Background: There is no effective therapy for many neurological disorders associated with significant neurological damage such as kernicterus. Patients with Kernicterus (Chronic bilirubin encephalopathy) which is a neurological dysfunction resulting from exposure of the brain to severe hyperbilirubinemia mostly during the neonatal period continue to experience significant disability. There is no known therapeutic intervention that can obviously improve this condition. The aim of this paper is to describe a novel therapeutic approach which in two months produced marked improvement of the neurological dysfunction caused by kernicterus. Patients and Methods:A girl with kernicterus was not speaking and not saying any word. She was lacking the balance (coordination) without obvious muscle weakness. She was unable to maintain the sitting posture on a chair for few minutes. She was unable to maintain straight standing posture when supported on chair at all. She had difficulty in holding things. The girl was treated with a novel therapeutic approach including two courses of intramuscular cerebrolysin and intramuscular citicoline.Results: After treatment the first month of treatment, speech development was initiated, and she was saying few words. She was able to sit normally on the chair and maintaining the sitting posture indefinitely. She was able to maintain more straight stable standing posture without holding a chair and with the ability to hold things at the same time indicting improved coordination. She also developed improved ability to hold small things like a pen. After the second month of treatment, the girl was able to stand alone and was making few steps slowly holding furniture. After treatment the second course of treatment, the girl was able to stand alone and walk rapidly holding furniture. Treatment was not associated with any side effects. Conclusion:The novel use of intramuscular cerebrolysin and citicoline in a patient with kernicterus was safe and effective.

Patients with end-stage renal disease (ESRD) die in the absence of renal replacement therapy (RRT). In developing countries RRT is not uniformly available and treatment often relies on conservative management and intermittent peritoneal dialysis (IPD). This study investigates the possibility of using acacia gum supplementation to improve the quality of life and provide children with ESRD with a dialysis-free period. Three patients referred to our hospital with ESRD during a 3-month period were enrolled in a therapeutic trial to investigate the efficacy of acacia gum (1 g/kg per day in divided doses) as a complementary conservative measure aimed at improving the quality of life. Inclusion criteria included a pre-dialysis creatinine clearance of <5 ml/min, current dietary restrictions and supplementation, at least one dialysis session to control uremic symptoms, absence of life-threatening complications, and sufficient motivation to ensure compliance with the study protocol. One patient complied with the protocol for only 10 days and died after 6 months, despite IPD. Two patients completed the study. Both reported improved well-being. Neither became acidotic or uremic, and neither required dialysis during the study period. Both patients maintained urinary creatinine and urea levels not previously achieved without dialysis. In conclusion, dietary supplementation with acacia gum may be an alternative to renal replacement therapy to improve the quality of life and reduce or eliminate the need for dialysis in children with ESRD in some developing countries.

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Keywords Chronic renal failure · Iraqi children Sirs, Little is known about the etiology of chronic renal failure (CRF) in Iraqi children because of the lack of a central reporting agency and pediatric nephrology working group. The aim of this study is to determine the etiology of CRF in children in the There were 54 patients in total, with a mean age of 8.6 years (range 1 month to 17 years); 34 patients were males and 20 patients (37%) were females. The male to female ratio was 1.7. Three patients (5.56%) were under the age of 1 year, 12 patients (22.22%) were between 1 and 5 years, 16 patients (29.62%) were between 5 and 10 years, and 23 patients (42.6%) were above 10 years at the time of first admission. Most patients (40, 74%) were on combined medical and dietary treatments and intermittent peritoneal dialysis, 10 patients (18.5%) were on conservative treatment, and 4 (7.4%) patients, all above 14 years, were on regular hemodialysis.

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This is the longest period of dialysis freedom reported in children with ESRF.

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