علاء جمعة منجي نصراوي

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.

Background: Bilirubin is toxic substance to the central nervous system of neonates, so when neonates suffer from sever hyperbilirubinemia they need to be treated with phototherapy and even exchange transfusion. Objectives: is to detect the effects of intravenous infusion of human albumin before double volume exchange transfusion in rapid reduction of total serum bilirubin after exchange and in decreasing the risk of second time exchange. Patients and methods: A randomized control trial study done between January and December 2017 on fifty three neonates admitted to neonatal care unit of AL-Zahraa Teaching Hospital at AL-Najaf that fulfill the inclusion criteria and exclusion criteria. So two groups enrolled in the study as control group(n=29) and albumin group (n=24) , the albumin group receive albumin 1g/kg 20% one hour prior to exchange transfusion while in control group exchange transfusion only without albumin used. Results: A significantly lower mean post exchange total serum bilirubin in albumin group than that in control group at 6,12and 24 hours as p-value< 0.001 ,the mean of phototherapy duration significantly decreased in test group in comparison to control group (8.6±0.96hoursvs 17.9±3.8hours) respectively as p-value<0.001, also none of albumin group need second time exchange while three cases in control group underwent second time exchange with no side effects related to albumin use noticed. Conclusion: We conclude that Albumin administration before exchange blood transfusion can effectively reduces total serum bilirubin, period of phototherapy and greatly minimize risk of another exchange transfusion.

Background: Hyperbilirubinemia is a prevalent clinical problem which affects 60% of term and 80% of preterm neonates. Garlic is the most well-known remedy used in Iraq for the treatment of jaundice. To test the effectiveness of garlic necklace in the treatment of neonatal jaundice. Methods: This cohort study was conducted in the neonatal intensive care unit (NICU) of Al Zahraa Teaching Hospital within January-November 2016. A total number of 110 neonates were included in the present study out of whom 36 neonates were allocated to the test group and 74 newborns were assigned to the control group. The neonates in both groups received the common treatment of jaundice, according to guidelines adopted in our hospital. Nonetheless, the neonates in the test group wear a seven-clove garlic necklace till discharge, in addition to the common treatment. We compared the two groups regarding the length of hospital stay and the rate of total serum bilirubin (TSB) decline. Results: As illustrated by the obtained results, a significant reduction was detected in the hours of hospitalization in the control group, as compared to the test group (P= 0.006). A significant reduction was observed in hours of hospitalization in the control group, as compared to the test group (P=0.006) suggesting the harmful effect of garlic on neonatal jaundice. This can be attributed to the long-time dependence of patients' families on garlic as a sole treatment before seeking medical help. Nonetheless, this treatment made jaundice worse needing prolonged phototherapy. The rate of decline in TSB in hospitalized patients was comparable in both groups (P= 85). This again suggests that garlic has no beneficial effect on the treatment of neonatal jaundice. Conclusion: Based on the results of the present study, garlic has no effect on the treatment of neonatal jaundice, rather it may cause prolonged phototherapy and hospital stay.

Abstract Thalassemias are group of inherited autosomal recessive blood disorder. The genetic defect, which could be either mutation or deletion, results in complete absence or reduction synthesis of one of the globin chain that make up hemoglobin. This cause reduction of haemoglobin molecules production ,resulting in decreased of oxygen carrying capacity of the circulation thus causing anemia, the characteristic presenting symptom of the thalassemia. Good chelation therapy and regular blood transfusion protocol have increased the life expectancy. Objectives : is to compare serum ferritin level and liver function test in a group of patients with beta thalassemia major in response to subcutaneous and oral chelating agent . Patients and Methods: Prospective analytic study design done on group of 60 patients with beta thalassemia major diagnosed by hemoglobin electrophoresis registered in thalassemia center in AL – Zahra Teaching Hospital for Maternity and Children in AL- Najaf AL- Ashraf , during a period from 1st of February 2019 to 1st of February 2020, aged 2.5 to 17.9 years with serum ferritin levels above 1000 ng/ml and liver transaminases below 5 folds the normal upper limit . The patients divided into 2 groups, 30 patients were on Deferasirox {Exjade} therapy and 30 patients were on Deferoxamine {Desferal} therapy . Base line S. Ferritin value as well as LFT (S. GOT , S. GPT , ALP and TSB) value, were taken as base line level and then every (8-12) weeks and were used to assess the changes that occurred in response to subcutaneous and oral chelating agent . Results : Our study show significant decline in SF (P value <0.05) in both groups after 1 year of treatment with oral or subcutaneous chelating agent. Patients on Exjade show more rate of decrement of serum ferritin (11%) compared to patients taken Desferal who a rate of decrement (6%). Patients on Exjade and Desferal therapy show increment in liver enzymes after 1 year of treatment with statistically significant results, p-value < 0.05 . Conclusions We found superiority in oral iron chelating agents (Exjade) to subcutaneous iron chelating agents (Desferal). Serum ferritin level is suitable for long term monitoring as an indicator of efficacy than liver biopsy .

Background: Cytokines may have a role in preterm labour pathophysiology. Many studies revealed the association of cytokines with preterm labour and explained partially the mechanism of preterm uterine contractions. Interleukin-23 (IL-23) is a novel pro-inflammatory cytokine that has been studied in many inflammatory and immunological conditions. The role of IL-23 overexpression in preterm labour is hypothesized by the causal link between inflammation and spontaneous preterm labour. Objective: The study aimed to investigate the role of IL-23 in patients with preterm labour. Study design: Case-control study. Setting: AL-Zahraa Teaching for Maternity and Pediatrics in Al-Najaf city/Iraq. Patient and methods: Fifty pregnant women in preterm labour with gestational age between 24 weeks to 36 weeks+6 days were controlled with fifty age- and gestational age-matched healthy pregnant women who were not in labour. The serum level of IL-23 was measured using the ELISA method and compared between the two groups. Result: There is a significant difference (P<0.001) in the mean serum level of IL-23 between patients with preterm labour (27.39±12.04 pg/ml) and those healthy preterm pregnant women who were not in labour (11.05±4.39 pg/ml). Using a cut-off value of 13.15 pg/ ml for IL-23, the specificity, sensitivity, positive & negative predictive value and accuracy for the diagnosis of preterm labour were 92%, 90%, 90.2%, 91.8% and 91% respectively. Conclusion: IL-23 is an excellent test with promising diagnostic value in patients with preterm labour.

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.