Comparison of perinatal outcome in growth restricted fetuses retaining normal umbilical artery Doppler flow to those with diminished end-diastolic flow.

BACKGROUND: Intrauterine growth restriction /retardation (IUGR) is defined as birth weight below the 10th percentile for a given gestational age. Placental insufficiency is the primary cause of intrauterine growth retardation in normally formed fetuses and can be identified using umbilical artery Doppler velocimetry which is a non-invasive technique. The objective of this study was to compare perinatal outcome in growth restricted fetuses retaining normal umbilical artery Doppler flow to those with diminished or severely reduced/absent end-diastolic flow. METHODS: This cross sectional study was conducted at Radiology department of Pakistan Navy Ship (PNS) Shifa Hospital, Karachi over one year period from. Established cases of asymmetrical IUGR, having estimated fetal weight < 10th percentile for gestational age and between 28-40 weeks of gestation were included in the study. Pulsatility index (PI) was calculated for each case. Perinatal outcomes like early delivery, caesarean section, respiratory distress syndrome, necrotizing enterocolitis, admission to neonatal ICU, prenatal and neonatal death were evaluated. Chi-square test was used to compare proportion difference of perinatal outcomes for normal and abnormal umbilical artery velocimetry, with 0.05 level of significance. RESULTS: Umbilical artery Doppler velocimetry showed a significant correlation with the perinatal outcome. In 90% of cases of IUGR having abnormal waveform, poor perinatal outcome was seen as compared to only 33.3% retaining normal Doppler flow. CONCLUSION: Growth restricted fetuses with normal umbilical artery Doppler velocimetry were at lower risk than those with abnormal waveforms.

Subclinical rickets.

OBJECTIVE: The study on sub clinical rickets is unique in the sense that it has not been preplanned conducted anywhere especially in Pakistan. The objective of present study was to explore the prevalence, gender and geographical distribution of sub clinical rickets and their related factors among school students. METHODS: Out of total participants, 189(90%) students were finally included in the study from rural, urban and suburban high schools of Hazara Division, KPK. The age of boys and girls students was 11 years to 16 years. Anthropometrics data along with daily intakes of meal and availability of sun shine was noted on record form. Sub clinical cases were diagnosed with abnormal biochemical findings without physical indications of rickets. RESULTS: Sub clinical rickets was found in 51(27%) students, out of which 15(8%) were boys and 36(19%) girls. Geographically, 26 cases of sub clinical rickets were from rural schools, 16 of urban and 09 found in suburban school. All sub clinical cases had serum level of sunshine vitamin D in between ≥18nmol/l to ≤39 nmol/l, but none of them had parathyroid level increased from upper normal range. Estimated quantities of vitamin D, calcium and phosphorus in daily intakes meal of boy's and girl's student were almost same and found less than recommended amount. CONCLUSION: Sub clinical rickets is camouflagic rickets among Hazarian school students, especially in girl gender. The major cause contributed to this problem is lack of synergistic effect of Sunshine Vitamin D.

Extensively Drug-Resistant Enteric Fever In Children: Surging Threats Of Antimicrobial Resistance And Possible Solutions.

