Karbala Journal of Medicine

Background: Metformin is widely used in polycystic ovary syndrome (PCOS), nevertheless, the treatment responsiveness reveals individual variation in patients with PCOS. Multidrug and toxins extrusion protein (MATE1) mediates metformin excretion in kidney and bile. MATE1 is encoded by SLC47A1 gene. In this study the single-nucleotide polymorphism (SNP) (rs1961669 A>G) was analyzed in an attempt to investigate the clinical, hormonal and biochemical effects of three months metformin treatment in women with polycystic ovary syndrome and to study the relation between MATE1 (SLC47A1) gene polymorphism and the response to metformin.
Patients and Methods: This study is a prospective group study; 231 women with PCOS were enrolled. All participated women with age range (18-40) were starting metformin tablet 500 mg per oral three times daily. Blood samples were taken from eligible patients to perform genetic analysis and estimation of follicle stimulating hormone, luteinizing hormone, total testosterone, fasting insulin, HbA1c, fasting blood glucose, sex hormone binding globulin and lipid profile.
Results: The study showed that SLC47A1 (rs1961669) (A>G) gene polymorphism has non-significant association with metformin response in PCOS. The comparison in demographic and biochemical parameters between pre and post metformin treatment results showed no improvement in clinical, hormonal and biochemical parameters.
Conclusion: SLC47A1 (rs1961669) (A>G) gene polymorphism had no association with clinical, hormonal and biochemical response to metformin in Iraqi women with polycystic ovarian syndrome.

Background: The current study is reflecting the commonness of gastric precancerous lesions in patients underwent upper GIT endoscopy.
Aim of the study to assess the prevalence of H. pylori related precancerous changes in gastric biopsies and theie clincopathological correlations.
Methods: The data was gathered from patients attending Al Hussein teaching hospital and private laboratories. It includes (414) patients who were subjected to esoph-agogastroduodenoscopy in this period. From all patients endoscopic mucosal biopsies were obtained and stained with hematoxylin-eosin. Giemsa stain was used to detect H. pylori organisms.
Results: All patients have gastritis and H. Pylori infection was detected in 301 (72.7%) patients. glandular atrophy, intestinal metaplasia and dysplastic changes were detected in 95 (22.9%), 36 (8.7%) and 6 (1.4%) patients respectively. There was a sig-nificant statistical relation between each of glandular atrophy and gastric intestinal metaplasia with age. There was a significant statistical relation between glandular at-rophy and H. Pylori. A significant negative relation between H. Pylori infection and the presence of intestinal metaplasia was observed meanwhile there was a significant correlation between the intestinal metaplasia and dysplastic changes.
Conclusion: The current study spots a light on how common the gastric changes can be detected in patients with chronic gastritis. There was a significant relation between the age and gastric glandular atrophy and intestinal metaplasia, a negative significant relation between H.Pylori infection and intestinal metaplastic changes. There was a significant relation between intestinal metaplasia and gastric dysplasia.

Background: Hodgkin lymphoma (HL) is one of the most common malignancies affecting the young Iraqi patients. This disease has diversified pathologies and clinical stages. Aims: To evaluate the clinical & pathological pattern of patients with HL in Middle Euphrates region of Iraq.
Materials & Methods: A retrospective descriptive study conducted at Al- Hussein cancer center in Karbala province of Iraq between February 2012 and June 2020.
Results: There were 193 patients with HL, 103 were male, 90 were female, M:F ratio was 1.14:1. Mean age at presentation was 27.17 years. Cervical lymph nodes was the common site for presentation (74.09%). Stage II was the most frequent stage (40.93%) while stage I was the least frequent (11.92%). Of classical HL type the mixed cellularity subtype was the most common one (49.74%), while the nodular lymphocyte predominant was representing (1.55%) only. A majority of our patients (79.27%) achieved complete remission post first line treat-ment.
Conclusion: The distribution of HL is mostly in young patients, the disease usually presented in early stage with very good response to treatment.

Background: Acute Kidney Injury (AKI) is a clinical condition that commonly occurs in crit-ically ill patients in the pediatric intensive care unit (PICU) with mortality rate of between (30-44)%.
Objectives: The aims of this study were to determine the incidence and stages of AKI and the short-term clinical outcome in patients admitted to PICU of Babylon Teaching Hospital for Gynecology and Children.
Methods: This observational study involved 143 patients aging more than one month admit-ted to pediatric intensive care unit (PICU) of Babylon teaching hospital for gynecology and children over 1 year. For each patient, renal functions were assessed: measurement of serum creatinine and blood urea at time of admission then repeated every 24hours whenever indicat-ed. Monitoring of the amount of urine output every hour.
We used classification system proposed by the Kidney Disease Improving Global outcomes (KDIGO) to define acute kidney injury stages
Results: Acute kidney injury occur in 45 patients (31%) of studied group while 98 patients (69%) were free from kidney injury.
Majority 27 patients (60%)) of total patient with Acute renal injury presented with stage 1.
10 patients (22%) presented with Stage 2 and 8 patients (18%) presented with stage 3.
Patients with AKI showed higher mortality (33.3) % compared with (22.4) % from patients without AKI.
Conclusion: AKI in critically ill children is found to have a high incidence and higher mortal-ity.

