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To determine underlying risk factors in neonates with hypoxic ischemic encephalopathy.Case-control study.Neonatology Unit at the Children's Hospital and the Institute of Childhealth, Lahore, from March to July 2005.All neonates (153) with the diagnosis of Hypoxic Ischemic Encephalopathy (HIE) were included in the study. Controls (187) were selected from admissions on the same day. Possible risk factors such as maternal age, parity, antenatal monitoring, place of delivery, prolonged second stage of labour, type of delivery, type of attendant at delivery and the gestational age were noted and compared.Sixty one (39.9%) mothers of asphyxiated babies reported no antenatal visits compared to 24.1% in the control group (OR 2.1, 95% CI 1.3-3.2; p=0.002). Only 6.5% of cases were born in government hospitals (teaching and district) in comparison to 20.9% of controls (OR 3.8, 95% CI 1.9-7.6; p=0.001). In 28.1% of cases, mothers had history of prolonged 2nd stage of labour in comparison to 5.9% of controls (OR 6.3, 95% CI 3.3-11.9; p0.001). Fifty five cases (35.9%) were delivered by unskilled birth attendants compared to 28 (14.9%) controls (OR 3.2, 95% CI 1.9-5.3; p0.001). No significant difference was found in maternal age, maternal parity, gestational age and the mode of delivery between the two groups.Delivery by unskilled birth attendant, prolonged second stage of labour, birth in a non-government hospital setup and absence of antenatal care were significant risk factors for hypoxic ischemic encephalopathy in neonates. Improvement in antenatal and intrapartum care may be helpful in decreasing the frequency of this problem.

To determine the level of thyroid autoimmunity among clinically euthyroid patients of type 1 and type 2 diabetics and to correlate the levels with pattern of diabetes.Cross-sectional analytical study.Diabetic Clinic of Shaikh Zayed Hospital, Lahore from August 2004 to April 2005.Blood samples were collected from 163 subjects (51 of type 1, 61 of type 2 diabetics and 51 non- diabetic controls) and sera were separated. They were all clinically euthyroid and selected conveniently. Thyroid profile (FT4, TSH and anti-TPO) was assessed in the three groups and compared.It was observed that at a cut off value of less than 100 units of anti-TPO level was normal, raised anti-TPO antibodies were found in 12% of normal control group, 61% in type 1 and 42.3% in type 2 diabetics. In type 1 diabetics, the TSH was higher in the younger age patients with progressive rise in anti-TPO antibodies level by age. The TSH, anti-TPO antibodies and BSF were significantly higher in type 1 diabetics than in the controls. In type 2 diabetics, TSH was moderately low but anti-TPO antibodies and BSF were higher than in the controls.Thyroid autoimmune process seems to be correlated more with type 1 diabetic patients than with type 2 patients.

To assess the prevalence of Thyroid peroxidase (TPO) auto antibodies among pregnant women and its relation with their pregnancy outcome.Cross-sectional analytical study.The study was carried out at Zayed Medical Complex, Lahore, in the department of Obs/Gynae and NHRC from July 2000 to July 2002.The study included 1,500 Euthyroid pregnant women, ages 18 - 40, registered for antenatal care at Obs/Gynae department. Previous fertility history was recorded and thyroid peroxidase antibody level was assessed by ELISA method. A cut off value of TPO antibody of upto 100 U/ml was considered negative and more than 100 U/ml was considered positive.The cases were followed for the outcome of their pregnancy and compared with TPO antibody levels. A comprehensive proforma was used to collect the data.The prevalence of positive TPO autoantibodies was found to be 11.2%. The raised TPO autoantibodies were found to have higher risk of abortion (O.R 49.2) and prematurity (O.R.8.1). The complications were found to be significantly raised among positive TPO autoantibodies cases, when analysed by parity and age of mother at time of registration.Thyroid autoimmune diseases among euthyroid pregnant women may contribute to low-birth-weight of neonates and high abortion rate in all pregnancies. Raised levels of TPO autoantibody is a good marker to assess early hypothyroidism state and should form a screening modality in Pakistan.

To find out the role of microalbuminuria as an indicator of kidney function among diabetics.Comparative study.Diabetes control clinic of Shaikh Zayed Hospital, Lahore, a tertiary care hospital, was the venue. The study was conducted during March 2002 to August 2003.Timed overnight urine samples were collected from all subjects and albumin was estimated using Radioimmunoassay (RIA) method. Albumin excretion rate (AER) was assessed in three groups including normals, Type 1 and Type 2 diabetics. AER over 30 microg/min was considered as significant.A significantly higher proportion of AER was observed in both types of diabetes. A higher proportion of increased AER was observed in females of Type 2 diabetics.The study has indicated that irrespective of the duration and type of diabetes the damage to the kidney can be avoided if good glycemic control is achieved.