BACKGROUND: Enteric fever is an infectious disease caused by Salmonella enterica including Salmonella Typhi and Paratyphi A and is associated with potentially serious outcomes, especially in developing countries. The study was conducted with the aim to present the clinical features, laboratory characteristics and antibiotic susceptibility in patients with culture-proven extensively drug-resistant (XDR) enteric fever and to explore drug combinations as a possible solution for the growing problem of antimicrobial resistance. METHODS: This descriptive cross-sectional study was conducted in the Paediatric unit of Ayub teaching hospital. Patients admitted with culture-proven XDR enteric fever were included. Patient characteristics were documented on a predesigned proforma. Response to antimicrobial agents including ceftriaxone and levofloxacin, azithromycin and meropenem and meropenem alone was assessed. Data was entered and analyzed using SPSS version 26. RESULTS: A total of 53 patients participated in this study. The majority of patients 36 (67.9%) were male and above 5 years of age(n=38,71.7%). The mean age of the participants was 7.08±3.02 years. The major presenting features included fever, anorexia and pain abdomen in 53 (100%), 51 (96.2%) and 41 (77.4%) respectively. The mean duration of symptoms prior to hospitalization was 8.92±3.361 days. Of the total patients, 32(60.4%) responded to the initial therapy with ceftriaxone and levofloxacin, 11(20.8%) patients responded to meropenem alone and 10 (18.9%) patients responded to meropenem and azithromycin in combination. There was no statistically significant difference in mean duration to show response in patients receiving either of the treatments (p=0.484). CONCLUSIONS: Paediatric patients with XDR enteric fever mainly presented with fever, anorexia and pain abdomen and showed good response to therapy with the combination of ceftriaxone and levofloxacin inspite of the apparent resistance on blood culture and sensitivity.

Prevalence of hepatitis B and C in healthy adult males of paramilitary personnel in Punjab.

BACKGROUND: Global prevalence of Hepatitis B varies from high (> 8%) in Africa, Asia and Western Pacific to low (< 2%) in Western Europe, North America and Australia. An estimated 180 million people worldwide including 4 million people in USA are infected with HCV. This cross-sectional observational study was carried out at Department of Pathology, Pakistan Rangers (Punjab) Central Hospital, Lahore from March to June 2010 to determine prevalence of HBV and HCV infection among serving asymptomatic healthy adult males of paramilitary force. METHODS: The healthy adult males from province Punjab serving in Pakistan Rangers Punjab without previous history of known positivity for HBV or HCV infection were included in the study. Demographic data including the district of origin were noted. HBsAg and anti-HCV antibodies were tested by rapid immuno-chromatographic method while positive tests were reconfirmed by enzyme immuno-assay (EIA). RESULTS: Out of total 15,793 adults screened for Hepatitis B & C viral infections, 14,027 adults belonged to the province of Punjab. There were 396 (2.82%) adults who were found positive for HBsAg and 511 (3.64%) positive for anti-HCV on screening. Retesting of the positive tests by EIA showed 396 (2.82%) positive for HBsAg, and 440 (3.13%) for anti-HCV respectively. Specificity of immune chromatographic method for HBsAg and anti-HCV calculated taking EIA as gold standard was 100% for HBsAg and 99.5% for anti-HCV while positive predictive value of the immuno-chromatographic methods was 100% for HBsAg and 86.1% for anti-HCV. Highest of prevalence of HBsAg was seen in Rahimyar Khan (7.58%) while high prevalence of anti-HCV was seen in Chiniot (8.9%), Faisalabad (7.2%), Vehari (7.03%), Muzaffargarh (5.95%) and Sheikhupura (5.83%). CONCLUSION: Overall prevalence of HBsAg and anti-HCV is on the decline. The isolated pockets of very high prevalence of HCV infection in the districts of Chiniot, Faisalabad, Vehari, Sheikhupura, Rahimyar Khan, Muzaffargarh, and Okara pose a community health problem with a dire need to adopt strict preventive measures in the medical and social practices with effective public awareness campaigns.

Aetiology and types of neonatal seizures presenting at Ayub Teaching Hospital Abbottabad.

BACKGROUND: Neonatal seizures (NS) affect approximately 1% of neonates. Clonic, tonic, myoclonic and subtle seizures are the common types. Birth asphyxia, sepsis, metabolic derangements, intracranial bleed, kernicterus, tetanus and 5th day fits are the common aetiologies. This study was planned to evaluate the types and causes of neonatal seizures. METHODS: It was a descriptive case series conducted at Ayub Teaching Hospital, Abbottabad from 12th December 2006 to 25th September 2007 on neonates having seizures. Serum chemistry, blood counts, cerebrospinal fluid examination and cranial ultrasound were done in all patients. Blood culture, renal and liver function tests, computerised tomography scan, metabolic and septic screening was done in selected patients. Descriptive statistics were applied for analysis. RESULTS: Tonic clonic seizure was the commonest type (28%) followed by multi-focal clonic, and focal tonic seizures (25% each). Birth asphyxia was found to be the main aetiology (46%). CONCLUSION: Tonic clonic seizure was the commonest type and birth asphyxia the main aetiology identified in the majority of neonatal seizures.

