Muhammad Faheem Afzal

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.

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.