Case Studies of Children's Health Issues PDF

1  Special thanks to - Dr. Inas Thamer Mousa - my father Dr.fadhil Abdullah and - my mother Dr.lamyaa muhssen 2  It is for educational purposes only. It is design to help you how to arrange your history ( story  ) , but It...

1  Special thanks to - Dr. Inas Thamer Mousa - my father Dr.fadhil Abdullah and - my mother Dr.lamyaa muhssen 2  It is for educational purposes only. It is design to help you how to arrange your history ( story  ) , but It may contain a lot of unreliable information *The patients name , address , age or some other information may not to be the real one , but otherwise the cases was written within the help of patients' own words , who were admitted to Al-Kadhimiya Teaching Hospital/ Baghdad, Iraq/ 2017 I hope you have some benefits after you finish it, and to be more oriented about what you may found in the ward, during the sessions or exams Wish you all the best  3 4 (from page 6 to 81) - Acute Post streptococcal Glomerulonephritis - Asthma - Bloody diarrhea - Cerebral palsy - Chemotherapy dose - Diabetic Ketoacidosis (DKA) - Diarrhea - G6PD - Hematemesis - Hemophilia - Henoch-Schonlein Purpura (HSP) - Hepatitis A - Immune Thrombocytopenic Purpura (ITP) - Leishmania - Meningitis - Organophosphorus poisoning - Pneumonia - Seizure - Urinary Tract Infection (UTI) - Whooping cough Neonate: - Low birth weight - Neonatal cyanosis - Neonatal jaundice - Neonatal seizure - Neonate shortness of breath 5  Acute Post streptococcal Glomerulonephritis Ahmed Hassan fadi, 7 years old , male, lived in alghazalia , his next of kin his mother zahraa aziz redha (from whom history was taken ), Date of admission 3rd of august 2017 Date of taking history : 3rd of august 2017 Chief complain: generalized body swelling for 2 day prior to admission History of present illness : 7 years old male who was previously healthy presented with generalized body swelling for 2 day prior to admission , which was sudden in onset start as swelling arounds the eye then it involved the face , later the whole body was involved especially the legs , associated with decreased urine output , which has cola color as described by his mother , he also had poor appetite and malaise ,his sleep and daily activities were affected , his mother also mention that he had sore throat about 2 weeks prior to the admission which lasted few days , subsided after used some oral medications prescribed by his private doctor, His family brought him to the hospital, in which he had some investigations , urine catheter had been put to him and he received some oral medications , He is in the first day of admission and his condition still the same , he had no previous similar attack. 6 Review of systems:- Cardiovascular: no chest pain, no palpitations, no loss of consciousness, no claudication, no cyanosis Respiratory: no cough or sputum, no wheeze, no hemoptysis, Gastrointestinal: no abdominal pain , no nausea or vomiting ,no change in bowel habit, no hematemesis, no hematochezia, and neither melena, nor tenesmus, Musculoskeletal: no muscles pain, or stiffness, no joint swelling, neither pruritus nor rashes. Neurological: there are no changes in sight, smell, hearing and taste, no seizures, or fainting attack, no headache, no speech problems, no sphincter disturbance Past history (Birth history ) : 1 - prenatal history : Good maternal health before and during pregnancy , no specific illness related to or complicated by pregnancy like hypertension or diabetes mellitus No history of bleeding during pregnancy , the mother experienced no skin rash or fever during pregnancy which may suggest TORCH infection , no history of drug use or x-ray exposure during pregnancy , with good antenatal care as the mother regularly visit primary health care center , and she received vaccine , she is neither smoker nor alcoholic 2- Natal history : Full term baby delivered vaginally at the hospital , the delivery passed smoothly and uneventfully , there was spontaneous rupture of membrane , last about 4 hours from rupture till baby delivery. 3- Post natal history : When Ahmed was newborn , he cried immediately , and he need no resuscitations efforts , he was neither cyanosed nor jaundiced , he had no congenital anomalies or infections had been encountered at that time, his first feeding was after 1 hour , and his first urination and pass motion were at the first day of birth , he didn't need any hospital admission during the neonatal period. 7 Past medical history He had no previous similar condition , with no previous hospital admission , He didn't experience specific illnesses such as communicable illness (chicken pox , measles , mumps rubella, whooping cough ) Vaccination history : Ahmed completed his vaccine schedule , at the first week of his life , he received BCG , (with BCG scar), oral polio vaccine (OVP), hepatitis B vaccine (HBV1), at 2 months he received DPT1 , OPV1 , HBV2 at 4 months he received DPT2 ,OPV2 at 6 months he received DPT3, OPV3 ,HBV3 at 9 month he received measles vaccine at 15 months he received MMR vaccine at 4 years he received booster dose of DPT and OPV Feeding history : Ahmed was bottle feed up to the age of 2 years, then the family planned a weaning process , Ahmed now feeds the usual table foods of the family Developmental history He is in the 2nd stage of primary school , he attends regularly to the school , and he can interact normally with his peers Past surgical history : Apart from the circumcision at the age of 9 months which was uneventful , he had no previous surgery the drug history : no history of allergy for specific drug family history : the mother is 21 years old , housewife ,completed only her primary school study , she had a good health , the father is 25 years old , he completed his primary school study , he is now works as a baker he has a good health , there is a consanguinity between them , he is her cousin , the family consist of 2 children , the older is 9 years old male with good health , and the second is our patient , there is no similar condition in the family , no chronic illnesses like hypertension , diabetes , asthma , epilepsy and no history of sudden death social history : they live in an urban area , in their own house , in which there are 3 rooms and supply by tap water & proper sewage system , there is no smoker in the house , with no indoor domestic animals. 8  Asthma Zainab ali hamza, 7 years old , female, lived in alshula'a , her next of kin is her mother Iman waleed hadi (from whom history was taken ), Date of admission 22nd of July 2017 Date of taking history : 23rd of July 2017 Chief complain: shortness of breath for one day prior to admission History of present illness : Noor is a known case of asthma , diagnosed Since the sixth month of her life , she had recurrent attacks of shortness of breath annually , and she is on intermittent course of short acting beta agonist &inhaled corticosteroids Presented to the emergency department with shortness of breath for 1 day prior to admission , her condition started before 1 week as a nasal congestion , sneezing and dry cough, which increase at night and after exercise , with no reliving factors , 3 days later she develop high grade fever (documented by her mother 38.5 c), continuous ,associated with sweating , especially at night relieving by paracetamol and cold sponge , the day preceding the admission she develop shortness of breath which was sudden in onset , present even at rest , not relieved by anything but without wheeze or cyanosis , her family consulted her private doctor , he prescribed oral medication and nebulizer , the condition seem to improve for few hours ,later , the condition started again , and the child became drowsy , her feeding , activity ,sleeping were markedly affected , her parent brought her to the hospital in which she immediately received oxygen , iv fluid , And some medication s, she is now in the 2nd day of admission , and there is improvement in her condition , as she had no further shortness of breath , fever had been subsided ,she start to regain her normal daily activity , sleep and feeding 9  Review of systems:- Cardiovascular: no chest pain, no edema, no palpitations, , no loss of consciousness, no cyanosis Gastrointestinal, no abdominal pain , no nausea or vomiting ,no change in bowel habit, no hematemesis, no hematochezia, and neither melena, nor tenesmus, Genitourinary: no frequency , no change in odor or color with normal urine stream , no terminal dribbling ,with no dysuria Musculoskeletal: no muscles pain or stiffness, no joint swelling, neither pruritus nor rashes. Neurological: there are no changes in sight, smell, hearing and taste, no seizures, or fainting attack, no headache, no poor balance, no speech problems, no sphincter disturbance. Past history (Birth history ) : 1 - prenatal history : Good maternal health before and during pregnancy , no specific illness related to or complicated by pregnancy like hypertension or diabetes mellitus No history of bleeding during pregnancy , the mother experienced no skin rash or fever during pregnancy which may suggest torch infection , no history of drug use or x-ray exposure during pregnancy , with good antenatal care as the mother regularly visit primary health care center , and she received vaccine , she is neither smoker nor alcoholic 2- natal history : Full term baby delivered vaginally at the hospital , the delivery passed smoothly and uneventfully , there was spontaneous rupture of membrane , last about 4 hours from rupture till baby delivery 3- post natal history : When noor was newborn , she cried immediately , and she need no resuscitations efforts , she was neither cyanosed nor jaundiced , she had no congenital anomalies or infections had been encountered at that time her first feeding was after 1 hour , and her first urination and pass motion were at the first day of birth ,she didn't need any hospital admission during the neonatal period. 10 Past medical history she had many previous similar condition especially during winter, with previous hospital admission , she didn't experience specific illnesses such as communicable illness (chicken pox , measles , mumps rubella, whooping cough ) Vaccination history : noor completed her vaccine schedule , at the first week of his life , she received BCG , (with BCG scar), oral polio vaccine (OVP), hepatitis B vaccine (HBV1), at 2 months she received DPT1 , OPV1 , HBV2 at 4 months she received DPT2 ,OPV2 at 6 months she received DPT3, OPV3 ,HBV3 at 9 month she received measles vaccine at 15 months she received MMR vaccine at 4 years she received booster dose of DPT and OPV Feeding history : noor was bottle feed up to the age of 2 years, then the family planned a weaning process , Noor now feeds the usual table foods of the family Developmental history she is in the 2nd stage of primary school , she attend regularly to the school , and she can interact normally with her peers Past surgical history : she had no previous surgery the drug history : no history of allergy for specific drug family history : the mother is 21 years old , housewife ,completed only her primary school study , she had a good health the father is 25 years old , he completed his primary school study , he is now works as a baker he has a good health , there is a consanguinity between them , he is her cousin , the family consist of 2 children , the older is 9 years old male with good health , and the second is our patient , there was no similar condition in the family , no chronic illnesses like hypertension , diabetes , asthma , epilepsy and no history of sudden death social history : they live in an urban area , in their own house , in which there are 3 rooms and supply by tap water & proper sewage system , there is no smoker in the house , with no indoor domestic animals. 