Karbala journal of medicine

Karbala Discriminant Formula to Differentiate Beta-Thalassemia Trait from Iron Deficiency Anemia

Waleed Khalid Al-Najafi — 2022-12-29

Abstract
Background: Hypochromic microcytic red blood cells are common findings in routine laboratory work in all age and ethnic groups. The differentiation between iron deficiency anemia and β-thalassemia trait represents a challenge in populations with limited access to costly lab investigations
Aim: To create a new mathematical formula using RBC hematological parameters to discriminate between iron deficiency anemia and β-thalassemia trait applicable to Karbala population.
Methods: A descriptive cross-sectional study was done at Karbala hereditary blood disease center. The sample of this study was selected from couples referred to the premarital screening centers in Karbala governorate, Iraq. All subjects were adults above 18 years old and diagnosed with β-thalassemia trait or iron deficiency anemia. New formula (Karbala) was developed using binary logistic regression (stepwise backward elimination). The new formula and 28 previously published formulas were evaluated using receiver operator curve ROC analysis.
Results: 1380 subjects were included in this study. The new formula created (Karbala discriminant formula) showed superior performance in ROC curve analysis. Karbala formula has a significantly higher AUC of 0.921 (0.905 – 0.935), followed by England Fraser, MDHL, Matos Carvalho, and Hameed.
Conclusion: Hematological discriminant formulas should be tailored to fit the local population of β-thalassemia trait. Karbala discriminant formula best fits our population.
Keywords: Hematological discriminant formula, β- thalassemia trait, iron deficiency anemia, binary logistic regression, Karbala formula, ROC curve, AUC, Youden index, accuracy, sensitivity, specificity, cut-off value.

The Diagnostic value of lung-to-liver signal intensity ratio as an indicator of fetal lung maturity in third-trimester pregnancy using magnetic resonance imaging.

Fatimah AlHaidery — 2022-12-29

Background: fetal MRI is an effective and non-invasive more accurate method for examining fetal lung development and predicting fetal respiratory outcomes.

Aims of the study: to study fetal lung-to-liver signal intensity ratio (LLSIR) using MR imaging T2-weighted images as an indication of fetal lung maturity and prediction of neonatal respiratory outcome in third-trimester pregnancy and to establish an optimal cut-off value of LLSIR.

Patients and Methods: a prospective study was conducted on 40 fetuses from 39 pregnant women who delivered within 24 hours of MRI scan during the period from January 2021 and January 2022 in AL-Imamain Al-Kadhimain Medical city/ Baghdad/ Iraq. LLSIR was evaluated using Half-Fourier acquisition single-shot turbo spin-echo (HASTE) MRI. Using receiver operating characteristic (ROC) curve analysis, the optimal cut-off value for the LLSIR to predict respiratory prognosis after delivery was determined.

Results: the gestational ages ranged from 28.1-to 40 weeks (mean, 34.8weeks). A significant relationship between magnetic resonance LLSIR and gestational age was demonstrated (p-value 0.001). The non-respiratory distress syndrome group had higher LLSIR compared with the respiratory distress syndrome group (2.81±0.32vs. 2.19±0.18, p-value 0.001). The term group had higher LLSIR compared with the preterm group (2.87±0.34 vs 2.34±0.29, p-value 0.001). ROC curve analysis showed LLSIR at a cut-off value of LLSIR ≤ 2.32 and AUC=0.977, revealing high sensitivity (100%) and high specificity (88.9%).

Conclusions: a significant relationship between fetal lung maturation and the LLSIR during the third trimester, as measured by T2-weighed MRI, and can be used as a prognostic indicator for the neonatal respiratory outcome. The best cut-off value that predicts the neonatal respiratory outcome is ≤ 2.32

Keywords: fetal lung maturity, gestational age, third trimester, Lung-to-liver signal intensity ratio · Magnetic resonance imaging

The impact of isotretinoin on platelet and white blood cell count in patient with acne vulgaris

Mayday Hadi Abdulwahab — 2023-04-27

Background: Acne is a multifactorial disease and represents a spectrum of disease severity from a couple of blackheads and pustules to severe nodulocystic fulminant acne. The severity of the disease differs from patient to patient therefore Isotretinoin is a commonly used for treating acne. However, isotretinoin may lead to elevated serum levels of triglycerides and cholesterol, and it may affect liver function tests. Moreover, the effect of isotretinoin on hematological parameters remains controversial and examines changes in the blood chemistry panel, hematological parameters of patients diagnosed with acne and treated with isotretinoin.

Methods: This comparative clinical trial carried out at Clinic in the Department of Dermatology in tow hospitals Salahaddin hospital and emergency hospital in Salahaddin city in Iraq. 116 patients were selected. Patients are suffering from acne and divided equally (58 patients each) to one of the two treatment regimens using isotretinoin and doxycycline. Group one was given oral isotretinoin twice daily for seven months and Group two was given doxycycline twice daily for same period. These patients were prepared before the time of study and were followed up during the treatment period. According to female, pregnancy prevented by two contraceptive methods. Both groups are investigated with the same investigations.

