EVALUATION OF NOCTURNAL ENURESIS IN THALASSEMIC PATIENTS IN HEREDITARY BLOOD DISEASE CENTER AT KARBALA TEACHING HOSPITAL.

Mohammed Hussein Hamadi Al-Dawwd 1 , 0day Abdul Ridha Mohammed Al Nasari 2 and Israa Mustafa Salih ALMusawi 3 . 1. F.I.B.M.S of pediatrics 2. F.I.B.M.S of pediatrics 3. C.A.B.A.P. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History

Patients and methods:-396 hemoglobinopathies patients with thalassemia and sickle thalassemia from 5-18 years regestrated at heridetary blood disease center in karbala teaching hospital for children from September 2016 to april 2017.from which 260 patient diagnosed as thalassemia major on regular blood transfusion every 2-4weeks,57 patient diagnosed as thalassemia intermedia ,79 patient diagnosed with sickle thalassemia syndrome.only 61 patients were conducted in our cross sectional study. Other types of hemoglobinopathies with or without diabetes and other chronic illness like heart failure ,renal failure ,diabetes insipidus were excluded from the study.
Detail history from all patients and their parents were taken including onset of voiding control ,,day and/or night wet, history of chronic disease(diabetes mellitus, heart failure ,renal failure ),diuretic drug ingestion ,family history of enuresis. After routine physical examination; specific investigation for enuretic patients including general urine examination ,urine culture and abdominal ultrasound for genitourinary system. By using SPSS 21(Statistical Package for the Social Sciences 21) the assosciation between different types of thalassemia and enuresis evaluated by P value (significant when P>0.05).

Discussion:-
In the current study,the result of Primary enuresis and secondary enuresisin thalassemia major, thalassemia intermediate and Sickle thalassemia were parallel to a cross sectional study performed among children (5-15 years old) visited the general pediatric out patient in Al-Imamain Al-Kadhimain Medical City in the capital Baghdad. In this study the prevalence of nocturnal enuresis was 29.5% (n=184), 84.8%(n=156) were of primary type and 15.2% (n=28)had secondary nocturnal enuresis [9].
The result of enuretic males and female patient in thalassemic and sickle thalassemia,was similar to that of Alaa A. Selah, Atheer J. Al-Saffar in Iraqi JMS 2015,in which Males were significantly more enuretic than females (60.3% versus 39.7% and P= 0.02) [9].
Also this result goes with Robert M. Kliegman, et al,2016,which reveals that Approximately 60% of children with nocturnal enuresis are boys. [4].
In Jamaica (the Caribbean) adopted the prospective interview method recorded a prevalence rate of 45 % among 8 years old sickle cell anemia patients; also noting a male predominance. [10].
The positive Family history of enuresis of thalassemic and sickle thalassemia patients goes with Ekinci O etal. who Find that family history of nocturnal enuresis and family problems were found to be more frequent in patients with thalassemia major. [11]. And Alaa A. Selah, Atheer J. Al-Saffar in Iraqi JMS 2015,in which positive family history of nocturnal enuresis (including both parents side and siblings), were significantly higher among enuretic children compared to non enuretic children [9].
Our result differs from that of Robert M. Kliegman, et al,2016which states that the Family history is positive in 50% of cases in general population. [4].
Urinalysis to evaluate urinary tract infection in thalassemic and sickle thalassemia patient reveal no significant finding and this not goes with Alaa A. Selah, Atheer J. Al-Saffar in Iraqi JMS 2015,and Mabiala Babela JR., etal.were children with positive history of urinary tract infection were significant. [9], [11].
However, this may be due to non-exclusion of confounding variables like diabetes mellitus, epilepsy and urinary tract infection these studies.