11  Bloody diarrhea Ahmed salam ismail , 2.5 months of age , lived in hay aladil , his next of kin his mother Zainab sammer kadhim (from whom history was taken ), Date of admission 2nd of august 2017 Date of taking history : 4th of august Chief complain: bloody , lose bowel motion , for 1 day prior the admission History of present illness : Ahmed who is 2.5 month of age who was previously healthy presented with bloody , lose bowel motion , for 1 day prior the admission , his condition start before 3 days when he developed high grade fever documented by his mother (38.5 c) , which was sudden in onset , continues , associated with sweating especially at night relive by cold sponge , not associated with abnormal body movement , 2 days later his mother described four or five lose stool per day which was sudden in onset moderate in amount mixed with small amount of bright red blood and mucus, as she said he didn't cry during passing motion , associated with repeated vomiting which was effortless , whitish in color , neither bloody nor billous , not related to feeding , with no reliving or aggravating factors , there was no abdominal distension , with normal urine output, but the child feeding , sleep , activities were markedly reduced His family brought him to the hospital , in which , after some investigations he managed by iv fluid and injectable form of medication , the child now in the 3rd day of admission , his condition start to improve as he regain his daily activity , his feeding and sleep improves also ,the fever had been subsided since the first day of admission but he still pass lose bowel motion mixed with blood , but less frequently , There was no previous similar attacks , and no history of contact with similar case 12  Review of systems:. Genitourinary: no frequency , no change in odor or color with normal urine stream , , no terminal dribbling ,with no dysuria Cardiovascular: no shortness of breath, no edema, no cyanosis Respiratory : no cough or sputum, no wheeze, no hemoptysis, Musculoskeletal: no muscles pain, or stiffness, no joint swelling, no skin rashes. Neurological: no seizures, or fainting attack, no change in behavior , no vision or hearing loss Past history (Birth history ) : 1 - prenatal history : Good maternal health before and during pregnancy , no specific illness related to or complicated by pregnancy like hypertension or diabetes mellitus No history of bleeding during pregnancy , the mother experienced no skin rash or fever during pregnancy which may suggest torch infection , no history of drug use or x-ray exposure during pregnancy , with good antenatal care as the mother regularly visit primary health care center , and she receive vaccine , she is neither smoker nor alcoholic 2- natal history : Full term baby delivered vaginally at the hospital , the delivery passed smoothly and uneventfully , there was spontaneous rupture of membrane , last about 5 hours from rupture till baby delivery 3- post natal history : When Ahmed was newborn , he cried immediately , and he need no resuscitations efforts , he was neither cyanosed nor jaundiced , he had no congenital anomalies or infections had been encountered at that time his first feeding was after 1 hour , and his first urination and pass motion were at the first day of birth , he didn't need any hospital admission during the neonatal period. 13 Past medical history He had no previous similar condition , with no previous hospital admission He didn't experience specific illnesses such as communicable illness (chicken pox , measles , mumps rubella, whooping cough ) Vaccination history : Ahmed received vaccine only at the first week of his life , he received BCG , (with BCG scar), oral polio vaccine (OVP), hepatitis B vaccine (HBV), Feeding history : The child is a bottle feeding (it is the mother preference ) Regarding the preparation : His mother said that , he usually takes About 6 feeds per day , she prepares it as 5 ounce with five leveled scoop Regarding the sterilization : He had 2 feeding bottles , unfortunately his mother didn't sterilize the feeding bottle , she used to wash it by tap water only Developmental history the child is 2.5 month of age regarding the cross motor development , there is still head lag to sitting position but he can follow moving objects 180 degree, and he is able to listen to the voice , and start to Coo Past surgical history : He had no previous surgery , and he didn't have circumcision yet the drug history : no history of allergy for specific drug family history : the mother is 21 years old , housewife ,completed only her primary school study , she had a good health , the father is 25 years old , he completed his primary school study , he is now works as a baker he has a good health ,there is a consanguinity between them , he is her cousin , the family consist of 2 children , the older is 5 years old male with good health , and the second is our patient ,there is no similar condition in the family , no chronic illnesses like hypertension , diabetes , asthma , epilepsy and no history of sudden death social history : they live in an urban area , in their own house , in which there are 3 rooms and supply by tap water & proper sewage system , there is no smoker in the house , with no indoor domestic animals. 14  Cerebral palsy Muhaemen hassan fadi, 6 years old , male, lived in alghazalia , his next of kin his mother zahraa ahmed redha (from whom history was taken ), Date of admission 3rd of august 2017 Date of taking history : 4th of august Chief complain: abnormal body movement for 1 day duration History pf present illness : Muhaemen is a known case of cerebral palsy diagnosed since few months of age , he had frequent attacks of abnormal body movement and he is on oral anti convulsant medications , twice daily , he was free of attacks for the previous 2 years presented now with generalized , tonic-clonic body movement , he had 2 attacks in the day preceding the admission , each of them last about few minutes , end spontaneously and after which the child sleep for about 2 hours , he had no fever or history of trauma , with no relieving or aggravating factor ,and as his mother said he received his medication that day as usual, his feeding was Markedly decreased ,and his condition also affect his usual daily activities and sleep The family consulted his private doctor , where admission was advised In the hospital , after history , clinical examination , some investigation in form of blood and urine test had been done to him , and he managed by oxygen , iv fluid , and injectable form of medication , he is now in the 2nd day of admission and his condition still the same as he suffer from 2 another attacks , and he still not feed or sleep properly , and not return to his usual daily activity , As we said he had previous similar condition, during each attacks he managed by iv fluid with injectable form of medication , and he needed to stay at hospital for about 1 week 15 Review of systems:- Gastrointestinal: no nausea or vomiting ,no change in bowel habit, no hematemesis, no hematochezia, and neither melena, nor tenesmus, Cardiovascular: no shortness of breath, no edema, , no cyanosis Respiratory : no cough or sputum, no wheeze, no hemoptysis, Musculoskeletal: neither pruritus nor rashes, but he had limited join movement and impaired muscle tone Past history (Birth history ) : 1 - prenatal history : Good maternal health before and during pregnancy , no specific illness related to or complicated by pregnancy like hypertension or diabetes mellitus No history of bleeding during pregnancy , the mother experienced no skin rash or fever during pregnancy which may suggest torch infection , no history of drug use or x-ray exposure during pregnancy , with good antenatal care as the mother regularly visit primary health care center , and she receive vaccine , she is neither smoker nor alcoholic 2- natal history : Preterm (32 weeks ), 2 kg male baby delivered vaginally at the hospital , there was a preterm premature rupture of membrane with clear liquor , as the mother said the delivery last about 4 hours , with no complication encountered at that time 3- post natal history : When Muhaemen was newborn he didn't cry immediately , resuscitation had been done to him about 5 minute later he started to cry , he had lips cyanosis , which end after few minutes spontaneously, muhaemen was admitted to neonatal intensive care unit for about 1 week , later he discharge on the family responsibility , he had no jaundice , no cyanosis , and no congenital anomalies encountered at that time , he pass motion ,urine during the first day of his birth. 16 Past medical history As we said had previous similar condition , and he is on oral anti convulsant medication , twice daily, and he was free of attack during the last 2 years , He didn't experience specific illnesses such as communicable illness (chicken pox , measles , mumps rubella, whooping cough ) Vaccination history : The family unfortunately neglected the vaccination schedule , the only vaccine he receive was in the first week of his life he received BCG vaccine with BCG scar on his left deltoid OPV 0 , HBV1 Feeding history : muhaemen was bottle feed up to the age of 2 years, then the family planned a weaning process , now he feeds the usual table foods of the family Developmental history Despite the chronological age of muhaemen is 6 years old , in which we expect he will be in the 1st stage of primary school , his developmental age is still in about the first few months , as he is unable to walk , crawl , or even roll over , he can only do simple physical activity like turning his head from side to side , grasp large objects , and unfortunately he is unable to speak few words till now Past surgical history : Apart from the circumcision at the age of 2 years which was uneventful , he had no previous surgery the drug history : he uses baclofen oral tab twice daily with no history of allergy for specific drug, family history : the mother is 21 years old , housewife ,completed only her primary school study , she had a good health , the father is 25 years old , he completed his primary school study , he is now works as a baker he has a good health there is a consanguinity between them , he is her cousin , the family consist of 2 children , the older is 9 years old male with good health , and the second is our patient there is no similar condition in the family , no chronic illnesses like hypertension , diabetes , asthma , epilepsy and no history of sudden death social history : they live in an urban area , in their own house , in which there are 3 rooms and supply by tap water & proper sewage system , there is no smoker in the house , with no indoor domestic animals. 