Karbala Journal of Medicine

Background: Due to their powerful antimicrobial activity against a wide range of microorganisms, Silver na-noparticles have been successfully implanted in numerous fields. In dentistry, AgNP implants can be used for prophylaxis, disinfection, and infection prevention in the oral cavi-ty.
Objective: Screening the roles of Silver nanoparticles towards dental caries
Methods: In this paper systematic review investigating for usage of AgNPs dentistry depending on Pub-Med, Google scholar and Scopus databases resulting on 75 open ac-cess articles.
Results: The results found involve-ment of Silver nanoparticles in vari-ous fields of dentistry and having a potent activity towards microbes. These papers can serve as a guide for developing clinical application pro-tocols for both permanent and tem-porary dentitions, which have differ-ent structures, and the behavior of formulations containing Silver nano-particles can produce different re-sults.
Conclusion: Silver nanoparticles could be used as a potential method in dentistry in a variety of implanta-tions. Furthermore, current under-standing of the precise dimensions, concentrations, antimicrobial mech-anisms, and toxicological properties of nano-Silver compounds is insuffi-cient to make conclusive statements about their clinical utility.

Background: Hypochromic microcytic red blood cells are common findings in routine laboratory work in all age and ethnic groups. The differentiation be-tween 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 pa-rameters 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 attend-ing the premarital screening clinics in Karbala governorate, Iraq. All subjects were adults above 18 years old diag-nosed with β-thalassemia trait or iron deficiency anemia. New formula (Kar-bala) was developed using binary lo-gistic 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 Karbala discrimi-nant formula showed superior perfor-mance in ROC curve analysis within Karbala population. 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 discrimi-nant formulas should be tailored to fit the local population of β-thalassemia trait. Karbala discriminant formula best fits our population.

Background: fetal Magnetic resonance imaging (MRI) is 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 to indicate fetal lung maturity and pre-dict neonatal respiratory outcome in third-trimester pregnancy and to estab-lish an ideal LLSIR cut-off value
Patients and Methods: a prospective study was conducted on 40 fetuses from 39 pregnant women who delivered within 24 hours of an MRI scan during the period from January 2021 and Jan-uary 2022 in AL-Imamain Al-Kadhimain Medical City/ Baghdad/ Iraq. LLSIR was evaluated using Half-Fourier acquisition single-shot turbo spin-echo (HASTE) MRI. An analysis of the receiver operating characteristic (ROC) curve was utilized to figure out the ideal cut-off value for the LLSIR to predict respiratory prognosis after deliv-ery was determined.
Results: The gestational ages ranged from 28.1 to 40 weeks (mean 34.8 weeks). It was revealed that there was a correlation between magnetic reso-nance LLSIR and gestational age (p-value 0.001). The non-respiratory dis-tress syndrome group had higher LLSIR compared with the respiratory distress syndrome group (2.81±0.32vs. 2.19±0.18, p-value 0.001). Compared to the preterm group, the term group exhibited a greater LLSIR. (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: The third- trimester LLSIR, as determined by T2-weighed images MRI, might be utilized as a prognostic marker for the neonatal res-piratory prognosis if there is a strong correlation between these two parame-ters. 2.32 is the recommended cut-off number for forecasting newborn respir-atory survival.

Background: Hypertension is com-mon among steroid resistant and ster-oid dependent nephrotic syndrome patients. hypertension is one of the most common sequelae of chronic kidney disease in pediatric age group.
Patients & methods: A cross sectional study which was carried out in Neph-rology Department at Central Child Teaching hospital & Al-Karamah Teaching hospital with total of 255 patients included 102 patients with nephrotic syndrome & with measure-ment of blood pressure of 102 child with no history of any disease, this study also included measurement of blood pressure for 51 patients with chronic kidney disease.
Results: In this study, the total num-ber of cases of nephrotic syndrome, chronic kidney disease, & normal children were 102, 51, 102 cases re-spectively, male to female ratio was 1.5:1 for both nephrotic syndrome & normal children while it was 1.8:1 for chronic kidney disease patients. hy-pertension was reported in 2 cases only of total 102 cases of normal population & in 33 cases of total 102 cases of nephrotic syndrome While it reported in 29 cases of total 51 cases of chronic kidney disease.
Conclusions: Nephrotic syndrome can be considered to be intermediate risk factor for development of hyperten-sion between normal children & chronic kidney disease. Hypertension was found to be more in steroid re-sistant nephrotic syndrome and ster-oid dependent nephrotic syndrome group than in steroid sensitive ne-phrotic syndrome group. hypertension also was found to be more in frequent relapsing nephrotic syndrome. The incidence of hypertension was more in nephrotic patients with elevated blood urea and S.Creatinine than in patient with normal renal function.

