Karbala Journal of Medicine

bBackground: The assessment of childhood asthma severity is important for the diagnosis and
determining the initial level or step of the treatment of childhood asthma. It can be performed
either by history alone for children less than five years old or by history and pulmonary
function test for older children.
Objective: to evaluate and compare the utility of history and lung function test in the
assessment of asthma severity in children
Patients and Method: Across-sectional study was conducted in Karbala teaching hospital of
pediatrics, during the period from October 1, 2013 - April 30, 2014. The study included 50
children of both genders diagnosed with asthma (diagnosis made by consultant pediatrician).
A questionnaire was designed for the assessment of asthma severity by history which
included symptoms frequency over the preceding 4 weeks respectively. The lung function
test was only done in children 6-year-old and more. All children in our study had performed
lung function test.
Results: The mean age of studied group was 9.6 ± 2.5. The result of asthma severity
assessment based on history was as follow: 14/50 patients (28%) had intermittent asthma,
36/50 (72%) had persistent asthma of different degrees, mild in 11/50 (22%), moderate in
19/50 (38%) and severe persistent asthma in 6/50 (12%). While according to lung function
test, 12/50 patients (24%) had intermittent asthma, 15/50 (30%) had mild persistent, 19/50
(38%) had moderate persistent and the remaining 4/50 patients (8%) had severe persistent
asthma. There was no significant statistical difference in severity assessment between the two
methods (P > 0.05).
Conclusions: Our study shows good correlation between history and lung function test
regarding classification of childhood asthma severity. History is an excellent tool for the
assessment of childhood asthma severity when lung functions test is unavailable or difficult
to be done in younger children.

bFebrile seizures are common pediatric problem, yet there is a great deal
of disagreement about the appropriate diagnostic evaluation of a child with this
disorder. Different predisposing factors have been suggested to enhance the
susceptibility to febrile seizure and its recurrence. Fever play an important role in causing
disturbances in fluid and electrolytes balance, hyponatremia has been thought to enhance the
susceptibility to seizures.
Objective: To determine the effect of hyponatremia in recurrent febrile convulsions.
Patients And Methods: A case-control study which carried out in Al- Zahraa teaching
hospital in Al-Najaf city during the period between 1st of January to end of October 2015.
One hundred fifty children were included in this study. We classified the patients into three
groups; group (A) included (50) children presented with fever without seizure, group (B);
(50) children presented with simple febrile convulsion, group (C); (50) children presented
with recurrent febrile convulsions. Group A conceder as control group. The serum level of Na
were estimated in these 3 groups by Na kits.
Results: One hundred fifty children were studied with age range between (6months
6years) old. We compare the S. Na among the three groups;
It is found that male in group A represented 26 (52%) and 24 (48%), 28(56%) in group B and
C respectively, while female represented by 24 (48%), 26 (52%), 22 (44%) in groups A, B, C
respectively, with p value of 0.726.
There were no significant difference between male and female, in all age groups.Also it is
shown that family history of febrile convulsion represented 20%, 50%, 50% in group A, B, C
respectively, in family history of recurrent febrile convulsion, represented 4%, 4%, 10%, in
group A, B, C respectively, and with family history of epilepsy show group A (0%), group B
(4%), group C (0%).
While p value in family history of febrile convulsion (0.002), in family history of recurrent
febrile convulsion (0.345), in family history of epilepsy (0.132).
So there were no significant difference in all parameters except family history of febrile
convulsion which is significant in all three groups, P value=0.002.
Also the study will show no significant difference in age, white blood cell count, and random
blood surge while there is significant difference in temperature.
A significant difference in serum sodium level which is lowest in group C. Regarding
Calcium level, there is significant difference between group A and B.
Conclusion:-There is a significant association between recurrent febrile convulsion and
lower level of serum sodium, in which serum sodium concentration is lowest in those patient
with recurrent febrile convulsion.

b
ackground: Autism is a behavioral syndrome with still poorly understood etiologies,
nevertheless, phenylketonuria (PKU) was frequently associated with autistic
symptoms, and the frequency of this association is variably reported
Aim of the study: to bear in mind the diagnosis of phenylketonuria in children presented
with autistic symptoms.
Patient and methods: Patients with Autistic disorder was diagnosed according to DSM-5
diagnostic criteria, We describe fourteen patients, eight males and six female, their
presentation were autistic behavior with clinical findings included hair hypopigmentation,
microcephaly , mousy urine odour and/or positive family history of sibling with same
condition,
Result: Autism was present in 14 (26%) of phenylketonuria cases diagnosed with same
period; 12 patients had classic PKU and 2 had mild PKU, with average age 5.1 ± 2.696 , all
of them are borne to related parent and they have one or more features making PKU index of
suspicion.
Conclusion: The present study confirms that PKU is one of the causes of autism. Delay in
the diagnosis and management of PKU, may leads to significant incidence autistic features in
these patients.