17  Chemotherapy dose Zainab mohammed hussein, 7 years old , female, lived in alshula'a , her next of kin her mother Iman waleed hadi (from whom history was taken ), Date of admission 22 of July 2017 Date of taking history : 22 of July 2017 Chief complain: to have chemotherapy( third dose) History of present illness : 7 years old female , who diagnosed with metastatic kidney tumors (renal cell carcinoma) , since 6 months ago , she had been scheduled to receive the third dose of chemo on 22 of July , she was admitted to the hospital at the day appointed to her , Her previous dose was on the 1st of July which pass smoothly and uneventfully , 18  Review of systems:- Gastrointestinal, no abdominal pain , no nausea or vomiting ,no change in bowel habit, no hematemesis, no hematochezia, and neither melena, nor tenesmus, Genitourinary: no frequency , no change in odor or color with normal urine stream , , no terminal dribbling ,with no dysuria Cardiovascular: no chest pain, no shortness of breath, no edema, no palpitations, , no loss of consciousness, no claudication, no cyanosis Respiratory : no cough or sputum, no wheeze, no hemoptysis, Musculoskeletal: no muscles pain, or stiffness, no joint swelling, neither pruritus nor rashes. Neurological: there are no changes in sight, smell, hearing and taste, no seizures, or fainting attack, no headache, no poor balance, no speech problems, no sphincter disturbance Past history (Birth history ) : 1 - prenatal history : Good maternal health before and during pregnancy , no specific illness related to or complicated by pregnancy like hypertension or diabetes mellitus No history of bleeding during pregnancy , the mother experienced no skin rash or fever during pregnancy which may suggest torch infection , no history of drug use or x-ray exposure during pregnancy , with good antenatal care as the mother regularly visit primary health care center , and she received vaccine , she is neither smoker nor alcoholic 2- natal history : Full term baby delivered vaginally at the hospital , the delivery passed smoothly and uneventfully , there was spontaneous rupture of membrane , last about 4 hours from rupture till baby delivery 3- post natal history : When Zainab was newborn , she cried immediately , and she need no resuscitations efforts , she was neither cyanosed nor jaundiced , she had no congenital anomalies or infections had been encountered at that time her first feeding was after 1 hour , and her first urination and pass motion were at the first day of birth ,she didn't need any hospital admission during the neonatal period. 19 Past medical history she had no previous similar condition , with no previous hospital admission , she didn't experience specific illnesses such as communicable illness (chicken pox , measles , mumps rubella, whooping cough ) Vaccination history : Zainab completed her vaccine schedule , at the first week of his life , she received BCG , (with BCG scar), oral polio vaccine (OVP), hepatitis B vaccine (HBV1), at 2 months she received DPT1 , OPV1 , HBV2 at 4 months she received DPT2 ,OPV2 at 6 months she received DPT3, OPV3 ,HBV3 at 9 month she received measles vaccine at 15 months she received MMR vaccine at 4 years she received booster dose of DPT and OPV Feeding history : Zainab was bottle feed up to the age of 2 years, then the family planned a weaning process , Ahmed now feeds the usual table foods of the family Developmental history she is in the 2nd stage of primary school , she attends regularly to the school , and she can interact normally with his peers Past surgical history : she had previous surgery for tumor recession ,before 3 years , 2 years later the tumor recurred the drug history : no history of allergy for specific drug family history : the mother is 21 years old , housewife ,completed only her primary school study , she had a good health the father is 25 years old , he completed his primary school study , he is now works as a baker he has a good health , there is a consanguinity between them , he is her cousin , the family consist of 2 children , the older is 9 years old male with good health , and the second is our patient there is no similar condition in the family , no chronic illnesses like hypertension , diabetes , asthma , epilepsy and no history of sudden death social history : they live in an urban area , in their own house , in which there are 3 rooms and supply by tap water & proper sewage system , there is no smoker in the house , with no indoor domestic animals. 20  Diabetic Ketoacidosis (DKA) Zainab ali hamza, 8 years old , female, lived in alshula'a , her next of kin her mother Iman waleed hadi (from whom history was taken ), Date of admission 22nd of July 2017 Date of taking history : 23rd of July 2017 Chief complain: repeated vomiting for 1 day prior to admission History of present illness : 8 years old female who diagnosed with diabetes mellitus type 1 sine 2 years , on insulin therapy twice daily , presented with sudden onset ,of repeated small amount clear , vomiting and diffuse abdominal pain , sudden in onset , dull in nature , continuous with no reliving or aggravated factors , lasting for 1 day which precede the admission, she also loss appetite , her mother mention that during the last few days which preceding the admission , she had markedly increase in water intake and urination , with generalized malaise and confusion , with no fever , she also mention that she missed 2 insulin injections due to vomiting ,her activities , sleep and feeding were markedly affected her parent brought her to the hospital , investigation in form of blood , urine , and blood glucose level , chest x ray were done to her , and she managed with iv fluid , antibiotics , and she is on insulin therapy , She is now in the 2nd day of admission , her condition was improved as she had no further vomiting, abdominal pain , and she is alert , with improvement in her sleep , feeding , and her daily activities. 21 Review of systems:- Gastrointestinal: no change in bowel habit, no hematemesis, no hematochezia, and neither melena, nor tenesmus. Genitourinary: no change in odor or color with normal urine stream , , no terminal dribbling ,with no dysuria Cardiovascular: no, chest pain, no shortness of breath, no edema, no palpitations, , no loss of consciousness, no claudication, no cyanosis Respiratory : no cough or sputum, no wheeze, no hemoptysis, Musculoskeletal: no muscles pain, or stiffness, no joint swelling, neither pruritus nor rashes. Neurological: there are no changes in sight, smell, hearing and taste, no seizures, or fainting attack, no headache, no poor balance, no speech problems, no sphincter disturbance Past history (Birth history ) : 1 - prenatal history : Good maternal health before and during pregnancy , no specific illness related to or complicated by pregnancy like hypertension or diabetes mellitus No history of bleeding during pregnancy , the mother experienced no skin rash or fever during pregnancy which may suggest torch infection , no history of drug use or x-ray exposure during pregnancy , with good antenatal care as the mother regularly visit primary health care center , and she received vaccine , she is neither smoker nor alcoholic 2- natal history : Full term baby delivered vaginally at the hospital , the delivery passed smoothly and uneventfully , there was spontaneous rupture of membrane , last about 4 hours from rupture till baby delivery. 3- post natal history : When Zainab was newborn , she cried immediately , and she need no resuscitations efforts , she was neither cyanosed nor jaundiced , she had no congenital anomalies or infections had been encountered at that time, her first feeding was after 1 hour , and her first urination and pass motion were at the first day of birth ,she didn't need any hospital admission during the neonatal period. 22 Past medical history she had no previous similar condition , with no previous hospital admission , she didn't experience specific illnesses such as communicable illness (chicken pox , measles , mumps rubella, whooping cough ) Vaccination history : Zainab completed her vaccine schedule at the first week of his life , she received BCG , (with BCG scar), oral polio vaccine (OVP), hepatitis B vaccine (HBV1), at 2 months she received DPT1 , OPV1 , HBV2 at 4 months she received DPT2 ,OPV2 at 6 months she received DPT3, OPV3 ,HBV3 at 9 month she received measles vaccine at 15 months she received MMR vaccine at 4 years she received booster dose of DPT and OPV Feeding history : Zainab was bottle feed up to the age of 2 years, then the family planned a weaning process , Ahmed now feeds the usual table foods of the family Developmental history she is in the 3rd stage of primary school , she attends regularly to the school , and she can interact normally with his peers Past surgical history : she had no previous surgery the drug history : She uses insulin injection twice daily , she hadno history of allergy for specific drug family history : the mother is 21 years old , housewife ,completed only her primary school study , she had a good health the father is 25 years old , he completed his primary school study , he is now works as a baker he has a good health , there is a consanguinity between them , he is her cousin , the family consist of 2 children , the older is 9 years old male with good health , and the second is our patient there is no similar condition in the family , no chronic illnesses like hypertension , diabetes , asthma , epilepsy and no history of sudden death. social history : they live in an urban area , in their own house , in which there are 3 rooms and supply by tap water & proper sewage system , there is no smoker in the house , with no indoor domestic animals. 23  Diarrhea Ahmed Ali Hassan, 8 months of age , lived in alkadhmiya , his next of kin his mother noor redha fadi (from whom history was taken ), Date of admission 3rd of august 2017 Date of taking history : 4th of august 2017 Chief complain: watery diarrhea for 5 days prior to admission. History of present illness : 8 months of age male baby presented with, watery diarrhea for about 5 day prior to admission during which the mother mention that he pass large amount of watery stool , 7 to 8 times per day , not related to the feeding , and the child didn't cry when he pass motion, with no blood or mucus , associated with repeated small amount , effortless clear vomiting which also seen not related to the feeding , and he develop low grade fever (not documented ,his mother felt it by toughing him only ) , continuous , not associated with chills or rigor, he had decrease in urine output during the last few days, and also he became lethargic and drowsy and his activity , sleeping and feeding were affected His parent brought him to the hospital , in which he had some investigations , and he received iv fluid with some medications he is now in the 2nd day of admission , and there is improvement in his condition , as there is decrease in number and amount of stool, he had no further vomiting , fever had been subsided ,he start to regain his normal daily activity , sleep and feeding there was no previous similar attack , and no history of contact with similar case. 24 Review of systems:- Genitourinary: no frequency , no change in odor or color with normal urine stream , , no terminal dribbling ,with no dysuria Cardiovascular: no shortness of breath, no edema, no cyanosis Respiratory : no cough or sputum, no wheeze, no hemoptysis, Musculoskeletal: no muscles pain, or stiffness, no joint swelling, no skin rashes. Neurological:, no change in behavior , no vision or hearing loss Past history (Birth history ) : 1 - prenatal history : Good maternal health before and during pregnancy , no specific illness related to or complicated by pregnancy like hypertension or diabetes mellitus No history of bleeding during pregnancy , the mother experienced no skin rash or fever during pregnancy which may suggest torch infection , no history of drug use or x-ray exposure during pregnancy , with good antenatal care as the mother regularly visit primary health care center , and she received vaccine , she is neither smoker nor alcoholic 2- natal history : Full term baby delivered vaginally at the hospital , the delivery passed smoothly and uneventfully , there was spontaneous rupture of membrane , last about 4 hours from rupture till baby delivery. 