Background: Congenital anomalies of the kidney and urinary tract (CAKUT) are a major cause of morbidity and collectively represent a significant cause of chronic kidney disease (CKD) in children and young adults.
Aims of study: To describe the types, presentations, and methods of diagnosis of the CAKUT cases, attended the central teaching hospital of pediatrics in Baghdad-Iraq.
Patients & methods: A retrospective Cross-sectional study, conducted during the period from June 2017 to December 2017 in the nephrology department of the central teaching hos-pital of pediatrics in Baghdad/Iraq, where medical records of all patients who were diagnosed with CAKUT during the period from January 2007 to December 2016, were reviewed and analyzed in relation to patient demographics, clinical presentation, investigations, types of anomalies which were further subdivided to obstructive and non-obstructive and the differ-ence between them.
Results: Total of (308) patients records were collected and analyzed. The patients aged less than one year (43.8%) at the time of diagnosis. There were (64%) male and (36%) female. The patients had vesicoureteric reflux (VUR) (44.5%), followed by pelviureteric junction obstruc-tion (PUJO). (8.4%) of patients had combined anomalies. Skeletal anomalies represented (4.2%). the patients presented with urinary tract infection (UTI) (50.6%). There were 149 pa-tients (48.4%) had elevated Blood urea at the time of diagnosis, while 63 patients (20.5%) had elevated Serum creatinine. the obstructive anomalies were diagnosed in the age group below one year (63%). The obstructive anomalies was seen among male patients (80.2%). The obstructive anomalies was seen among patients presented with UTI (65.4%). (11.1%) of pa-tients with non-obstructive anomalies presented with failure to thrive (FTT).
Conclusion: Most of the patients diagnosed with CAKUT were males, aged less than one year. VUR was the most common anomaly, followed by PUJO. UTI was the most common presentation and skeletal anomalies were the most common extra-renal anomaly.

Background: Tonsillectomy is one of the most frequently performed surgical interventions in children. Pain control for pediatric’ patients undergoing tonsillectomy remains problematic.
Objectives: To investigate the effects of peritonsillar infiltration of tramadol or bupivacaine in reducing post-tonsillectomy pain in children.
Patients and methods: A Quasi-interventional study. One hundred fifty children aged 5–15 years were enrolled, who were scheduled for elective tonsillectomy or adenotonsillectomy at the ENT department. Patients were allocated randomly into three groups with 50 patients in each. Group A received peritonsillar infiltration of tramadol, group B received peritonsillar infiltration of 5ml of 2% Bupivacaine. While equal quantities of isotonic saline were used for infiltration in the control group (C). No significant difference between the groups in relation to age, gender, weight, type of surgery, and duration of the operation. Peritonsillar infiltration was performed after tonsillectomy in all groups, but before tracheal extubation. The visual analog scale (VAS) was used to measure and compare postoperative pain for the three groups.
Results: The tramadol group shows a significantly lower pain score in the early postoperative hours compared to the bupivacaine and control groups. Further, the bupivacaine group shows significantly lower pain scores compared to the control group within the first hour postopera-tively. No significant difference was found between the groups in regards nausea and vomit-ing side effects.
Conclusions: Peritonsillar tramadol infiltration offers greater control for post-tonsillectomy pain than bupivacaine or placebo in the early postoperative period. With no obvious side ef-fects. Bupivacaine was superior to placebo in reducing early postoperative pain.

Background and objective: Coronavirus disease 2019 (Covid 19) is the most severe pandemic hit the world during the last century. Generally, the diseases course has two phases, a viral phases and a more damaging immune mediated phases. The latter might lead to major organ failure and even death. Many therapeutic options have been tried most of them was not proven regarding safety and efficacy. Tocilizumab is the most widely used cytokine antagonist in order to combat for the cytokine storm of covid 19. It is an Anti- IL 6 monoclonal antibody used in severe cases to reverse the expected cytokine storm. Until recently, there is insufficient data regarding indications, safety, efficacy and exact dosing regimen of tocilizumab. The current narrative review tried to answer the above parameters in question.
Method: This is a narrative review involving the effectiveness, the dose and indications of tocilizumab as a treatment option for covid 19 infection. To do so, search on Pubmed using the following keywords: tocilizumab, covid 19, effectiveness, dose and indication with varying mixes.
Results: the search results revealed a total of 514 results, of them only 236 were included in this review.
Conclusion: Tocilizumab, is highly effective therapy especially for severe and critical covid 19 infections. The usual recommended dose by FDA (up to 3 infusions of 8 mg/ kg body wt.) is the rule, but can be used in a lower dosage and as a single dose, also.

Background: A seizure is a paroxysmal time limited change in motor activity and /or behavior that results from abnormal electrical activity in the brain and most common seizures in children are provoked by somatic disorders or originating outside the brain.
The aim of our study was to retrospectively evaluate all the patients with seizure re-quired admission to Pediatric Intensive Care Unit to determine the etiologies of sei-zure and their clinical outcome.
Materials and Methods: A total of 378 children were admitted to PICU from Janu-ary 2019 to January 2020, 40 patients were eligible, Age ranged above one month to 16 years. Seizures were organized as epileptic or acute symptomatic, pediatric risk fac-tors, classification of diagnosis, description and duration of convulsion, medications given to the patients with duration of admission to Intensive Care Unit and immediate outcome.
Results: The numbers of males equal to the females, mean age was 14.6 months, the most common causes of seizures were acute symptomatic, most frequent coexistent diagnosis was infectious diseases and 70% progress to status epilepticus.
Seizures were generalized in (28) 70% patients, (12) 30% had focal. Intravenous phenytoin and phenobarbiton was second line of therapy in 57.5%.
Acute symptomatic seizures were usually new onset, and duration was shorter. Epilep-tic seizures tended to be recurrent and were likely to progress to SE.
However type of seizures didn’t change severity of the disease, also laboratory test results, requirement for mechanical ventilation, duration of admission and mortality were not significant between epileptic/ acute symptomatic patients.
Conclusion: Seizure in critically ill children, which may evolve in to status epilepticus is an important condition that require attention regardless of cause. Intensified educa-tional programs for Pediatric Intensive Care Unit physicians and international guide-lines are necessary for a more efficient approach to children with seizures.