Muhammad Ashraf Sultan

Congenital hypothyroidism in neonates

Context: Congenital hypothyroidism (CH) is one of the most common preventable causes of mental retardation in children and it occurs in approximately 1:2,000-1:4,000 newborns. Aims and Objectives: The aim of this study is to determine the frequency of CH in neonates. Settings and Design: This cross-sectional study was conducted in neonatal units of the Department of Pediatrics Unit-I, King Edward Medical University/Mayo Hospital, Lahore and Lady Willington Hospital Lahore in 6 months (January-June 2011). Materials and Methods: Sample was collected by non-probability purposive sampling. After consent, 550 newborn were registered for the study. Demographic data and relevant history was recorded. After aseptic measures, 2-3 ml venous blood analyzed for thyroid-stimulating hormone (TSH) level by immunoradiometric assay. Treatment was started according to the individual merit as per protocol. Statistical Analysis Used: Data was analyzed by SPSS 17 and Chi-square test was applied to find out the association of CH with different variables. Results: The study population consisted of 550 newborns. Among 550 newborns, 4 (0.8%) newborns had elevated TSH level. CH had statistically significant association with mothers hypothyroidism (P value 0.000) and mothers drug intake during the pregnancy period (P value 0.013). Conclusion: CH is 0.8% in neonates. It has statistically significant association with mothers hypothyroidism and mothers drug intake during pregnancy.

Comparing the Effects of Zinc Supplementation as Adjunct to the Conventional Therapy and Placebo on Morbidity in Children with Pneumonia Between Ages 1 Year to 5 Years

Background: Pneumonia is one of the leading causes of morbidity and mortality in children younger than 5 years of age. Treatments are available for timely management of pneumonia but mortality is still high in developing countries like Pakistan. Zinc may have an important protective role in cases of childhood pneumonia and can help in reducing potential complications of pneumonia and can also help to reduce the incidence of mortality in children less than five years of age. So we conducted this study to find the therapeutic role of zinc as an adjunct to standard therapy for pneumonia in comparison to placebo. Objective: To compare the effect of zinc supplementation and placebo on morbidity in children with pneumonia age 1 year to 5 years in one year duration. Study duration: One year. Methodology: This randomized control trial was conducted in the Department of Pediatrics Unit-I, King Edward Medical University/Mayo Hospital, Lahore, Pakistan. After the consent was taken, 150 children from 1 year to 5 years of ages with pneumonia consistent with World Health Organization (WHO) acute respiratory infections (ARI) definition along with crepitation’s on auscultation were registered by non-probability purposive sampling and were randomized into treatment group (Group A) and placebo group (Group B). Seventy five children were supplemented with zinc for 15 days while 75 children were supplemented with placebo. Outcome measure was duration of hospital stay in both groups. Results: The mean age of children in zinc therapy group was 3.01 years while the mean age of children in placebo group was 2.85 years. In zinc therapy group, there were 48 (64.0%) male and 27 (36.0%) female children. In placebo group, there were 48 (64.0%) male and 27 (36.0%) female children. The mean hospital stay was 3 ± 1 days in zinc group while 7 ± 3 days in placebo groups (P<0.05) and showing that zinc therapy is better than placebo. Conclusion: Zinc supplementation as adjunct to the conventional therapy for management of pneumonia reduces hospital stay.

Diagnostic accuracy of Sultan's scoring criteria in confirmed cases of measles

World Health Organization (WHO) clinical case definition for the diagnosis of measles lacks diagnostic accuracy. We thus propose two separate scoring criteria for the diagnosis of acute and post measles cases. This study was conducted to determine the diagnostic accuracy of scoring criteria in confirmed cases of measles. This cross-sectional validation study was conducted in the Department of Paediatrics Unit-I, King Edward Medical University, Lahore, Pakistan, from March-August 2009. Sixty-one cases fulfilling the WHO clinical case definition of measles were included in the study, and divided into Group A (Acute measles) and Group B (Post measles). A separate criterion was used for each. Positive Serology (IgM) was taken as confirmed cases. At scores ≥ 3, ≥ 4 and ≥ 5, the sensitivity, specificity, positive predictive value (PPV) and negative predictive values (NPV) were calculated. Appropriate statistical tests were applied. In Group A, out of 36 cases, 28 (78%) had total score ≥ 4, whereas IgM was positive in 24 (67%). The scoring criteria had sensitivity, specificity, PPV and NPV of 100%, 66.7%, 86% and 100% respectively. In Group B, out of 25 cases, 23 (92%) had a total score ≥ 4 whereas IgM was positive in 22 (88%) cases. The scoring criteria had sensitivity, specificity, PPV and NPV of 100%, 66.7%, 96% and 100% respectively. The measure and strength of association were statistically significant for both Groups. At scores ≥ 3 and ≥ 5, sensitivity, specificity and predictive values were not statistically significant in either group. This study has shown that the criteria for the diagnosis of acute and post measles cases at a score ≥ 4 are valid to make a clinical diagnosis.