Clinical Profile of Pediatric Diabetic Ketoacidosis in Karbala City, IRAQ

BACKGROUND Diabetic ketoacidosis (DKA) is the most severe diabetic emergency and is still associated with a significant mortality (∼1–2% in western countries, but particularly in developing countries where mortality is substantially higher). It is a state of severe uncontrolled diabetes caused by insulin deficiency and requires urgent treatment with insulin and fluids to prevent death. DKA occurs more commonly in younger people, but the mortality is higher in the elderly. Approximately 25% of new patients with diabetes will present with DKA. In children with established diabetes the risk of DKA is increased in those with poor metabolic control and previous episodes of DKA, adolescent girls, children with psychiatric disorders including eating disorders and those with psychosocial difficulties. The majority of the remainder are due to inadequate insulin during intercurrent illness. THE AIM OF STUDY: To evaluate the clinical profile of pediatric DKA in Karbala city /Iraq. PATIENTS AND METHODS: This is a retrospective study involved diabetic patients admitted to Karbala paediatric teaching hospital and al Hindyia general hospital from the 1st of January to the 31th of December 2014 who had been admitted as a case of diabetic ketoacidosis. A total no. of 68 patients included in this study, they are classified according to the age, gender, severity of DKA, the precipitating factor of DKA and according to the residency. RESULTS: From the 68 patients whom included in this study, there were 16 males and 52 females with male: female ratio of 0.3: 1. The patients divided according to the age into 3 groups (1-5, 6-10 & 11-15 years). The factors which precipitate DKA were: 18 patients presented in state of DKA as first presentation of IDDM, infections were the precipitating factor in 31 patients and the other 24 patients were due to omission of insulin. The patients classified according to the severity of DKA in regard to the age groups and gender and the results show as that 18   patients were presented in mild DKA, 24 patients in state of moderate DKA and the other 26 patients were presented in state of severe DKA. CONCLUSION: DKA is an acute metabolic complication of IDDM that can be life-threatening. Although the incidence of DKA is more common in girls, the severity of the condition is more in boys.  Keywords: pediatric, DKA, IDDM, Karbala

Risk Factors for Congenital Heart Diseases in a Group of Children in Holy Karbala Governorate/IRAQ

Background: Prevention of congenital cardiovascular defects has been hampered by a lack of information about modifiable risk factors for abnormalities in cardiac development. Over the past decade, there have been major breakthroughs in the understanding of inherited causes of congenital heart disease (CHD), including the identification of specific genetic abnormalities for some types of malformations. Aim of study: To investigate some of the risk factors and their significance in the development of congenital heart diseases among children in Holy Karbala governorate. Methods: A case control study was done on pediatric patients with a confirmed diagnosis of congenital heart disease from January 2012 to January 2013 in Karbala Pediatric Teaching Hospital. A total of 212 patients, 106 cases and 106 controls were included in this study. Results: maternal age<20 years represent 4.7 % of cases, while those above 30 years of age represent 37.7 % of cases. Paternal age >40 years found in 37 cases (34.9 %) and 24 control (22.6 %). full term gestation found in 91 cases and 101 controls.  Residency in urban area found in 84 % of cases and 75.5 % of controls. Consanguinity was positive in 37 cases (34.9 %) and 18 controls (17 %). Second birth order and more found in 81 % of cases. Family history of congenital heart disease was positive in 11(10.4%) cases and 2 control (1.9%). Winter months' conception found in 44 cases (41.5%) and 21 control (19. 8%).low social class found in39 cases (36.8%) and 17 control (16%).isolated VSD found in 29 % of cases for whom consanguinity was positive in 9 cases and negative in 21 cases. Conclusion: Analysis of our results showed that paternal and maternal age, urban residency, winter month’s conception, low socioeconomic status, being 2nd borne or more and positive consanguinity are independent risk factors for CHD. KEY WORDS: CHD, pediatric, risk factors, Karbala