenteritis is one of the most common infectious diseases of human, ranking second to acute respiratory tract infections, and it is a worldwide cause of morbidity with a significance cause of death in children below five years, in developing countries.Objectives: to evaluate effect of zinc supplementation on children admission duration to hospital and their residency for those who had diarrheal diseases.Methods: In this study, 50 children were enrolled, having the age between 6mth-5yr, they have been admitted for diarrhea in Al-zahraa teaching hospital in Al-najaf governorate for the period of(March-June)2011 . those patients are subdivided into two group in regard to zinc supplementation as group one who constitute 25 patients managed without zinc given , while other 25 patients designed as group two who received 20 mg elemental zinc for 14 days from starting day, serum zinc level was recorded for each group , and the duration of their hospital stay was recorded .spss and chi square . Result: the study showed that using zinc tablets has a good effect on the duration of hospital stay , as 52% of those children (group-2)who received zinc were discharged after 3 days of admission in comparison to 3(12%) of those children(group-1) who have not received zinc tablet .Conclusion: using zinc tablet for every child admitted to hospital because of diarrhea will shortens patient residency and time of hospital stay.Recommendation: We recommend;(1)Adding zinc for every child presented with diarrhea whether admitted to hospital or treated as out- patient.(2)Further studies are required to assess the benefit of adding other trace element to the management such as vitamin-A and copper. Keywords Zinc supplementation, zinc, diarrhea