Meningococcaemia In Children-An Under Recognized Public Health Problem In Pakistan.

Background: Meningococcaemia is a serious bacterial disease caused by Neisseria meningitidis resulting in septicaemia and meningitis in previously well individuals and is associated with serious consequences including mortality. As the data from our region is scarce, the study was conducted with an aim to highlight the disease manifestations and outcomes so that appropriate interventions are devised. Method: A descriptive study was conducted in Paediatrics A Unit from 1st March 2020 to 30th September 2021 after approval of institutional review board. Children admitted with features of meningococcaemia in the form of fever and typical petechial purpuric rash were included in the study. Results: A total of 46 patients with meningococcaemia were included in the study. Of these, 24 (52.2%) were male. Majority of the patients 22 (47.8%) were in the age group of 1 year to five years, Major complications were meningitis in 39 (84.8%), septic shock in 26 (56.5%) and purpura fulminans in 12 (26.1%) patients. Mortality was documented in 6 (13%) patients. Outcome was associated with age. (p= 0.039). There was a significant difference in outcome in patients with prolonged PT/APTT (p=0.031), purpura fulminans (p=0.000) and septic shock (p=0.021). Conclusion: Meningococcaemia is prevalent in our region in paediatric population. The disease has a fulminant course with a myriad of complications and potentially fatal outcomes especially in children under one year of age.

An audit of morbidity and mortality of hospitalised neonates in neonatal care unit of a tertiary care hospital in Abbottabad.

BACKGROUND: Perinatal as well as neonatal mortality record in our country is one of the highest in the world. Home deliveries, lack of adequate facilities, poverty and lack of education are sonme of the important known causes. The present study was planned to determine neonatal mortality in Hazara. METHODS: Hospital records of neonatal admissions at Ayub Teaching Hospital (ATH) Abbottabad from 1st January 2007-31st December 2007 were analysed retrospectively. Percent neonatal mortality was calculated from the record, along with the causes of neonatal mortality. RESULTS: A total of 1705 neonates were admitted in the study period at the department of neonatology Ayub Teaching Hospital Abbottabad. Out of 1,705 neonates 947 (56%) were males while 857 (44%) were females with a male to female ratio of 1.24:1 . Majority, 1,411 out of 1,705 (83%), of the neonates was admitted during the 1st week of their life, mean age 6 days. Asphyxia, sepsis and prematurity were the three most common causes of neonatal admissions contributing 27%, 26% and 24% respectively. Overall mortality was 11%. CONCLUSION: Neonatal mortality is an important contributing factor to infant mortality in Hazara Division. Majority of patients was admitted in the first week of life which indicates that good antenatal and natal care can reduce the mortality and morbidity of our neonates. Improvement in the prenatal, natal and nursery care as a whole can reduce the neonatal mortality in preterm as well as full term neonates.

COVID 19 In Children: An Experience From A Paediatric Tertiary Care Setting.