3- post natal history : When ahmed was newborn , he cried immediately , and he need no resuscitations efforts , he was neither cyanosed nor jaundiced , he had no congenital anomalies or infections had been encountered at that time his first feeding was after 1 hour , and his first urination and pass motion were at the first day of birth , he didn't need any hospital admission during the neonatal period. 25 Past medical history He had no previous similar condition , with no previous hospital admission , He didn't experience specific illnesses such as communicable illness (chicken pox , measles , mumps rubella, whooping cough ) Vaccination history : at the first week of his life , he received BCG , (with BCG scar), oral polio vaccine (OVP), hepatitis B vaccine (HBV1), at 2 months he received DPT1 , OPV1 , HBV2 at 4 months he received DPT2 ,OPV2 at 6 months he received DPT3, OPV3 ,HBV3 Feeding history : The child is a bottle feeding (it is the mother preference ) & his mother start to feed him semi solid food since 1 month ago Regarding the preparation : His mother said that , he usually takes About 6 feed per day , she prepare it as 5 ounce with five leveled scoop Regarding the sterilization : He had four feeding bottles , his mother used to boil the feeding bottle to 10 minutes (except the teat she removed it when boiling start ). Developmental history Ahmed is 8 months of age regarding the cross motor development , he is able sit alone without support fine motor : he grasp object with thumb and fingers with ulnar support , language development he can produce , Repetitive constant sound (mama, dada ,.) socially : he responds to his name, and he can waves by-by Past surgical history : He had no previous surgery , and he didn't have circumcision yet the drug history : no history of allergy for specific drug family history : the mother is 21 years old , housewife ,completed only her primary school study , she had a good health the father is 25 years old , he completed his primary school study , he is now works as a baker he has a good health , there is no consanguinity between the parent , and Ahmed is the first child in the family.There is no similar condition in the family , no chronic illnesses like hypertension , diabetes , asthma , epilepsy and no history of sudden death. social history : they live in an urban area , in their own house , in which there are 3 rooms and supply by tap water & proper sewage system , there is no smoker in the house , with no indoor domestic animals. 26  G6PD Glucose-6-phosphate dehydrogenase (G6PD) deficiency Fatima Ahmed hassan, 3 years old , female , lived in alghazalia , her next of kin is her mother noor Mohamed hadi (from whom history was taken ), Date of admission 2nd of august 2017 Date of taking history : 2nd of august 2017 Chief complain with yellowish discoloration of sclera for 1 day duration History of present illness : 3 years old female who was previously healthy presented with yellowish discoloration of sclera for 1 day duration , which was sudden in onset , preceded by one day of broad bean ingestion , associated ,with dark tea color urine and no change in stool color , the child feeding , sleep , activity were not affected her family brought her to hospital , after some investigation ,the doctor ensure her family that she didn't need any medication.but she has to be in the hospital for observation She is now in the first day of admission , and her condition still the same There was no previous similar attack , with no family history of the same condition. 27 Review of systems:- Gastrointestinal:no abdominal pain , no nausea or vomiting ,no change in bowel habit, no hematemesis, no hematochezia, and neither melena, nor tenesmus, Genitourinary: no frequency , normal urine stream , no terminal dribbling ,with no dysuria Cardiovascular: no, chest pain, no shortness of breath, no edema, no palpitations, , no loss of consciousness, no claudication, no cyanosis Respiratory : no cough or sputum, no wheeze, no hemoptysis, Musculoskeletal: neither pruritus nor rashes. Neurological: there are no changes in sight, smell, hearing and taste, no seizures, or fainting attack, no headache, no poor balance, no speech problems, no sphincter disturbance Past history (Birth history ) : 1 - prenatal history : Good maternal health before and during pregnancy , no specific illness related to or complicated by pregnancy like hypertension or diabetes mellitus No history of bleeding during pregnancy , the mother experienced no skin rash or fever during pregnancy which may suggest torch infection , no history of drug use or x-ray exposure during pregnancy , with good antenatal care as the mother regularly visit primary health care center , and she received vaccine , she is neither smoker nor alcoholic 2- natal history : Full term baby delivered vaginally at the hospital , the delivery passed smoothly and uneventfully , there was spontaneous rupture of membrane , last about 4 hours from rupture till baby delivery. 3- post natal history : When Fatima was newborn , she cried immediately , and she need no resuscitations efforts ,she was neither cyanosed nor jaundiced , she had no congenital anomalies or infections had been encountered at that time, her first feeding was after 1 hour , she pass motion ,urine at the first day of birth , she didn't need any hospital admission during the neonatal period. 28 Past medical history she had no previous similar condition , with no previous hospital admission ,she didn't experience specific illnesses such as communicable illness (chicken pox , measles , mumps rubella, whooping cough ) Vaccination history : at the first week of her life , she received BCG , (with BCG scar in her left deltoid ), oral polio vaccine (OVP), hepatitis B vaccine (HBV1), at 2 months she received DPT1 , OPV1 , HBV2 at 4 months she received DPT2 ,OPV2 at 6 months she received DPT3, OPV3 ,HBV3 at 9 month she received measles vaccine at 15 months she received MMR vaccine Feeding history : Fatima was bottle feed up to the age of 2 years, then the family planned a weaning process , Fatima now feeds the usual table foods of the family Developmental history she is able to jump ,stand briefly on one foot, ride tricycle , go up and down stairs on alternating foot. , she is able to copy a circle , count 3 object , she knows age, sex, and can make sentences of three wards and she can put on her shoes Past surgical history : she had no previous surgery the drug history : no history of allergy for specific drug family history : the mother is 21 years old , housewife ,completed only her primary school study , she had a good health , the father is 25 years old , he completed his primary school study , he is now works as a baker he has a good health , there is a consanguinity between them , he is her cousin , the family consist of 2 children , the older is 9 years old male with good health , and the second is our patient. There is no similar condition in the family , no chronic illnesses like hypertension , diabetes , asthma , epilepsy and no history of sudden death social history : they live in an urban area , in their own house , in which there are 3 rooms and supply by tap water & proper sewage system , there is no smoker in the house , with no indoor domestic animals. 29  Hematemesis Ahmed hassan fadi, 3 years old , male, lived in alghazalia , his next of kin his mother zahraa aziz redha (from whom history was taken ), Date of admission 3rd of august 2017 Date of taking history : 4th of august 2017 Chief complain: bloody vomiting for few hours prior to admission History of present illness : 3 years old male baby presented with bloody vomiting , which preceded by 3 to four episodes of non-bloody emesis the condition start before 2 days as a watery diarrhea which was large in amount ,4 to 5 times per day , not related to eating , and not associated with pain , blood or mucus ,associated with repeated vomiting which was small in amount , effortless not related to the feeding which was firstly clear vomiting a, there was normal urine output , his activity , sleeping and feeding were affected His parent brought him to the hospital , in which he had some investigations , and he received iv fluid with some medication he is now in the 2nd day of admission , and there is improvement in his condition , as there is decrease in number and amount of stool had no further vomiting , ,he start to return to his usual daily activity , sleep and feeding there was no previous similar attack , and no history of contact with similar case 30 Review of systems:- Genitourinary: no frequency , no change in odor or color with normal urine stream , , no terminal dribbling ,with no dysuria Cardiovascular: no, chest pain, no shortness of breath, no edema, no palpitations, , no loss of consciousness, no claudication, no cyanosis Respiratory : no cough or sputum, no wheeze, no hemoptysis, Musculoskeletal: neither pruritus nor rashes. Neurological: there are no changes in sight, smell, hearing and taste, no seizures, or fainting attack, no headache, no poor balance, no speech problems, no sphincter disturbance Past history (Birth history ) : 1 - prenatal history : Good maternal health before and during pregnancy , no specific illness related to or complicated by pregnancy like hypertension or diabetes mellitus No history of bleeding during pregnancy , the mother experienced no skin rash or fever during pregnancy which may suggest torch infection , no history of drug use or x-ray exposure during pregnancy , with good antenatal care as the mother regularly visit primary health care center , and she received vaccine , she is neither smoker nor alcoholic 2- natal history : Full term baby delivered vaginally at the hospital , the delivery passed smoothly and uneventfully , there was spontaneous rupture of membrane , last about 4 hours from rupture till baby delivery. 3- post natal history : When ahmed was newborn , he cried immediately , and he need no resuscitations efforts , he was neither cyanosed nor jaundiced , he had no congenital anomalies or infections had been encountered at that time his first feeding was after 1 hour , and his first urination and pass motion were at the first day of birth , he didn't need any hospital admission during the neonatal period. 