Objective: To determine the frequency of autoimmune thyroiditis in children with Celiac disease and the effect of gluten free diet on autoimmune thyroiditis. Methods: We enrolled 100 patients, age 1-12 years of either gender diagnosed as Celiac disease (CD) in this prospective observational study in the Department of Pediatric Medicine, from 1st January 2018 to 30th June 2019. Diagnosis of autoimmune thyroiditis was made if anti–thyroperoxidase >35 iu/ml or anti–thyroglobulin >20 iu/ml at diagnosis of CD and then at one year on gluten free diet (GFD) in all cases. Children with repeat anti-tTG levels > 10 times upper limit normal at 6-months after enrollment were labelled as non-compliant to GFD. Descriptive statistics were used to analyze the data. Results: Mean age of the participants was 5.94±3.16 years and 53% were females. Fourteen cases of autoimmune thyroiditis were detected at enrollment and six (7%, n/N = 6/86) were later diagnosed on follow-up who were initially negative. Seven hypothyroid cases among the autoimmune thyroiditis were treated with thyroxine and became euthyroid on follow-up testing. Compliance to GFD was 52%. Autoimmune thyroiditis improved on gluten free diet in four cases (28.6%). Of the six euthyroid cases at diagnosis three cases became hypothyroid and all were non-compliant. Conclusion: Frequency of autoimmune thyroiditis was 20% over a follow-up period of one year. Good compliance with the GFD has some effect on improving autoimmune thyroiditis and maintaining euthyroid status of CD patients. doi: https://doi.org/10.12669/pjms.36.6.2226 How to cite this:Rasheed J, Hassan R, Khalid M, Zafar F. Frequency of autoimmune thyroiditis in children with Celiac disease and effect of gluten free diet . Pak J Med Sci. 2020;36(6):---------. doi: https://doi.org/10.12669/pjms.36.6.2226 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Objective: To correlate the immunofluorescence (IF) findings on renal biopsies of patients of glomerulonephritis (GN) with the clinical course of the disease. Methods: This retrospective descriptive study was done at the Department of Pediatrics Medicine Unit-I, Nishtar Hospital Multan, from January 2008 to January 2019. A total of 387 cases of both gender, aged up to 16 years, diagnosed having GN on the basis of renal biopsies by light microscopy (LM) and IF findings, were included. Outcome as remission, partial remission, no remission with stable kidney disease, no remission with progressive kidney disease and end-stage kidney disease (ESKD) were computed. Chi square test was applied to see the correlation of IF findings and outcome by taking p value less than 0.05 as statistically significant. Results: Focal segmental glomerulosclerosis (FSGS) was found to be the commonest histopathology finding noted in 158 (40.8%) followed by mesangioproliferative GN 74 (19.1%) and membranous nephropathy 42 (10.9%). Complete remission was observed in 145 (37.5%) cases whereas ESKD was seen in 26 (6.7%). Distinct pattern of IF findings were shown when distribution of IF findings were seen with respect to all study variables (p value < 0.001). For outcome, 134 (51.3%) IF negative cases had complete remission while 93 (35.6%) negative IF findings also had partial remission. ESKD was seen among 14 (25.9%) IgM positive and three (33.3%) IgA positive cases. Conclusion: Immunofluorescence proved an important diagnostic tool in reaching the exact diagnosis in various types of GN. Distinct correlation between IF findings and clinical course of various types of GN was observed. IF negative cases had better outcome and was not having progressive course of disease so prognosis remained better than IF positive cases in this study. doi: https://doi.org/10.12669/pjms.37.1.2497 How to cite this:Zafar F, Mehar MF, Khan AA, Safdar RS. Clinical correlation and prognostic significance of immunofluorescence in renal biopsies of patients having Glomerulonephritis. Pak J Med Sci. 2021;37(1):76-80. doi: https://doi.org/10.12669/pjms.37.1.2497 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Many perinatal deaths follow birth asphyxia that occurs in babies of women who are referred on developing life-threatening obstetric complications. Objectives: To determine the antenatal and intrapartum risk factors for perinatal asphyxia among babies delivered by women admitted as emergency obstetric referrals. Study Design: Cross-sectional study. Setting: Pediatric Unit 1, Nishtar Hospital Multan, Pakistan. Period: From May 2017 to April 2018. Material & Methods: A total of 150 newborn term babies (and their mothers) with a 1, 5, & 10-minutes Apgar score 4 or less (perinatal asphyxia) were considered for the study. Antepartum and intraparturn risk factors were noted among newborn babies (and their mothers) from socio-demographic characteristics, obstetric complications or labour management. Results: Out of150 neonates, 57(38%) were presented with perinatal asphyxia at the age of 1 minute, 62(41.3%) at the age of 5 minutes and 31(20.1%) neonates were presented at the age of 10 minutes. In these cases, 45(30%) were related to maternal causes, 71(47.3%) to placental causes and 34(22.7%) to fetal cause. Conclusions: Early recognition of antepartum and intraparturn risk factors for perinatal axphyxiaamong emergency obstetric referrals, followed by prompt and appropriate management, may reduce the perinatal deaths from perinatal asphyxia.