background: Renal biopsy is a very important diagnostic tool for many kidney
diseases which play important role in the diagnosis, management and prognosis of
kidney diseases.
Aim of study: To study the indications, histopathological findings, and complications of
renal biopsies in multicenter in Baghdad-Iraq.
Materials and Methods: In this retrospective and descriptive study, we included renal
biopsies done in multicenter in Baghdad-Iraq, from 1st of January 2014 to 31 of December
2016, which was 120 patients up to 17 years of age
Results: Out of 120 patients, 68 cases (56.6%) were males, and 52 cases (43.3%) were
females, steroid resistant nephrotic syndrome was the main indication of renal biopsy 42%
followed by acute glomerulonephritis 19% and then evidence of systemic lupus
erythematosus 15%, minimal change nephrotic syndrome was the most common primary
kidney disease 39% followed by focal segmental glomerulosclerosis 31%. And lupus
nephritis was the most common secondary kidney disease 83%, hematuria and mild pain at
site of biopsy was the most common complications of renal biopsy 31.4% and 40%
respectively.
Conclusion: Renal biopsy is useful in diagnosis, assess level of chronicity, management, and
prognosis of kidney diseases. Steroid resistant nephrotic syndrome remain the most common
indication for renal biopsy, minimal change disease and focal segmental glomerulosclerosis is
the most common histopathological lesions in primary kidney diseases, lupus nephritis is the
most common secondary kidney diseases. Renal biopsy under ultrasound guidance is safe
with self-limited complications in form of hematuria and mild pain at site of biopsy

b
ackground: Thrombocytopenia refers to a reduction in platelet count to <150 × 109/L.
It may occur due to decreased production) hypoproductive thrombocytopenia) such as
aplastic anemia (AA) and acute leukemia (AL), or increased destruction of normally
synthesized platelets (hyperproductive thrombocytopenia) such as immune thrombocytopenic
purpura (ITP).
Platelet indices, namely plateletcrit (PCT), mean platelet volume (MPV), platelet distribution
width (PDW), platelet –large cell ratio (P-LCR) and immature platelet fraction (IPF) .Platelet
Volume Indices (PVIs) are a group of parameters which are inexpensive to measure and are
derived from routine blood counts.
Objective In this study, we aimed to assess the sensitivity and specificity of these indices and
set cutoff values that aid in diagnosis of thrombocytopenia causes.
Patients and Methods: We recruited 90 individuals as thrombocytopenic patients, who were
divided into two groups: group I (n= 40) included newly diagnosed immune thrombocytopenic
purpura (ITP) patients (hyperproductive thrombocytopenia), whereas group II(n = 50) included
hypoproductive thrombocytopenia patients .The MPV and PDW were derived from automated
cell counter. A comparison of the sensitivity and specificity for MPV and PDW in both
conditions (hypo and hyper-production thrombocytopenia) were evaluated.
Results: All platelet indices were significantly higher in ITP than in ( AA and AL), and platelet
indices showed sufficient sensitivity and specificity ; the best cutoff value for MPV was greater
than 10.6 fl and for PDW was greater than 16fl, with a sensitivity(90,95) and specificity(86,80)
respectively.. The area under the curve (AUC) of the receiver operating characteristics curve
of platelet indices was large enough to enable the diagnosis of ITP. the PDW had the larger
AUCs(0.938)than MPV where AUCs (0.900) , which means that these values are very reliable
for ITP.
Conclusion: Platelet volume indices can differentiate with some certainty ITP from AL and
AA, and helps pediatricians to avoid the invasive bone marrow aspiration which need expert
hematologist for its interpretation.

b Thyroglossal duct cysts (TGDCs) are the most common form of congenital neck
cyst, accounting for up to 70% of such lesions. There has been no consensus on which factors
predict outcome of thyroglossal duct cyst excision.
Objective: To evaluate the relevance of symptomatology, age at presentation and the
histopathology of TGDCs.
Methods: Retrospective review of patients with TGDC at Al-Hissain medical city. Data
collected included patient’s age, gender, clinical presentation, presence or absence of
preoperative infection, size and location of the lesion,
Results: Thirty –one patients were identified (71% female and 29% male). Age of presentation
was bimodal and ranged from few months to 17 years. The most common presenting symptom
was the presence of an asymptomatic midline neck mass (71%). A history of preoperative
TGDC infection was present in 3% of patients ≤2 years of age and in 10% of patients ≥5 years
of age.
Conclusions: The finding of a midline neck mass is the most common presentation of TGDCs
in toddlers, whereas infection is the most common presenting symptoms in school-aged
children. Complete and precise clinical information is a prerequisite in order for pathologists
to make accurate diagnoses of congenital cervical cysts

bHemophagocytic lymphohistiocytosis (HLH This aggressive and potentially life-threatening
disease most often affects infants from birth to 18 months of age, but cases in older children
and adults have been reported. We describe a 14-year-old boy whom (HLH) developed. He
suffered from fever with disturbed level of conciseness. Physical examination revealed drowsy
but easily arousal, pallor,
no cyanosis, no jaundice
, faint macular rash,
soft distended abdomen,
and hepatomegaly. Laboratory findings were abnormal liver function, coagulopathies,
hypertriglyceridemia, high renal indices, urinalysis show hematuria and proteinuria, anemia,
thrombocytopenia, high serum ferritin level and abnormal bone marrow findings

bCastleman’s disease is an uncommon and poorly understood disorder of atypical
lymphoproliferative disorder of unknown etiology atypical. Renal manifestations, such
as proteinuria, hematuria, and renal dysfunction, are common in Castleman’s disease;
however, a nephrotic syndrome rarely occurs.
We have encountered an unusual case of Castleman’s disease characterized by
nephrotic syndrome because of glomerulopathy mimicking membranoproliferative
glomerulonephritis.
The diagnoses were confirmed by cervical lymph node and renal biopsy.