31 Past medical history He had no previous similar condition , with no previous hospital admission , He didn't experience specific illnesses such as communicable illness (chicken pox , measles , mumps rubella, whooping cough ) Vaccination history : at the first week of his life , he received BCG , (with BCG scar in his left deltoid ), oral polio vaccine (OVP), hepatitis B vaccine (HBV1), at 2 months he received DPT1 , OPV1 , HBV2 at 4 months he received DPT2 ,OPV2 at 6 months he received DPT3, OPV3 ,HBV3 at 9 month he received measles vaccine at 15 months he received MMR vaccine Feeding history : Ahmed was bottle feed up to the age of 2 years, then the family planned a weaning process , Ahmed now feeds the usual table foods of the family Developmental history He is able to jump ,stand briefly on one foot, ride tricycle , go up and down stairs on alternating foot. He also able to copy a circle , count 3 object , he knows age, sex, and can make sentences of three wards and he can put on his shoes Past surgical history : Apart from the circumcision at the age of 9 month which was uneventful , he had no previous surgery the drug history : no history of allergy for specific drug family history : the mother is 21 years old , housewife ,completed only her primary school study , she had a good health , the father is 25 years old , he completed his primary school study , he is now works as a baker he has a good health , there is a consanguinity between them , he is her cousin , the family consist of 2 children , the older is 9 years old male with good health , and the second is our patient there is no similar condition in the family , no chronic illnesses like hypertension , diabetes , asthma , epilepsy and no history of sudden death social history : they live in an urban area , in their own house , in which there are 3 rooms and supply by tap water & proper sewage system , there is no smoker in the house , with no indoor domestic animals. 32  Hemophilia Ahmed hassan fadi, 3 years old , male, lived in alghazalia , his next of kin his mother zahraa aziz redha (from whom history was taken ), Date of admission 3rd of august 2017 Date of taking history : 3rd of august 2017 Chief complain: right knee joint swelling for few hours prior to admission History of present illness : Ahmed is a 3 years old male , diagnose with hemophilia since he was 9 month of age , (after circumcision) , presented with painful right knee joint swelling , which was sudden in onset , his family didn’t recall any history of trauma , enlarge slightly during the day , associated with pain , and inability to move the leg , and also it was warm to tough , he had no any other sites of bleeding , no nose , gum bleeding , no change in urine and stool color , His family brought him to the emergency department , after some investigation , he had factor replacement , with some medication he advice to have rest , use cold packs and to have physiotherapy after the swelling subside , he is now in the first day of admission there is improvement in his condition , as the swelling decreased in size and the pain had been subsided It is the second attack during this year as the first one occurred at the same joint , and managed in the same way , in which he recovered completely after 1 week. 33 Review of systems:- Gastrointestinal, no abdominal pain , no nausea or vomiting ,no change in bowel habit, no hematemesis, no hematochezia, and neither melena, nor tenesmus, Genitourinary: no frequency , no change in odor or color with normal urine stream , , no terminal dribbling ,with no dysuria Cardiovascular: no, chest pain, no shortness of breath, no edema, no palpitations, , no loss of consciousness, no claudication, no cyanosis Respiratory : no cough or sputum, no wheeze, no hemoptysis, Musculoskeletal: neither pruritus nor rashes. Neurological: there are no changes in sight, smell, hearing and taste, no seizures, or fainting attack, no headache, no poor balance, no speech problems, no sphincter disturbance Past history (Birth history ) : 1 - prenatal history : Good maternal health before and during pregnancy , no specific illness related to or complicated by pregnancy like hypertension or diabetes mellitus No history of bleeding during pregnancy , the mother experienced no skin rash or fever during pregnancy which may suggest torch infection , no history of drug use or x-ray exposure during pregnancy , with good antenatal care as the mother regularly visit primary health care center , and she received vaccine , she is neither smoker nor alcoholic 2- natal history : Full term baby delivered vaginally at the hospital , the delivery passed smoothly and uneventfully , there was spontaneous rupture of membrane , last about 4 hours from rupture till baby delivery. 3- post natal history : When ahmed was newborn , he cried immediately , and he need no resuscitations efforts , he was neither cyanosed nor jaundiced , he had no congenital anomalies or infections had been encountered at that time his first feeding was after 1 hour , and his first urination and pass motion were at the first day of birth , he didn't need any hospital admission during the neonatal period. 34 Past medical history He had previous similar condition during this year. He didn't experience specific illnesses such as communicable illness (chicken pox , measles , mumps rubella, whooping cough ) Vaccination history : at the first week of his life , he received BCG , (with BCG scar in his left deltoid ), oral polio vaccine (OVP), hepatitis B vaccine (HBV1), at 2 months he received DPT1 , OPV1 , HBV2 at 4 months he received DPT2 ,OPV2 at 6 months he received DPT3, OPV3 ,HBV3 at 9 month he received measles vaccine at 15 months he received MMR vaccine Feeding history : Ahmed was bottle feed up to the age of 2 years, then the family planned a weaning process , Ahmed now feeds the usual table foods of the family Developmental history He is able to jump ,stand briefly on one foot, ride tricycle , go up and down stairs on alternating foot. He also able to copy a circle , count 3 object , he knows age, sex, and can make sentences of three wards and he can put on his shoes Past surgical history : Apart from the circumcision at the age of 9 months , he had no previous surgery the drug history : no history of allergy for specific drug family history : the mother is 21 years old , housewife ,completed only her primary school study , she had a good health , the father is 25 years old , he completed his primary school study , he is now works as a baker he has a good health ,there is a consanguinity between them , he is her cousin , the family consist of 2 children , the older is 9 years old male with good health , and the second is our patient there is no similar condition in the family , no chronic illnesses like hypertension , diabetes , asthma , epilepsy and no history of sudden death social history : they live in an urban area , in their own house , in which there are 3 rooms and supply by tap water & proper sewage system , there is no smoker in the house , with no indoor domestic animals. 35  Henoch-Schonlein Purpura (HSP) Ahmed hassan fadi, 7 years old , male, lived in alghazalia , his next of kin his mother zahraa aziz redha (from whom history was taken ), Date of admission 3rd of august 2017 Date of taking history : 4th of august 2017 Chief complain painless skin rash over the legs , thigh , and buttock for few hours prior to admission History of present illness : 7 years old male presented with painless skin rash over the legs , thigh , and buttock , the child was previously healthy till the 2 weeks preceding the admission when he develop flu like illness of cough , sneezing ,runny nose , congestion, low grade fever, malaise and poor feeding lasting about few day , resolved spontaneously without treatment after which he seemed to be in good health till the day preceding the admission as he sudden developd painless skin rash over the legs , thigh , and buttock , associated with multiple bluish skin discoloration at the same sites, with bilateral knee joint pain and swelling , which migrate later to involve the ankle joint , , there was no change in stool color , no hematemesis , no jaundice , no abdominal pain , no fever , but he had poor appetite , and poor sleep and daily activities His family brought to the hospital , at which he had some investigations , and he received iv fluid , with some analgesic for joint pain He is in the 2nd day of admission there were improvement in his condition as the joint pain markedly improved , his appetite , sleep , and activities also improved , but he still has the skin rash 36 Review of systems:- Gastrointestinal: no abdominal pain , no nausea or vomiting ,no change in bowel habit, no hematemesis, no hematochezia, and neither melena, nor tenesmus, Cardiovascular: no, chest pain, no shortness of breath, no edema, no palpitations, , no loss of consciousness, no claudication, no cyanosis Respiratory : no wheeze, no hemoptysis, Neurological: there are no changes in sight, smell, hearing and taste, no seizures, or fainting attack, no headache, no poor balance, no speech problems, no sphincter disturbance Past history (Birth history ) : 1 - prenatal history : Good maternal health before and during pregnancy , no specific illness related to or complicated by pregnancy like hypertension or diabetes mellitus No history of bleeding during pregnancy , the mother experienced no skin rash or fever during pregnancy which may suggest torch infection , no history of drug use or x-ray exposure during pregnancy , with good antenatal care as the mother regularly visit primary health care center , and she received vaccine , she is neither smoker nor alcoholic 2- natal history : Full term baby delivered vaginally at the hospital , the delivery passed smoothly and uneventfully , there was spontaneous rupture of membrane , last about 4 hours from rupture till baby delivery. 3- post natal history : When ahmed was newborn , he cried immediately , and … he need no resuscitations efforts , he was neither cyanosed nor jaundiced , he had no congenital anomalies or infections had been encountered at that time his first feeding was after 1 hour , and his first urination and pass motion were at the first day of birth , he didn't need any hospital admission during the neonatal period. 37 Past medical history He had no previous similar condition , with no previous hospital admission He didn't experience specific illnesses such as communicable illness (chicken pox , measles , mumps rubella, whooping cough ) Vaccination history : Ahmed completed his vaccine schedule , at the first week of his life , he received BCG , (with BCG scar), oral polio vaccine (OVP), hepatitis B vaccine (HBV1), at 2 months he received DPT1 , OPV1 , HBV2 at 4 months he received DPT2 ,OPV2 at 6 months he received DPT3, OPV3 ,HBV3 at 9 month he received measles vaccine at 15 months he received MMR vaccine at 4 years he received booster dose of DPT and OPV Feeding history : Ahmed was bottle feed up to the age of 2 years, then the family planned a weaning process , Ahmed now feeds the usual table foods of the family Developmental history He is in the 2nd stage of primary school , he attends regularly to the school , and he can interact normally with his peers Past surgical history : Apart from the circumcision at the age of 9 month which was uneventful , he had no previous surgery the drug history : no history of allergy for specific drug family history : the mother is 21 years old , housewife ,completed only her primary school study , she had a good health , the father is 25 years old , he completed his primary school study , he is now works as a baker he has a good health. there is a consanguinity between them , he is her cousin , the family consist of 2 children , the older is 9 years old male with good health , and the second is our patient. there is no similar condition in the family , no chronic illnesses like hypertension , diabetes , asthma , epilepsy and no history of sudden death social history : they live in an urban area , in their own house , in which there are 3 rooms and supply by tap water & proper sewage system , there is no smoker in the house , with no indoor domestic animals. 