Allergic bronchopulmonary aspergillosis (ABPA) is an illness caused byhypersensitivity to colonized Aspergillus fumigatus, mostly involving susceptible adult patientswith history of asthma and cystic fibrosis. Timely given appropriate treatment can reduceclinical symptoms, decrease lung infiltrates and stop progression to chronic lung disease. Inliterature review, treatment strategies used in ABPA children are limited. Herein we present acase of 10-year old asthmatic girl who, on developing ABPA, was successfully treated by theuse of low dose corticosteroids combined with itraconazole for 3 months duration. We suggestthat in financial constraint circumstances, ABPA in children can be successfully treated withoutanti-IgE therapy.

Hypersensitivity pneumonitis (HP) is a rarely diagnosed interstitial lung disease with variable manifestations. It results from repeated inhalation of certain antigens, e.g. mold, avian antigen, etc. in susceptible patients. The diagnosis is made by exposure history, relevant clinical presentation, and specific radiologic features. It is treated by avoidance of triggers and use of corticosteroids. We report a 7.5-year girl with HP. She was admitted for cough and severe respiratory distress.

Background: Celiac disease (CD) is an immune-mediated enteropathy stimulatedby intake of gluten, rye and barley in genetically prone persons. In children, gastrointestinalsymptoms are usual if disease is diagnosed in first two years of life but as the age at onset of theillness advances to late years, extra-intestinal manifestations have been increasingly recognizedaffecting almost all organ systems. Objectives: To determine the prevalence of varied clinicalmanifestations of CD in children. To assess classical and non-classical features in patients withCD. Study Design: Cross sectional study. Setting: Nishtar Hospital Multan. Period: July 2016to July 2017. Material & Methods: Ninety-six patients with celiac disease were analyzed. Thediagnosis was confirmed by serological antibodies and positive biopsy wherever needed. Allthe cases were evaluated for different intestinal or extra-intestinal features. Also the cases werecategorized based on their primary clinical features into two groups. The classical group hadCD patients with usual symptoms. The non-classical group had atypical symptoms. Results:The mean age of CD patients at the time of diagnosis was 5.98 ± 3.19 years. Median valuefor duration of clinical symptoms was 24 months. The common typical clinical presentationsincluded failure to thrive 86 (89.6%), short stature 86 (89.6%), diarrhea 78 (81.3%), unexplainedanemia 78 (81.3%) and clubbing 41 (42.7%). The atypical features noted in our study wereconstipation 21 (21.9%), hypertransaminasemia 38 (39.6 %) and neurological symptoms likeirritability/ behavioral changes 41 (42.7%). Family history of gluten allergy or other autoimmunediseases was present in 29 (30.2%) of patients. Children presented with non-classical symptomswere older than 2 years of age and they showed high prevalence of associated immune andnon immune diseases compared to those in classical group. Conclusion: The knowledge ofvaried behavior of CD may prevent delay in diagnosis. CD must be particularly screened inpatients with unexpected anemia, rickets, clubbing, short stature and in cases with positivehistory in family.