BACKGROUND: The pandemic of COVID 19 has affected a number of people around the globe. The data from paediatric population is scarce. The present study is aimed to present the paediatric perspective of the disease in terms of different clinical presentations, laboratory parameters, complications, and outcomes so as to develop an insight into disease manifestations in children. METHODS: This descriptive case series was conducted in the department of Paediatrics after approval of institutional review board. All children admitted in paediatric unit with confirmed SARS-COV-2 infection either by PCR or antibody test were included in the study. Patients' characteristics were documented on a predesigned proforma and analysed using SPSS 26.0. RESULTS: A total of 17 patients comprising 13 (76.5%) male and 4(23.5%) female were included in the study. The major clinical features were fever, cough and shortness of breath documented in 15 (88.2 %) patients. Major complications were shock in 13 (76.5%), respiratory complications in 16 (94.11%), CNS complications in 4 (23.5%), cardiac complications in 5 (29.4%), hepatic involvement in 3 (17.6%) Acute Kidney Injury in 4 (23.5%) patients and 9 (52.9 %) patients were labelled as having Multisystem Inflammatory Syndrome in Children (MIS-C). A total of 7 (41.2%) patients had coexistent comorbid diseases. A total of 13 (76.47%) patients were discharged, 2 (11.8%) patients expired and 2 (11.8%) left against medical advice. CONCLUSION: The clinical presentation of paediatric patients with SARS-COV-2 infection is highly variable. Multisystem inflammatory syndrome associated with SARS-COV-2 must be considered in the differential diagnosis of children presenting with multiorgan dysfunction.

Burden And Spectrum Of Respiratory Ailments In Paediatric Tertiary Care Setting.

BACKGROUND: Respiratory tract infections are a significant cause of mortality and morbidity in paediatric age group all over the world and especially in under developed regions. The present study was conducted with an aim to assess the burden and the types of respiratory illnesses in our region. METHODS: The study was a cross sectional study conducted at Paediatric A unit of Ayub teaching hospital from 1st October, 2018 to 31st March, 2019. All patients aged 1 month and above who required admission for various respiratory ailments were included in the study. RESULTS: A total of 2255 patients were admitted in Paediatric A unit over a six months period. Of these, 603 (26.74%) patients were admitted with various respiratory problems and were included in the study. Among these, 389 (64.5%) patients were male and 214 (35.5%) were female. Mean age of the participants was 18.77±30.87 months. The major disease categories were bronchopneumonia in 189 (31.3%), bronchiolitis in 176 (29.2%), measles pneumonia in 60 (10%), lobar pneumonia in 52 (8.6%) and upper RTI in 32 (5.3%). Mean duration of stay was 3.13±2.08 days. Majority of the patients 482 (79.9%) were up to 24 months of age, followed by 77 (12.8%) patients in 25-60 months age and 44 (7.3%) patients more than 60 months of age. A total 295 (48.92%) patients were vaccinated while 308 (51.07%) patients were either partially vaccinated 116 (19.2%) or unvaccinated 192 (31.8%). A total of 576 (95.5%) patients were discharged, 17 (2.8%) patients expired and 5 (0.8%) were referred to higher specialty. Bronchopneumonia was the leading cause of mortality in this study. CONCLUSIONS: Respiratory tract infections constitute a major threat to the health of paediatric patients especially in the first two years of life. Improvement in vaccination coverage is essential in reducing the burden of a majority of respiratory ailments along with health education.

Prevalence of obesity in school children of Hazara division.

BACKGROUND: Limited data is available in Pakistan regarding prevalence of obesity in school going children. The objective of this study was to find out obesity prevalence in school going children in Hazara division. METHODS: It was descriptive study. Data of 3200 students was collected over six month period, from Hazara Division. Four schools were selected in each district two for boys and two for females. District Kohistan was excluded from study as female education is not permitted beyond primary education. Children 5-14 year age group were included in the study. Initial 20 students of each class were selected for study. Anthropometric data (weight, height) for each student was collected and entered on Performa structured for this purpose. BMI was calculated and values were compared with standard BMI charts of National Health Centre for health statistics. RESULTS: Prevalence of obesity was 4.78%. Out of 3,200 children enrolled 153 (4.78%) were obese. Male to female ratio was 1:1.2. The prevalence of obesity was high in private school students than government schools (66.66% and 33%). The prevalence was high in both sexes in 12-14 years and 6-7 years age groups (49% and 20.26%). CONCLUSION: Prevalence of obesity in present study is similar to the results from developing countries in the region but prevalence is lower than developed countries. Problem of obesity also exists in developing countries and there is need to create awareness about obesity and related complications.

