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Article
Diagnostic Value of C - Reactive Protein and Other Hematological Parameters in Neonatal Sepsis

Authors: Hafadh Jaleel Hussein --- Yusra Fayyadh Alwan
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2012 Volume: 11 Issue: 3 Pages: 370-375
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:There have been many attempts to develop screening tests or scoring systems that can identify infected infants at the time of initial assessment, sparing others from invasive diagnostic procedures, intravenous antibiotics therapy, mother-infant separation and parental anxiety.OBJECTIVE:Is to analyze hematological parameters and C - reactive protein so as to evaluate their diagnostic value in neonatal sepsis.PATIENTS AND METHODS:A cross-sectional study was performed in the neonatal care unit (N.C.U) at the Central Teaching Hospital for Pediatrics and Al-Habibiya Maternity and Children Teaching Hospital during a period from the first of June 2005 to the first of January2006One hundred neonates having clinical features of sepsis and 100 normal asymptomatic neonates were evaluated with a set of investigations including C-reactive protein(CRP), White Blood cellsCount(WBC), Absolute Neutrophil count (ANC), Platelets count (thrombocytopenia), Immature to Total neutrophil ratio (I/T ratio) and Erythrocyte Sedimentation Rate (ESR) to diagnose neonatal sepsis.RESULTS:C-reactive protein (CRP) was positive in (82.4%) of group-A and (81.8%) of group-B and had a specificity of 93.0%. ANC was the second most sensitive test having sensitivity of 61.8% for group-A and 48.5% for group-B and specificity of 86.0%.The sensitivities of platelets count (thrombocytopenia), WBC, I/T ratio and ESR for group-A were: 55.9%, 29.4%, 17.6% and 26.5% respectively, with specificities of 91.0%,89.0%, 92.0% and 81.0% respectively. While group-B had sensitivities of 42.0%, 33.3%,15.2% and 22.7% respectively with specificities of 91.0%, 89.0%, 92.0% and 81.0%respective ly.CONCLUSION:The implementation of CRP and other hematological parameters (ANC, Platelets count and WBCs) are useful in early detection of neonatal sepsis and diagnosis of neonatal sepsis in those who have false negative blood cultures


Article
A retrospective Study of Testicular Relapse in Acute Lymphoblastic Leukemia

Authors: Ali Jameel Ahmed --- Hafadh Jaleel Hussein --- Yusra Fayyadh Alwan
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2013 Volume: 12 Issue: 4 Pages: 511-518
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Testicular relapse in ALL usually appear as painless testicular enlargement mostly unilateral. Diagnosed by wedge biopsy. The testis is a frequent site of relapse.OBJECTIVE:To find out the incidence of testicular relapse in ALL, time of diagnosis of testicular relapse, age group more commonly associated with testicular relapse, the association of testicular relapse with other relapses (medullary or extra-medullary), and prognosis of patients with testicular relapse.PATIENTS AND METHODS:Aretrospective study in the central teaching hospital of children in Baghdad- unit of hematology and oncology, during January 2000 – December 2006.Two hundred-four males were studied retrospectively. Informations were obtained from patients' files.RESULTS:The incidence of testicular relapse was in 18 patients represented (8.8%) of total cases of boys with ALL below 15 years. Relapse is mainly unilateral in 15 patients (83.3%) and mostly in the right side in 11 patients (61.1%) of total cases with testicular relapse.There is no significant statistical incidence of relapse with the age of patient represented by 2 cases (6.2%) from (0-2 years), 11 cases (8.2%) from (2-10 years), and 5 cases (13%) more than (10 years). Time of diagnosis of relapse was mainly during the oral maintenance therapy (13) patients (72.5%). Testicular relapse was isolated in 8 patients (44%) and combined with other relapses in 10 patients (56%) of them 7 patients (39%) with bone marrow relapse and 3 patients (17%) with CNS relapse.The outcome of patients with testicular relapse was better after discontinuation of chemotherapy “after three years of treatment” (2 cases diagnosed with relapse both of them still alive) represented (100%), while during the maintenance therapy of 13 patients, 6 (46.2%) of them still alive, 6 patients (46.2%) of them died, and 1 patient (7.6%) with no report, while induction chemotherapy 2 cases 1 (50%) alive and 1 (50%) died). Patients with isolated testicular relapse had better outcome represented by 6 patients (75%) still alive and 2 patients (25%) died, patients with combined relapse had worse outcome, represented by 3 patients (30%) alive, 5 patients (50%) died, and 2 patients (20%) with no report.Incidence of testicular relapse significantly decreased after the introduction of more intensive chemotherapy in Jan 2004 from 9.8% to 3.1%.CONCLUSION:Incidence of testicular relapse decrease with introduction of intensive chemotherapy and had higher incidence during the maintenance therapy, associated with increased incidence with other medullary and extra-medullary relapses, and has better prognosis when it is late and isolated than for early and combined relapse


Article
Risk Factors for Recurrent Febrile Convulsions in Children
عوامل الخطورة للاختلاجات الحرارية المتكررة عند الاطفال