… Background: Celiac disease (CD) is an immune-mediated enteropathy stimulated by intake of gluten, rye and barley in genetically prone persons. In children, gastrointestinal symptoms are usual if disease is diagnosed in first two years of life but as the age at onset of the illness advances to late years, extra-intestinal manifestations have been increasingly recognized affecting almost all organ systems. Objectives: To determine the prevalence of varied clinical manifestations of CD in children. To assess classical and non-classical features in patients with CD. Study Design: Cross sectional study. Setting: Nishtar Hospital Multan. Period: July 2016 to July 2017. Material & Methods: Ninety-six patients with celiac disease were analyzed. The diagnosis was confirmed by serological antibodies and positive biopsy wherever needed. All the cases were evaluated for different intestinal or extra-intestinal features. Also the cases were categorized based on their primary clinical features into two groups. The classical group had CD patients with usual symptoms. The non-classical group had atypical symptoms. Results: The mean age of CD patients at the time of diagnosis was 5.98 ± 3.19 years. Median value for duration of clinical symptoms was 24 months. The common typical clinical presentations included failure to thrive 86 (89.6%), short stature 86 (89.6%), diarrhea 78 (81.3%), unexplained anemia 78 (81.3%) and clubbing 41 (42.7%). The atypical features noted in our study were constipation 21 (21.9%), hypertransaminasemia 38 (39.6 %) and neurological symptoms like irritability/ behavioral changes 41 (42.7%). Family history of gluten allergy or other autoimmune diseases was present in 29 (30.2%) of patients. Children presented with non-classical symptoms were older than 2 years of age and they showed high prevalence of associated immune and non immune diseases compared to those in classical group. Conclusion: The knowledge of varied behavior of CD may prevent delay in diagnosis. CD must be particularly screened in patients with unexpected anemia, rickets, clubbing, short stature and in cases with positive history in family.

ABSTRACT… Each Year Billions of dollars have been spent on the various programmes for Maternal and child health services incollaboration with international organizations and hundreds of doctors and thousands of skilled (SBAs) birth attendants and lady healthworkers have been trained. Objective: To evaluate the impact of neonatal resuscitation programs on the prevalence of birth asphyxia in ahospital which drains a large population of Punjab. Study design: Cross sectional. Duration & Place of study: Department of PaediatricMedicine, Nishtar Medical College & Hospital, Multan from January 2008-December 2008. Methods: All newborns with a H/o failure toinitiate or sustain respiration at birth or H/o associated convulsions who were admitted (referred or hospital based) with the diagnosis ofBirth Asphyxia and a weight > 1.5 kg were included, still born and those with lethal congenital malformations were excluded. Aquestionnaire was designed after extensive review of literature and data recorded. The data of past 10 years for Birth Asphyxia was alsocollected from the hospital record and compared with the present results. Result: In year 1998 a total of 722 Newborns were admitted inour neonatal unit out of which 210 (29.0%) were diagnosed as Asphyxia Neonatorum. This number has progressively increased over thepast 10 years with a total of 846 out of total 2079 newborns (40.78%) admitted in 2008 with a diagnosis of asphyxia. Out of the total 846patients, there were 69% Male and 31% Female with a M:F ratio of 2.2:1. 46% were delivered by SVD (17.39% in Nishtar Hospital 15.21%by dais, 32.6% by Private doctors and 34.78% by LHV) and 54% were delivered by caesarian section, out of which 46.29% were deliveredin Private hospitals and 54% in Nishtar Hospital. Overall 65% deliveries were in the private sector or at home and 35% in the Governmenthospitals 60% babies had come from Multan and 40% from other town or cities. A H/o one or more antenatal visits was present in 68% ofmothers. Out of total cases of B.A. 26% were in B.A Grade-I 59% in Birth Asphyxia Grade-II 15% in B.A Grade-III. Out of this total 45%th expired. Discussion & Conclusion: As we are moving towards the 4 MDG and Pakistan strives to improve its health indicators and weclaim to decrease the infant mortality, neonatal and perinatal mortality rate. The incidence of birth asphyxia rises with increased burden ofmorbidity. Even though the principles of NRPs are recommended for international application, this program widely used in the developedworld has not been properly disseminated in communities in the developing countries, especially Pakistan.