Accuracy of multiphase helical tomography in detection and characterisation of suspected renal masses using histopathological findings as gold standard.

BACKGROUND: The introduction of multiphase helical computed tomography has created many important advances in the detection and characterisation of renal masses. Renal cell carcinoma (RCC) is the seventh most common cancer and makes up 80-85% of all primary renal cancer in adults. If it is found and treated early, the chances of survival from kidney cancer are high. This cross-sectional comparative was carried out at department of CMH/MH Rawalpindi from 1st February 2007 to 25 March 2008 to evaluate accuracy of multiphase helical tomography in detection and characterisation of suspected renal masses using histopathological findings as gold standard. METHODS: Thirty patients with suspicion of having renal masses were scanned with multiphase CT scanning and 5 mm thick contiguous section were obtained from kidneys before and after injection of intravenous contrast material. The corticomedullary phase images were obtained after a delay of 25 seconds and nephrographic phase images, after a delay of 120 seconds after initiation of contrast medium injection. The numbers of lesions detected in all three phases were determined. The mass was then characterised by evaluation of its features and by its degree of contrast enhancement. Results of CT scan were compared with histopathology. RESULTS: At review of unenhanced, corticomedullary and nephrographic phase images, 26, 29 and 30 lesions, respectively, were identified. One malignant lesion was not identified and 3 malignant lesions falsely appeared benign in the corticomedullary phase. All lesions were detected in the nephrographic phase and only 1 malignant lesion falsely appeared benign. The corticomedullary phase had a sensitivity of 86.2% and nephrographic phase 96.6% in malignant lesion detection. CONCLUSION: Enhancement of renal neoplasm is time dependent and is better in nephrographic phase. Small, hypovascular tumours and those placed in medulla may be missed or inadequately characterised if nephrographic phase scanning is not done.

A Rare Case Of Berardinelli Seip Syndrome.

Berardinelli Seip Syndrome is a rare disorder associated with loss of adipose tissue leading to a myriad of findings owing to derangements of carbohydrate and lipid metabolism. There is no cure and the management comprising low fat diet, metformin and leptin replacement is aimed at preventing complications. We report this syndrome in a male child from Afghanistan.

Frequency and clinical presentation of UTI among children of Hazara Division, Pakistan.

BACKGROUND: Urinary tract infection is common in children and result in permanent renal damage and end stage renal failure in significant number of patients. It is imperative to diagnose urinary tract infection early and to treat adequately. We carried out this study to look into frequency and clinical profile of UTI in children admitted in our unit. METHODS: Three hundred and seventy five patients with UTI, diagnosed by urine culture with age from 0-15 years admitted in pediatric unit during 2003-2006 were included in study. Urine sample for culture was collected by midstream clean catch, urine collecting bag and Suprapubic methods depending upon the age of patient. A proforma was used to record clinical presentation and laboratory findings of these patients. RESULTS: Frequency of Urinary tract infections among children examined by urine culture was 375 out of 1000 (37.5%) out of which 36 (9.6%) were male and 339 (90.4%) were females. Almost half of them 48.5% were less than 3 years old. About 60% of patients belong to Kohistan and Batagram districts and failure to thrive was common presenting feature (56.6%) in patients of these two districts. Fever was common clinical presentation 91% followed by Dysuria (65%) and failure to thrive (40%). CONCLUSION: Frequency and clinical profile of urinary tract infection in children in Hazara Division is not significantly different from that of developing and developed countries.

Clinical outcome in measles patients hospitalized with complications.