38  Hepatitis A Abdullah Mohamed Hassan , 8 years old , male, lived in alkadhimiya , his next of kin his mother zahraa aziz redha (from whom history was taken ), Date of admission 3rd of august 2017 Date of taking history : 3rd of august 2017 Chief complain: yellowish discoloration of sclera for 1 day prior to admission History pf present illness : 8 years old male ,who was previously healthy presented with yellowish discoloration of sclera for 1 day prior to admission , His family reports 1 week of flu-like symptoms of headache, low-grade , continuous fever, nausea, loss of appetite, and malaise, joint pain which subside slightly with paracetamol till the day preceding the admission when he suddenly develop yellowish discoloration of sclera associated with dark color urine , and his stool had been lighter than usual his feeding was markedly affected , and his sleep, activities also affected His parent brought him to the hospital, some investigations had been done he received iv fluid , and he is under observation , his condition still the same. 39 Review of systems:- Genitourinary: no frequency , ,normal urine stream , , no terminal dribbling ,with no dysuria Gastrointestinal, no abdominal pain ,no change in bowel habit, no hematemesis, no hematochezia, and neither melena, nor tenesmus, Cardiovascular: no, chest pain, no shortness of breath, no edema, no palpitations, , no loss of consciousness, no claudication, no cyanosis Respiratory : no cough or sputum, no wheeze, no hemoptysis, Musculoskeletal: no muscles pain, , neither pruritus nor rashes. Neurological: there are no changes in sight, smell, hearing and taste, no seizures, or fainting attack, no headache, no poor balance, no speech problems, no sphincter disturbance Past history (Birth history ) : 1 - prenatal history : Good maternal health before and during pregnancy , no specific illness related to or complicated by pregnancy like hypertension or diabetes mellitus No history of bleeding during pregnancy , the mother experienced no skin rash or fever during pregnancy which may suggest torch infection , no history of drug use or x-ray exposure during pregnancy , with good antenatal care as the mother regularly visit primary health care center , and she receive vaccine , she is neither smoker nor alcoholic 2- natal history : Full term baby delivered vaginally at the hospital , which was uneventful , there was spontaneous rupture of membrane , last about 4 hours from rupture till baby delivery 3- post natal history : When Abdullah was newborn , he cried immediately , and he need no resuscitations efforts , he was neither cyanosed nor jaundiced , he had no congenital anomalies or infections had been encountered at that time his first feeding was after 1 hour , and his first urination and pass motion were at the first day of birth , he didn't need any hospital admission during the neonatal period. 40 Past medical history He had no previous similar condition , with no previous hospital admission , He didn't experience specific illnesses such as communicable illness (chicken pox , measles , mumps rubella, whooping cough ) Vaccination history : abdullah completed his vaccine schedule , at the first week of his life , he received BCG , (with BCG scar), oral polio vaccine (OVP), hepatitis B vaccine (HBV1), at 2 months he received DPT1 , OPV1 , HBV2 at 4 months he received DPT2 ,OPV2 at 6 months he received DPT3, OPV3 ,HBV3 at 9 month he received measles vaccine at 15 months he received MMR vaccine at 4 years he received booster dose of DPT and OPV Feeding history : Abdullah was bottle feed up to the age of 2 years, then the family planned a weaning Abdullah, Ahmed now feeds the usual table foods of the family Developmental history He is in the 3rd stage of primary school , he attend regularly to the school , and he can interact normally with his peers Past surgical history : Apart from the circumcision at the age of 9 month which was uneventful , he had no previous surgery the drug history : no history of allergy for specific drug family history : the mother is 28 years old , housewife ,completed only her primary school study , she had a good health , the father is 31 years old , he completed his primary school study , he is free worker ,he has a good health , there is a consanguinity between them , he is her cousin , the family consist of 2 children , the older is 12 years old male with good health , and the second is our patient there is no similar condition in the family , no chronic illnesses like hypertension , diabetes , asthma , epilepsy and no history of sudden death social history : they live in an urban area , in their own house , in which there are 3 rooms and supply by tap water & proper sewage system , there is no smoker in the house , with no indoor domestic animals. 41  Immune Thrombocytopenic Purpura (ITP) Sarah Ali hamza, 7 years old , female, lived in alshula'a , her next of kin is her mother Iman waleed hadi (from whom history was taken ), Date of admission 12th of august 2017 Date of taking history : 15th of august 2017 Chief complain: red and purple spots all over the body for few hours prior to admission History of present illness : 7 years old female patient presented with painless , small red and purple spots all over the body , which appeared suddenly, there was no change in stool color , no hematemesis ,or jaundice, , the child had flu like illness of cough , sneezing ,runny nose , congestion, low grade fever, malaise and poor feeding before about 2 week prior to admission lasting about few day , resolved spontaneously without treatment , His parent brought her to the hospital, some investigations had been done , and she is under observation , and her condition still the same. 42 Review of systems:- Cardiovascular: no, chest pain, no edema, no palpitations, , no loss of consciousness, no cyanosis Respiratory : no wheeze, no hemoptysis, Gastrointestinal, no abdominal pain , no nausea or vomiting ,no change in bowel habit, no hematemesis, no hematochezia, and neither melena, nor tenesmus, Genitourinary: no frequency , no change in odor or color with normal urine stream , , no terminal dribbling ,with no dysuria Musculoskeletal: no muscles pain, or stiffness, no joint swelling. Neurological: there are no changes in sight, smell, hearing and taste, no seizures, or fainting attack, no headache, no poor balance, no speech problems, no sphincter disturbance Past history (Birth history ) : 1 - prenatal history : Good maternal health before and during pregnancy , no specific illness related to or complicated by pregnancy like hypertension or diabetes mellitus No history of bleeding during pregnancy , the mother experienced no skin rash or fever during pregnancy which may suggest torch infection , no history of drug use or x-ray exposure during pregnancy , with good antenatal care as the mother regularly visit primary health care center , and she received vaccine , she is neither smoker nor alcoholic 2- natal history : Full term baby delivered vaginally at the hospital , the delivery passed smoothly and uneventfully , there was spontaneous rupture of membrane , last about 4 hours from rupture till baby delivery. 3- post natal history : When Sarah was newborn , she cried immediately , and she need no resuscitations efforts , she was neither cyanosed nor jaundiced , she had no congenital anomalies or infections had been encountered at that time her first feeding was after 1 hour , and her first urination and pass motion were at the first day of birth ,she didn't need any hospital admission during the neonatal period. 43 Past medical history she had many previous similar condition especially during winter, with previous hospital admission , she didn't experience specific illnesses such as communicable illness (chicken pox , measles , mumps rubella, whooping cough ) Vaccination history : Sarah completed her vaccine schedule , at the first week of his life , she received BCG , (with BCG scar), oral polio vaccine (OVP), hepatitis B vaccine (HBV1), at 2 months she received DPT1 , OPV1 , HBV2 at 4 months she received DPT2 ,OPV2 at 6 months she received DPT3, OPV3 ,HBV3 at 9 month she received measles vaccine at 15 months she received MMR vaccine at 4 years she received booster dose of DPT and OPV Feeding history : Sarah was bottle feed up to the age of 2 years, then the family planned a weaning process , Sarah now feeds the usual table foods of the family Developmental history she is in the 2nd stage of primary school , she attends regularly to the school , and she can interact normally with his peers Past surgical history : she had no previous surgery the drug history : no history of allergy for specific drug family history : the mother is 21 years old , housewife ,completed only her primary school study , she had a good health , the father is 25 years old , he completed his primary school study , he is now works as a baker he has a good health , there is a consanguinity between them , he is her cousin , the family consist of 2 children , the older is 9 years old male with good health , and the second is our patient there is no similar condition in the family , no chronic illnesses like hypertension , diabetes , asthma , epilepsy and no history of sudden death social history : they live in an urban area , in their own house , in which there are 3 rooms and supply by tap water & proper sewage system , there is no smoker in the house , with no indoor domestic animals. 44  Visceral Leishmania Sarah Ali hamza, 7 years old , female, lived in alshula'a , her next of kin is her mother Iman waleed hadi (from whom history was taken ), Date of admission 12th of august 2017 Date of taking history : 15th of august 2017 Chief complain: nose and gum bleeding for few hours prior to admission History of present illness : 7 years old female presented with nose , and gum bleeding for 1 day duration The patient condition start before 2 months ago as a sudden onset , high grade , remittent fever , associated with night sweat ,relieving slightly with paracetamol and cold sponge , during these 2 months she also lethargic with lose weight and appetite, , unfortunately the family neglected the case till the day preceding the admission as she suddenly developed nose , and gum bleeding associated with small red and purple dots all over the body , there was no change in stool color , no hematemesis , or skin pigmentation , nor jaundice. Her parents visit private clinic where immediate admission was advised , at the hospital , some investigations had been done to her , and she received iv fluid with injectable and oral forms of medications , she is in the 4th day of admission , and there is improvement in her condition as the fever ,nose and gum bleeding had been subside since the 2nd day of admission She start to regain her daily activity and there were improvement regarding her sleep and feeding. 