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 outcome in pediatric patients with steroid resistant nephrotic syndrome, demographic characteristics, renal biopsy findings, and response to immunosuppressive treatment.
Materials and Methods: This retrospective study included 136 patients diagnosed as primary steroid resistant nephrotic syndrome followed by pediatric nephrology department in central child teaching hospital during the period from 2000 to December 2015 (by collecting files of patients). the study done from June 2016 to December 2016. Age at first episode, gender and family 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 commonly used and most effective drug is Cyclosporine A in which 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, histopathology and 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.

Background: Acne is a multifactorial inflammatory disorder and represents a spectrum range from a pair of black-heads and pustules to severe nodulo-cystic fulminant acne. The severity of the disease differs from patient to pa-tient; therefore, For the treatment of acne, isotretinoin is frequently utilized. Isotretinoin, however, may cause tri-glyceride and cholesterol levels in the blood to rise and may interfere with liver function tests. Also, the impact of isotretinoin on hematological parame-ters is still debatable and is examined by looking at alterations to the blood chemistry profile and haematological parameters of acne patients who are on isotretinoin. This study was aimed to show the effect of Isotretinoin on WBC and platelet count in a patient with ac-ne vulgaris.
Methods: This comparative study was conducted in a Clinic at the Department of Dermatology in two hospitals, Sala-haddin hospital and the general hospi-tal, in Tikrit city, Iraq. One hundred sixteen patients were selected. Patients suffer from acne and are divided equal-ly (58 patients each) into one of the two treatment regimens (Isotretinoin and doxycycline). Group one was given oral Isotretinoin 0.5mg/kg divided twice daily for six months, and Group two was given doxycycline 100 mg twice daily for the same period.
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, it was 21.72±4.95years. The mean platelet counts increased, whereas the white blood cell count decreased after isotretinoin treatment. But without any statically significant association.
Conclusions: This study\\'s results re-vealed no statistically significant effect of white blood cells and platelet count after therapy by Isotretinoin.

Background: Anti-Müllerian hormone (AMH) synthesized in the “granulosa cells” of the ovarian graffian follicles and can suppress the growth of pri-mordial follicles.
Objective: To assess the AMH asso-ciation with antral follicular count on the 2nd menstrual day to evaluate its diagnostic potency in the definition of polycystic ovary syndrome (PCOS).
Patients and methods: |A case control study, involving two groups of total hundred infertile women. The first group included fifty PCOS cases, while the controls included 50 non-PCOS infertile cases. Detailed history was obtained from candidates, and on the 2-3 cycle day underwent the following hematological tests: testosterone, fol-licular stimulating hormone, AMH, luteinizing hormone, and estradiol. As well, transvaginal ultrasonography was performed to assess hormo-nal/follicular association evaluated by the count of early antral follicles.
Results: The AMH levels in the PCOS were significantly higher compared to the controls (13.8±5.9 vs. 6.0±2.6ng/ml), correspondingly. A significant increase in the follicles’ count among PCOS women compared to control (17.6±6.8 vs. 8.0±3.8), re-spectively. AMH correlated signifi-cantly high with follicular count in the PCOS group. The levels of AMH and testosterone were significantly corre-lated in the PCOS group.
Conclusion: During the initial follicu-lar phase, AMH in PCOS is strongly correlated with antral follicle status. Such a link is stronger when compared with other hormones affecting follicu-lar function. This could highlight the importance of AMH concentration as superior predictor of the early follicu-lar counts than traditional hormonal assays. Hence, AMH levels offer a good diagnostic potency in the defini-tion of PCOS.