Author: Yusra Fayyadh Alwan (FIBMS) a *Hafadh Jaleel Hussein (FIBMS) د. يسرى فياض علوان
Journal: Al-Kindy College Medical Journal مجلة كلية الطب الكندي ISSN: 18109543 Year: 2013 Volume: 9 Issue: 2 Pages: 14-16
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Febrile convulsions are the most frequent type of seizures in children under 6 years of age. Significant percentage of these children will later suffer from recurrence of febrile convulsion.Objectives: To identify the main risk factors for recurrent febrile convulsions in children.Methods: we carried out a case control study involving 89 children those who experienced first attack of febrile convulsions and 92 children with recurrent attack of febrile convulsions. The study was conducted in Central Children Teaching Hospital, Baghdad during the period 2006- 2007. Results: Compared to children with first attack of febrile convulsion, children with recurrent seizures were younger at onset (4- 12m) (67% vs. 44%), mainly male (70% vs. 51%) and had more often family history (first degree relative) history of epilepsy, low degree of temperature (45% vs. 23%) and frequent febrile illnesses (83% vs. 50%). second degree family history of febrile convulsion and onset of febrile convulsion in relation to onset of fever and type of convulsion (simple vs. complex) were not significant risk factors.Conclusions: Awareness of these risk factors should lead pediatricians to suggest administration of short course of diazepam at onset of each febrile illness to prevent recurrent febrile convulsions. Also, public education on recurrent febrile convulsions is needed.

الخلاصةالاختلاجات الحرارية هي أكثر أنواع الاختلاجات في الأطفال الذين تقل أعمارهم عن6 سنوات. هدفنا من هذه الدراسة هو بيان العوامل الرئيسية التي تلعب دورا" في تكرار الاختلاجات الحرارية. أجريت هذه الدراسة الاستطلاعية في مستشفى الطفل المركزي في بغداد للفترة من الأول من كانون الثاني 2006 لغاية كانون الثاني 2007 . ضمت الدراسة 181 طفلا" يعاني من اختلاجات حرارية أعمارهم تتراوح ما بين 4 اشهر إلى 6 سنوات، 92 طفل يعاني من اختلاجات حرارية متكررة ( 2 أو أكثر ) و 89 طفل يعاني من اختلاج حراري واحد فقط ( العينة المقارنة ) . تم اعتماد عوامل الخطورة التالية: العمر الحالي للمريض والعمر الذي بدأ به أول اختلاج حراري ، الجنس ، عدد مرات الاختلاجات الحرارية ، وجود تاريخ عائلي ( قرابة من الدرجة الأولى أو الثانية ) للاختلاجات الحرارية أو الصرع، نوع الاختلاج الحراري بسيط أو معقد، درجة الحرارة والوقت الفاصل بين ارتفاع الحرارة وحدوث الاختلاج، عدد مرات حدوث الإمراض المصاحبة بارتفاع درجة الحرارة خلال السنة.الاستنتاج :العوامل التي تؤدي الى زيادة خطر تكرار الاختلاجات الحرارية هي :عمر الطفل اقل من 12 شهر عند حدوث أول اختلاج حراري, جنس الطفل الذكور أكثر من الإناث, وجود تاريخ عائلي للاختلاجات الحرارية, درجة حرارة الطفل عند حدوث الاختلاج الحراري ( اقل من 39 ), تكرار حدوث الإمراض المصاحبة بارتفاع درجة الحرارة خلال السنة, وجود تاريخ عائلي للصرع. بينما وجود اختلاجات حرارية في الأقرباء من الدرجة الثانية في تاريخ العائلة والوقت الفاصل بين ارتفاع درجة الحرارة وحدوث الاختلاج الحراري تعتبر عوامل غير مهمة.


Article
CLINICAL PRESENTATIONS AND COMPLICATIONS OF GUILLAIN BARRE SYNDROME IN CHILDREN WELFARE TEACHING HOSPITAL

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Abstract

Background: Guillain Barré syndrome is an acute inflammatory demyelinating disease of the peripheral nerves. Its synonyms are: acute inflammatory demyelinating polyradiculoneuropathy, idiopathic polyneuritis, acute infective polyneuropathy and post infections polyneuritis. Objectives: We attempt to study the clinical presentations and complications in patients with GBS who were admitted to children welfare Teaching Hospital and to compare the results with the other studies.Type of the study: A retrospective study.Methods: A study done on seventy patients with GBS who were admitted to children Welfare Teaching Hospital in Medical City-Baghdad from different parts of Iraq between January 2002-December 2006.Results: Forty (57.14%) of them were males and 30(42.86%) were females, a male to female ratio 1.33:1. There were more cases during winter months. Antecedent events were found in 44 patients (62.86%),26 patients (37.14%) had no history of antecedent events. It was found that 24 patients (34.3%) had only bilateral lower limbs weakness and 46 patients (65.7%) had both bilateral lower and upper limbs weakness. Sensory manifestations occurred in 35 patients (50%). Cranial nerves involvement was observed in 25 patients (35.7%). Autonomic nerves involvement was observed in 9 patients (12.9%). Respiratory muscles were involved in 20 patients (28.6%), 11 patients (15.7%) were admitted to the RCU and needed ventilator setting, 3 patients (4.28%) died in RCU. The results were compared with similar studies from other parts of the world.Conclusions: This study showed that there is no specific pattern of motor weakness involvement and all cases show symmetrical muscle weakness.Bulbar nerves (glossopharyngeal and vagus nerves) involvement is the commonest cranial nerve involvements.Autonomic nerves involvement and respiratory muscles involvement are the main cause of death in GBS. GBS patients should be admitted to the hospital and RCU with ventilator setting should be available along with well trained medical staff. Because the disease may run a prolonged course, we recommend close follow up of the patient to see the end result at that time.

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