45 Review of systems:- Cardiovascular: no, chest pain, no edema, no palpitations, , no loss of consciousness, no cyanosis Respiratory : no cough or sputum, no wheeze, no hemoptysis, Gastrointestinal, no abdominal pain , no nausea or vomiting ,no change in bowel habit, no hematemesis, no hematochezia, and neither melena, nor tenesmus, Genitourinary: no frequency , no change in odor or color with normal urine stream , , no terminal dribbling ,with no dysuria Musculoskeletal: no muscles pain, or stiffness, no joint swelling, neither pruritus nor rashes. Neurological: there are no changes in sight, smell, hearing and taste, no seizures, or fainting attack, no headache, no poor balance, no speech problems, no sphincter disturbance Past history (Birth history ) : 1 - prenatal history : Good maternal health before and during pregnancy , no specific illness related to or complicated by pregnancy like hypertension or diabetes mellitus No history of bleeding during pregnancy , the mother experienced no skin rash or fever during pregnancy which may suggest torch infection , no history of drug use or x-ray exposure during pregnancy , with good antenatal care as the mother regularly visit primary health care center , and she received vaccine , she is neither smoker nor alcoholic 2- natal history : Full term baby delivered vaginally at the hospital , the delivery passed smoothly and uneventfully , there was spontaneous rupture of membrane , last about 4 hours from rupture till baby delivery. 3- post natal history : When Sarah was newborn , she cried immediately , and she need no resuscitations efforts , she was neither cyanosed nor jaundiced , she had no congenital anomalies or infections had been encountered at that time her first feeding was after 1 hour , and her first urination and pass motion were at the first day of birth ,she didn't need any hospital admission during the neonatal period. 46 Past medical history she had no previous similar condition she didn't experience specific illnesses such as communicable illness (chicken pox , measles , mumps rubella, whooping cough ) Vaccination history : Sarah completed her vaccine schedule , at the first week of his life , she received BCG , (with BCG scar), oral polio vaccine (OVP), hepatitis B vaccine (HBV1), at 2 months she received DPT1 , OPV1 , HBV2 at 4 months she received DPT2 ,OPV2 at 6 months she received DPT3, OPV3 ,HBV3 at 9 month she received measles vaccine at 15 months she received MMR vaccine at 4 years she received booster dose of DPT and OPV Feeding history : Sarah was bottle feed up to the age of 2 years, then the family planned a weaning process , Sarah now feeds the usual table foods of the family Developmental history she is in the 2nd stage of primary school , she attend sregularly to the school , and she can interact normally with his peers Past surgical history : she had no previous surgery the drug history : no history of allergy for specific drug family history : the mother is 21 years old , housewife ,completed only her primary school study , she had a good health , the father is 25 years old , he completed his primary school study , he is now works as a baker he has a good health , there is a consanguinity between them , he is her cousin , the family consist of 2 children , the older is 9 years old male with good health , and the second is our patient. There is no similar condition in the family, no chronic illnesses like hypertension , diabetes , asthma , epilepsy and no history of sudden death social history : they live in an urban area , in their own house , in which there are 3 rooms and supply by tap water & proper sewage system , there is no smoker in the house , with no indoor domestic animals. 47  Meningitis Abdullah mazin Hassan , 7 years old , male, lived in alkadhimiya , his next of kin his mother zainab qassim Redha (from whom history was taken ), Abdullah mazin Hassan , 7 years old , male, Date lived in alkadhimiya of admission 3rd of august, 2017 his next of kin his mother zainab qassim Redha (from whom history was taken ), Date of taking history : 5th of august 2017 Date of admission 3rd of august 2017 Chief complain: increase body temperature for Date of taking history : 5 of august12017 th day duration Chief complain: increase body temperature for 1 day prior to admission History of present illness : 7 years old male who was previously healthy presented with increase body temperature for 1 day duration , which was high grade , (documented by his mother 39 c), sudden in onset , continuous , relieved by paracetamol and cold sponge , not associated with chills and rigor , at the same time he had severe headache , and small amount of projectile vomiting , which was clear neither bloody nor billous , his family also mention that he became confused and drowsy , and his sleep, feeding and activities were markedly reduced His family brought him to the hospital , in which some investigations had been done to him ,he received iv fluid with some medications, the members of his family also received a prophylaxis medication the child now in the 3rd day of admission , his condition start to improve as he regain his daily activity , his feeding and sleep were also improved ,the fever and headache , vomiting had been subsided since the 3rd day of admission There was no previous similar attacks , and no history of contact with similar case. 48 Review of systems:- Neurological: there are no changes in sight, smell, hearing and taste, no seizures, or fainting attack, no poor balance, no speech problems, no sphincter disturbance Gastrointestinal, no abdominal pain ,no change in bowel habit, no hematemesis, no hematochezia, and neither melena, nor tenesmus, Genitourinary: no frequency , ,normal urine stream , , no terminal dribbling ,with no dysuria Cardiovascular: no, chest pain, no shortness of breath, no edema, no palpitations, , no loss of consciousness, no claudication, no cyanosis Respiratory : no cough or sputum, no wheeze, no hemoptysis, Musculoskeletal: no muscles pain, , neither pruritus nor rashes. Neurological: there are no changes in sight, smell, hearing and taste, no seizures, or fainting attack, no headache, no poor balance, no speech problems, no sphincter disturbance Past history (Birth history ) : 1 - prenatal history : Good maternal health before and during pregnancy , no specific illness related to or complicated by pregnancy like hypertension or diabetes mellitus No history of bleeding during pregnancy , the mother experienced no skin rash or fever during pregnancy which may suggest torch infection , no history of drug use or x-ray exposure during pregnancy , with good antenatal care as the mother regularly visit primary health care center , and she received vaccine , she is neither smoker nor alcoholic 2- natal history : Full term baby delivered vaginally at the hospital , the delivery passed smoothly and uneventfully , there was spontaneous rupture of membrane , last about 4 hours from rupture till baby delivery. 3- post natal history : When Abdullah was newborn , he cried immediately , and he need no resuscitations efforts , he was neither cyanosed nor jaundiced , he had no congenital anomalies or infections had been encountered at that time his first feeding was after 1 hour , and his first urination and pass motion were at the first day of birth , he didn't need any hospital admission during the neonatal period. 49 Past medical history He had no previous similar condition , with no previous hospital admission , He didn't experience specific illnesses such as communicable illness (chicken pox , measles , mumps rubella, whooping cough ) Vaccination history : Ahmed completed his vaccine schedule , at the first week of his life , he received BCG , (with BCG scar), oral polio vaccine (OVP), hepatitis B vaccine (HBV1), at 2 months he received DPT1 , OPV1 , HBV2 at 4 months he received DPT2 ,OPV2 at 6 months he received DPT3, OPV3 ,HBV3 at 9 month he received measles vaccine at 15 months he received MMR vaccine at 4 years he received booster dose of DPT and OPV Feeding history : Abdullah was bottle feed up to the age of 2 years, then the family planned a weaning Abdullah, Ahmed now feeds the usual table foods of the family Developmental history He is in the 2nd stage of primary school , he attends regularly to the school , and he can interact normally with his peers Past surgical history : Apart from the circumcision at the age of 9 month which was uneventful , he had no previous surgery the drug history : no history of allergy for specific drug family history : the mother is 28 years old , housewife ,completed only her primary school study , she had a good health , the father is 31 years old , he completed his primary school study , he is free worker ,he has a good health , there is a consanguinity between them , he is her cousin , the family consist of 2 children , the older is 12 years old male with good health , and the second is our patient there is no similar condition in the family , no chronic illnesses like hypertension , diabetes , asthma , epilepsy and no history of sudden death social history : they live in an urban area , in their own house , in which there are 3 rooms and supply by tap water & proper sewage system , there is no smoker in the house , with no indoor domestic animals. 50  Organophosphorus poisoning Sarah Ali hamza, 7 years old , female, lived in abugreeb , her next of kin is her mother Iman waleed hadi (from whom history was taken ), Date of admission 12th of august 2017 Date of taking history : 14th of august 2017 Chief complain: loss of conscious for about few hours prior to admission History of present illness : 7 years old female patient referred from abugreeb hospital , she was a suspected case of organophosphorus poisoning , as she found to be unconscious while she was playing in agricultural areas recently treated with organophosphate for about few hours prior to her first admission , with no history of fever or recent trauma she had been brought immediately to the emergency department of abugreeb hospital , where she received the initial resuscitation there , such as oxygen ,gastric lavage , iv fluid with some medication, the patient remain unconscious for 1 day , so she referred to our hospital , some investigations has been done to her and she received iv fluid with some medications , she is the 3rd day of admission , she start to regain her conscious , but she was confused , with disturbed mental status 51 Review of systems:- Cardiovascular: no, chest pain, no edema, no palpitations, no cyanosis Respiratory : no cough or sputum, no wheeze, no hemoptysis. Gastrointestinal, no abdominal pain , no nausea or vomiting ,no change in bowel habit, no hematemesis, no hematochezia, and neither melena, nor tenesmus, Genitourinary: no frequency , no change in odor or color with normal urine stream , , no terminal dribbling ,with no dysuria Musculoskeletal: no muscles pain, or stiffness, no joint swelling, neither pruritus nor rashes. Neurological: there are no changes in sight, smell, hearing and taste, , no headache. Past history (Birth history ) : 1 - prenatal history : Good maternal health before and during pregnancy , no specific illness related to or complicated by pregnancy like hypertension or diabetes mellitus No history of bleeding during pregnancy , the mother experienced no skin rash or fever during pregnancy which may suggest torch infection , no history of drug use or x-ray exposure during pregnancy , with good antenatal care as the mother regularly visit primary health care center , and she received vaccine , she is neither smoker nor alcoholic 2- natal history : Full term baby delivered vaginally at the hospital , the delivery passed smoothly and uneventfully , there was spontaneous rupture of membrane , last about 4 hours from rupture till baby delivery. 