BACKGROUND: Measles is a highly communicable viral illness and is common cause of childhood mortality and morbidity. Keeping in view the high prevalence of measles in the developing world, we carried out this study to look into the complicated measles cases and clinical outcome in patients admitted in children ward of Ayub Teaching Hospital. METHODS: Detailed history and physical examination of all the hospitalized patients with complication of measles were recorded in a proforma. Immunization and nutritional status of each admitted patient was assessed and the clinical outcome of measles was compared with demographic profile. RESULT: One hundred thirty six hospitalized patients with complications of measles were studied. There was 60.3% male and 57.3% of patients were vaccinated against measles. Malnourished patients were 71.35% and had longer hospital stay (> 5 days). Pneumonia (39.7%) and diarrhoea (38.2%) were the commonest complications. Seven children died and encephalitis (57.1%) was the commonest cause of death. CONCLUSION: The most common complications of measles are pneumonia and diarrhoea with dehydration requiring admission. Malnutrition results in more complications and longer hospital stay. Mortality is significantly associated with encephalitis.

Frequency of dyslipidaemia in type 2 diabetes mellitus in patients of Hazara division.

BACKGROUND: Diabetes mellitus increases the risk of atherosclerotic vascular disease because of associated dyslipidaemia. Many studies advocate aggressive management of lipid disorders in Type 2 Diabetes to decrease these complications. This study was carried out to know the frequency of dyslipidaemia in our patients and also to determine that whether patients with good glycaemic control (HbA1c < or = 8%) are having better lipid profile than poorly controlled group. Cross-sectional survey was conducted in Medical OPD and Medical 'B' Ward of Ayub Teaching Hospital, Abbottabad between March 2006 to March 2007. METHODS: Patients with Type 2 Diabetes mellitus coming to Medical OPD as well as among those admitted in Medical 'B' Ward fulfilling the inclusion criteria were selected. Blood was taken in the fasting state for lipid profile, fasting blood glucose and glycosylated haemoglobin determination. RESULTS: Among 100 patients with Type 2 Diabetes, 78 were found to have hypertriglyceridaemia, while, 92 had LDL-Cholesterol in borderline cardiovascular risk status. Out of 78 patients with hypertriglyceridaemia 46 (59%) were poorly controlled diabetics (HbA1c > 8%) emphasizing the importance of good glycaemic control. However none of our patients had a low HDL-Cholesterol as found in some other studies. CONCLUSION: Hypertriglyceridaemia along with impaired LDL-Cholesterol is present in majority of our patients. Good glycaemic control does affect the lipid profile in Type 2 Diabetes mellitus. However to provide the benefits of lipid lowering therapy to our patients, as confirmed in many studies, we need more awareness and placebo controlled double blind studies.

Mushroom poisoning in children: clinical presentation and outcome.

BACKGROUND: A variable clinical picture characterizes mushroom poisoning. The Amatoxin, the main toxic component of these fungi, are responsible for gastrointestinal symptoms as well as hepatic and renal failure. As acute gastroenteritis is extremely common in our set up, so every patient presenting with these symptoms is treated as gastroenteritis of viral aetiology. The authors present the clinical picture of the phalloid syndrome, its treatment and immediate outcome. METHODS: All children age less than 16 years admitted in Saidu Hospital Swat from January to December 2006 with mushroom poisoning were included in the study. Patients with doubtful history or with associated illness were not included. The diagnosis was based on the clinical picture of the patient, history and the laboratory data. In addition to maintenance of fluid and electrolyte balance and treating sepsis, oral Silymarin and intravenous penicillin was started. Liver function tests, renal functions tests, serum electrolytes and coagulation profile was done in all the patients. The severity of poisoning was graded according to hepatic transaminase elevations and prolongation of prothrombin time. RESULTS: Of the 18 patients, fifteen were above five years of age. Female were twice in number. Fifteen patients developed hepatic failure and three patients developed renal failure. Thirteen patients expired. CONCLUSION: To start timely management, Mushroom poisoning should be considered in the differential diagnosis in patients presenting with food poisoning particularly coming in groups. Delay in diagnosis is associated with high mortality.

Status epilepticus: aetiology and outcome in children.