Results: Among the 116 cases included in the study, (36) were male and (80) were female. The mean age of group one was 21.97±4.87 years and in group two was 21.72±4.95years Mean, platelet count increased, whereas white blood cell count decreased after isotretinoin treatment. But without any statically significant association.

Conclusions: The results of this study revealed that no statically significant effect of white blood cells and platelets count after therapy by isotretinoin.

Keywords: Acne, Isotretinoin, white blood cells and platelets.

Aim of study

The aim of this study was to assess and compare the efficacy of oral isotretinoin on WBC and platelet count in acne vulgaris patients.

A, The outcome of steriod resistant nephrotic syndrome of children in central teaching hospital of pediatrics

Faleeha Obaid Hasan — 2022-12-29

OUTCOME OF IDIOPATHIC STEROID RESISTANT NEPHROTIC SYNDROME OF CHILDREN IN CENTRAL TEACHING HOSPITAL OF PEDIATRICS

Abstract

Background: Steroid resistant nephrotic syndrome accounts for 10%-20% of all cases of idiopathic nephrotic syndrome. These patients are at risk of developing end stage renal disease.

Aim of the study: to determine the demographic characteristics, renal biopsy findings, response to immunosuppressive treatment, and outcome in pediatric patients with steroid resistant nephrotic syndrome.

Materials and Methods: This retrospective study included 136 children patients diagnosed as primary steroid resistant nephrotic syndrome followed by pediatric nephrology department in central teaching hospital of pediatric during the period from 2000 to December 2015.the study done from June 2016 to December 2016.Age at first episode, gender and familial history of nephrotic syndrome were recorded. Demographic characteristics, clinical features at presentation, renal biopsy findings, response to immunosuppressive treatment and outcome were analyzed.

Results: one hundred thirty six patients involved in the study, Mean age at first episode of nephrotic syndrome was 7.18+_ 3.9 years (range: 1 - 16 years). renal biopsy was done for 83 patients and main histopathology was focal segmental glomerulosclerosis found in 54 patients represent (65.1%).Many items of drugs given to the patients and most common used and most effective drug is Cyclosporine A in which 34(34%) from patients achieved complete remission. There were 21 patients (15.4%) get complete remission, 38 patients (27.9%) lost follow up, 6 patients (4.4%) died, 13 patients (9.6%) developed stage 3 chronic kidney disease 24 patients (17.6%) developed stage 4 Chronic kidney disease and 34(25%) patients developed End stage renal disease. There is significant relationship between hypertension, hematuria, and impaired renal functions at presentation and response to immunotherapy and development of end stage renal disease ,while there is no significant relationship between age of patient at presentation, gender and histopathology with development of end stage renal disease.

Conclusion: we found near half of the patients developed chronic renal failure and 25% developed end stage renal disease. Patients with atypical presentation, resistance to immunosuppressive are liable to develop End stage renal disease significantly .In addition, we found Cyclosporine A is more effective than other immunotherapy as the initial therapy for many patients. However, did not find relation between histopathology and progression to End stage renal disease.

Key wards: steroid resistant nephrotc syndrome, cyclosporine A, chronic kidney disease, end stage kidney disease.

A, The the incidence of hypertension in children with nephrotic syndrome in comparison with low & high risk group & associated risk factors

Mohamed Saad Fadhil Al Ubaidy — 2022-12-29

The Incidence of Hypertension In Children With Nephrotic Syndrome in Comparison with Low & High Risk Group & Associated Risk Factors

Abstract

Background: Hypertension is very common among Nephrotic patients. In Nephrotic Syndrome, the kidneys become leaky so massive protein leaks into urine, decreasing the plasma colloid osmotic pressure and then fluid flows into tissue space. Nephrotic Syndrome also can cause water and sodium retention. Fluid retention in body can cause increased blood volume, leading to hypertension. hypertension is one of the most common sequelae of chronic kidney disease (CKD) in pediatric age group. CKD associated HTN develops by a large variety of pathophysiological mechanisms. BP is one of the most critical determinants of the progression rate of renal failure in children and cardiovascular mortality in childhood onset renal failure.

Objective: To study the relative frequency of hypertension in children with nephrotic syndrome & the factors that increase the incidence of hypertension in these patients &To compare the incidence of hypertension in patients with nephrotic syndrome, patient with chronic kidney disease & normal population as low, medium, high risk groups.

Patients & methods: A cross sectional study which was carried out in Nephrology Department at Central Child Teaching hospital & Al-Karamah Teaching hospital with total of 102 patients with nephrotic syndrome diagnosed and or treated and followed up in the pediatric nephrology consultation clinic & nephrology ward during 2016 & 2017 & with measurement of blood pressure of 102 child with no history of any disease who visit the outpatient clinics in Central Child Teaching hospital over 8 months period from 1st of may to the 1st of September 2017, this study also included measurement of blood pressure for 51 patients with chronic kidney disease who admitted to Hemodialysis Centre in Central Child Teaching hospital during 2016 & 2017.