3- post natal history : When Sarah was newborn , she cried immediately , and she need no resuscitations efforts , she was neither cyanosed nor jaundiced , she had no congenital anomalies or infections had been encountered at that time her first feeding was after 1 hour , and her first urination and pass motion were at the first day of birth ,she didn't need any hospital admission during the neonatal period. 52 Past medical history she had many previous similar condition especially during winter, with previous hospital admission , she didn't experience specific illnesses such as communicable illness (chicken pox , measles , mumps rubella, whooping cough ) Vaccination history :.Sarah completed her vaccine schedule at the first week of his life , she received BCG , (with BCG scar), oral polio vaccine (OVP), hepatitis B vaccine (HBV1), at 2 months she received DPT1 , OPV1 , HBV2 at 4 months she received DPT2 ,OPV2 at 6 months she received DPT3, OPV3 ,HBV3 at 9 month she received measles vaccine at 15 months she received MMR vaccine at 4 years she received booster dose of DPT and OPV Feeding history : Sarah was bottle feed up to the age of 2 years, then the family planned a weaning process, Sarah now feeds the usual table foods of the family Developmental history she is in the 2nd stage of primary school , she attends regularly to the school , and she can interact normally with his peers Past surgical history : she had no previous surgery the drug history : no history of allergy for specific drug family history : the mother is 21 years old , housewife ,completed only her primary school study , she had a good health , the father is 25 years old , he completed his primary school study , he is now works as a baker he has a good health , there is a consanguinity between them , he is her cousin , the family consist of 2 children , the older is 9 years old male with good health , and the second is our patient. There is no similar condition in the family , no chronic illnesses like hypertension , diabetes , asthma , epilepsy and no history of sudden death. social history : they live in an rural area , in their own house , in which there are 3 rooms and supply by tap water & proper sewage system , there is no smoker in the house , with no indoor domestic animals. 53  Pneumonia Ahmed bahaa jumaa , 2.5 months of age , lived in alghazalia , his next of kin his mother noor aziz Riyadh (from whom history was taken ), Date of admission 3rd of august 2017 Date of taking history : 4th of august 2017 Chief complain: shortness of breath for 1 day prior to admission History of present illness : 2.5 month of age male baby who was previously healthy presented with shortness of breath for 1 day duration , which preceded by 3 days of flu like illness of runny nose, congestion ,nonproductive cough poor feeding, and low grade fever (not documented , felt by his mother by tough ), not associated with rigor or chills , the day preceding the admission he develop shortness of breath which was sudden in onset ,progress in severity as it became worsen during the day , not relieve by anything interfere with patient daily activity , sleep , and feeding , His parent brought him to the emergency department , investigations in form of blood , urine test , chest x ray had been done , and he received oxygen, Iv fluid , with some medications , he is in the 2nd day of admission , and there is improvement in his condition ,as he has no shortness of breath any more , and he start to regain his daily activities with good sleep and feeding. 54 Review of systems:. Cardiovascular: no edema, no cyanosis Gastrointestinal :no vomiting ,no change in bowel habit, no hematemesis, no hematochezia, and neither melena, nor tenesmus, Genitourinary: no frequency , no change in odor or color with normal urine stream , , no terminal dribbling ,with no dysuria Musculoskeletal: no muscles pain, or stiffness, no joint swelling, no skin rashes. Neurological: no seizures, or fainting attack, , no change in behavior , no vision or hearing loss Past history (Birth history ) : 1 - prenatal history : Good maternal health before and during pregnancy , no specific illness related to or complicated by pregnancy like hypertension or diabetes mellitus No history of bleeding during pregnancy , the mother experienced no skin rash or fever during pregnancy which may suggest torch infection , no history of drug use or x-ray exposure during pregnancy , with good antenatal care as the mother regularly visit primary health care center , and she received vaccine , she is neither smoker nor alcoholic 2- natal history : Full term baby delivered vaginally at the hospital , the delivery passed smoothly and uneventfully , there was spontaneous rupture of membrane , last about 4 hours from rupture till baby delivery. 3- post natal history : When Ahmed was newborn , he cried immediately , and he need no resuscitations efforts , he was neither cyanosed nor jaundiced , he had no congenital anomalies or infections had been encountered at that time his first feeding was after 1 hour , and his first urination and pass motion were at the first day of birth , he didn't need any hospital admission during the neonatal period. 55 Past medical history He had no previous similar condition , with no previous hospital admission , He didn't experience specific illnesses such as communicable illness (chicken pox , measles , mumps rubella, whooping cough ) Vaccination history : Ahmed received vaccine only at the first week of his life , he received BCG , (with BCG scar), oral polio vaccine (OVP), hepatitis B vaccine (HBV), Feeding history : The child is a bottle feeding (it is the mother preference ) Regarding the preparation : His mother said that , he usually takes About 6 feeds per day , she prepare it as 5 ounce with five leveled scoop Regarding the sterilization : He had four feeding bottles , his mother used to boil the feeding bottle to 10 minutes (except the teat she removed it when boiling start ) Developmental history the child is 2.5 month of age regarding the cross motor development , there is still head lag to sitting position , also he can follow moving objects 180 degree, and he is able to listen to the voice , and start to Coo Past surgical history : He had no previous surgery, and he didn't have circumcision yet the drug history : no history of allergy for specific drug family history : the mother is 21 years old , housewife ,completed only her primary school study , she had a good health , the father is 25 years old , he completed his primary school study , he is now works as a baker he has a good health , there is no consanguinity between the parent , and Ahmed is the first child in the family. There is no similar condition in the family , no chronic illnesses like hypertension , diabetes , asthma , epilepsy and no history of sudden death social history : they live in an urban area , in their own house , in which there are 3 rooms and supply by tap water & proper sewage system , there is no smoker in the house , with no indoor domestic animals. 56  Seizure Ahmed saad jumaa , 8 months of age , lived in alhadhmiya , his next of kin his mother Noor Redha Fadi (from whom history was taken ), Date of admission 3rd of august 2017 Date of taking history : 3rd of august 2017 Chief complain: abnormal body movement for about 1 hour prior to admission History of present illness : 8 months of age , male baby presented to the emergency department with abnormal body movement for 1 hour prior to admission ,His condition start before 3 days as flu like illness , the day preceding the admission he developed high grade fever (documented by his mother 38 c) , which was continuous , relieved by cold sponge , 1 hours preceding the admission he suddenly develop generalized , tonic - clonic body movement , last about few minutes , end spontaneously and with no cyanosis ,with no relieving or aggravating factor after which he became drowsy for about half an hour, then he became better without any deficit , he had no history of trauma , or recent vaccination and , his feeding , activity ,sleeping were markedly affected during the last few days The family brought him to hospital, after some investigations he received iv fluid with some medications , he is now in the first day of admission , and there is improvement in his condition , as he had no further attack, fever had been subsided ,he start to regain his normal daily activity , sleep and feeding. 57 Review of systems:- Gastrointestinal, no vomiting ,no change in bowel habit, no hematemesis, no hematochezia, and neither melena, nor tenesmus, Genitourinary: no frequency , no change in odor or color with normal urine stream , no terminal dribbling ,with no dysuria Cardiovascular: , no shortness of breath, no edema, no cyanosis Respiratory : no cough or sputum, no wheeze, no hemoptysis, Musculoskeletal: no muscles pain, or stiffness, no joint swelling, no skin rashes. Neurological:, no change in behavior , no vision or hearing loss Past history (Birth history ) : 1 - prenatal history : Good maternal health before and during pregnancy , no specific illness related to or complicated by pregnancy like hypertension or diabetes mellitus No history of bleeding during pregnancy , the mother experienced no skin rash or fever during pregnancy which may suggest torch infection , no history of drug use or x-ray exposure during pregnancy , with good antenatal care as the mother regularly visit primary health care center , and she received vaccine , she is neither smoker nor alcoholic 2- natal history : Full term baby delivered vaginally at the hospital , the delivery passed smoothly and uneventfully , there was spontaneous rupture of membrane , last about 4 hours from rupture till baby delivery. 3- post natal history : When ahmed was newborn , he cried immediately , and he need no resuscitations efforts , he was neither cyanosed nor jaundiced , he had no congenital anomalies or infections had been encountered at that time his first feeding was after 1 hour , and his first urination and pass motion were at the first day of birth , he didn't need any hospital admission during the neonatal period. 58 Past medical history He had no previous similar condition , with no previous hospital admission , He didn't experience specific illnesses such as communicable illness (chicken pox , measles , mumps rubella, whooping cough ) Vaccination history : at the first week of his life , he received BCG , (with BCG scar), oral polio vaccine (OVP), hepatitis B vaccine (HBV1), at 2 months he received DPT1 , OPV1 , HBV2 at 4 months he received DPT2 ,OPV2 at 6 months he received DPT3, OPV3 ,HBV3 Feeding history : The child is a bottle feeding (it is the mother preference ) & his mother start to feed him semi solid food since 1 month ago Regarding the preparation : His mother said that , he usually takes About 6 feeds per day , she prepare it as 5 ounce with five leveled scoop Regarding the sterilization : He had four feeding b