BACKGROUND: Convulsing Status Epilepticus (CSE) is a common paediatric emergency especially under 24 months age group. Present study was done to know causes of Status Epilepticus (SE) and outcome during admission and at the time of discharge. METHODS: A descriptive study in children 2 months to 15 years of age, admitted in Department of Paediatrics, Ayub Medical College, Abbottabad with first status epilepticus, was done to evaluate aetiology, complications and immediate outcome after relevant history, examination, laboratory tests. All information was recorded on Performa designed especially for this purpose. Study was conducted over 2 year period from November 2005 to November 2007. RESULTS: Total number of children admitted with SE was 125. Majority of SE episodes were related to acute febrile illnesses. Acute viral encephalitis was the common cause of SE especially in children younger than 24 months followed by febrile convulsions. Fifteen (12%) patients expired while neurological complications secondary to brain injury developed in 10(8%) cases. Mean seizure duration was 4.92 +/- 9.18 hours in children with normal outcome, 5.93 +/- 5.76 hours in children who died, and 12.85 +/- 12.91 hours in children with abnormal neurological outcome at discharge (p > 0.05). Correlation between age and duration of seizure was not significant (p > 0.05). CONCLUSION: SE is a common paediatric emergency associated with high mortality and morbidity. In young children SE is commonly associated with acute viral encephalitis. Antiviral treatment should be started earlier in this group of young children after history, examination, laboratory tests along with appropriate management of SE.

Estimation of foetal weight in third trimester using thigh measurements.

BACKGROUND: Estimation of foetal weight is essential in daily obstetric practice particularly close to term. It guides clinicians to finalize important obstetrical decisions. Low birth weight and excessive foetal weight at delivery both are associated with an increased risk of neonatal complications during labour and the puerperium. The objectives of this cross sectional study were to estimate the foetal weight using only two thigh parameters and its comparison with birth weight. This study was conducted in Radiology Department PNS Shifa during 1st June, 2007 to 30 Nov, 2007. METHODS: All pregnant females coming to Radiology Department for Ultrasound examinations in 3rd trimester were the Subjects of study. All infants were delivered with in 48 hour of ultrasound examination. 100 patients were included in this study. Thigh measurements were made by conventional two-dimensional ultrasonography. The Isobe formula was compared with already established Aoki's formula and actual birth weight using paired sample t-test. RESULTS: Isobe's formula showed a significant correlation with the actual birth weight. In 90% of cases estimated foetal weight was within 10% of the actual birth weight. CONCLUSION: The Isobe's formula was found to be convenient among all the established formulas for estimated foetal body weight. Measurement of head circumference was not necessary near term.

Respiratory distress: a rare presentation of rickets.

Nutritional rickets has multiple presentations like skeletal deformities, tetany, hypocalcemic seizures, recurrent diarrhea, dental abnormalities, developmental delay and floppiness. Here a rare presentation of nutritional rickets is reported in five months old baby who had respiratory distress since two months and signs of respiratory distress resolved after start of vitamin-D supplementation.

Etiology of strokes and hemiplegia in children presenting at Ayub Teaching Hospital, Abbottabad.

BACKGROUND: Strokes in pediatric age group are not common. However diagnosing the cause of stroke will help in providing preventive and curative treatment. Present study was conducted to find etiology of strokes/hemiplegia in children. METHODS: This study was conducted in Department of Pediatrics, Ayub Teaching Hospital Abbottabad from December 2002 to December 2005. All children from two months to fifteen years of age were included in the study. Children with weakness due to acute poliomyelitis and Guillan barre syndrome were excluded. Investigations were based on findings on history and clinical examination and included full blood count, PT, APTT, Platelets count, ECG, Echocardiography, hematocrit, lumber puncture with CSF analysis and culture and CT-scan skull. Data of all the patients presenting with strokes/hemiplegia was entered on prepared proforma. RESULTS: The main etiology of strokes was intracranial infection causing strokes in 23(56.09%)children and majority of children (78.26%) in this group were below five years. Etiology was un-known in 7(17.07%) children after necessary available investigations. CONCLUSIONS: Intracranial infection Infections that is meningitis and encephalitis are commonest etiology of strokes and hemiplegia in paediatrics patients presenting at Ayub Teaching Hospital, Abbottabad.