Results: In this study, the total number of cases of nephrotic syndrome, CKD, & normal children were 102, 51, 102 cases respectively, male to female ratio was 1.5:1 for both nephrotic syndrome & normal children while it was 1.8:1 for CKD patients. HT was reported in 2 cases only of total 102 cases of normal population (2%) & in 33 cases of total 102 cases of nephrotic syndrome (32.3%) While it reported in 29 cases of total 51 cases of CKD (56.9%). there is no significant association between gender, age at time of presentation, & family history of renal disease with hypertension in nephrotic patients while there is significant correlation between family history of HTN, abnormal renal function tests, type of nephrotic according to relapse or steroid response or histological types on renal biopsy & type of treatment with hypertension in nephrotic patients. Hypertension was reported in 11 nephrotic patients with initial attack (10.8%) while it developed later in 22 patients (21.6%). only one patient out of 21 patients (4.8%) of induction group was hypertensive initially, while 5 patients out of 34 patients (14.7%) with Sensitive group were hypertensive. With frequent relapses & dependence group, hypertension was reported in 16 patients among 29 patients (55.2%) with frequent relapses, while in resistance cases, hypertension was reported in 11 cases out of 18 cases (61.1%), among 16 patients with elevated blood urea, hypertension reported in 10 patients (62.5%), while of 14 patients with elevated s.creatinine, hypertension developed in 9 patients (64.3%). HT was found in 21 patients among 82 patients who treated with steroid only (25.6%), while HT was found in 13 patients among 20 patients who received steroids & 2nd line of therapy (65%).

Conclusions: Nephrotic syndrome can be considered to be intermediate risk factor for development of HT between normal children & CKD, incidence of hypertension in CKD in this study is more than 50%. Hypertension developed later in nephrotic patients more than it developed at initial presentation. Hypertension was reported more in nephrotic patients with positive family history of hypertension. Hypertension was found to be more in SRNS & SDNS group than in SSNS group. Hypertension also was found to be more in FRNS. The incidence of hypertension was more in nephrotic patients with elevated blood urea & S.Creatinine than in patient with normal renal function. Hypertension was found to be more in nephrotic patients not responding to steroid only & treated with 2nd line of therapy.

Key words: Hypertension, Nephrotic Syndrome, Chronic Kidney Disease.

Anti-müllerian Hormone Associated with Antral Follicular Count in Cases of Polycystic Ovary Syndrome

Maysaloon Adnan — 2022-12-29

Background: Anti-Müllerian hormone (AMH) is a glycoprotein, synthesized in the “granulosa cells” of the graffian follicles of the ovaries and can suppress the growth of primordial follicles.

Objective: to assess the association of concentration of AMH with antral follicular count (AFC) on day 2-3 of the menstrual cycle, in cases of polycystic ovary syndrome (PCOs).

Patients and methods

This case-control cross-sectional study was piloted on two groups of total hundred infertile women. The first group included fifty cases with PCOS, while the control group included 50 non-PCOS infertile cases. A detailed history was obtained from all candidates, and on days 2-3 of the cycle underwent the following hematological tests: testosterone, follicular stimulating hormone (FSH), AMH, luteinizing hormone (LH), and estradiol (E₂). As well, transvaginal ultrasonography (TVUS) was performed to assess hormonal/follicular association evaluated by the count of early antral follicles (2–9mm diameter).

Results

The AMH levels in the PCOS women were significantly (P-0.001) higher compared to the control group (13.8±5.9 vs. 6.0±2.6ng/ml), correspondingly. A significant increase (P-0.001) in the count of follicles measured (2-9 mm) in size at TVUS in PCOS women compared to control (17.6±6.8 vs. 8.0±3.8), respectively. AMH correlated significantly high (P-0.001) with AFC in the PCOS group. The plasma levels of AMH and testosterone were significantly correlated in the PCOS group (P-0.05).

Conclusion

During the initial follicular phase, serum AMH in PCOS is strongly correlated with the antral follicle status. Such a link is stronger when compared with other hormones affecting follicular function. Serum AMH concentration in PCOS on days 2-3 of the cycle is a superior predictor of the early AFCs than traditional hormonal assays. Hence, AMH serum levels offer a good diagnostic potency in the definition of PCOS.

the Effects of Silver Nanoparticles on Treated Dental Caries: meta-analysis study

Ayat Majeed — 2022-12-29

Silver nanoparticles (AgNPs) have been successfully implanted in many fields related to their significant antimicrobial activity towards many microorganisms. In dentistry, AgNP can be implanted as disinfection, prophylaxis as well as prevention of infections in the oral cavity. In this paper investigating for usage of AgNPs dentistry depending on PubMed and Goggle scholar databases resulting on 75 open access articles. The results found involvement of AgNPs in various fields of dentistry and having a potent activity towards microbes, concluding could utilizing AgNPs as a promising approach in dentistry in different implantations.