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: Acute viral hepatitis (AVH) in children is a serious and major public health concern globally and in developing countries such as Pakistan. We conducted this study to determine the clinical and epidemiological spectrum of AVH due to hepatitis A virus (HAV) and hepatitis E virus (HEV) infection in children.Methodology: This cross-sectional study was conducted at the Pediatric Medicine Department of a tertiary care hospital from February 20, 2020, to February 20, 2022. A total of 200 children 1-12 years of age who presented with symptoms and signs of AVH were enrolled. Demographic and clinical characteristics were noted, and venous blood was drawn for the assessment of HAV IgM and HEV IgM using an enzyme-linked immunosorbent assay (ELISA). Descriptive statistics are run, and the results are presented as tables.Results: Of the children, 75% were diagnosed with acute HAV infection. The median duration of illness was six days (range: 2-21 days). The most common age group affected was 6-10 years (43.5%), of which 56.5% were males. Most of the children belonged to low and middle socioeconomic status (86.5%), and 41.5% consumed underground water for drinking. Fever was the most common symptom, followed by appetite loss and yellow discoloration of urine. Alanine aminotransferase (ALT) was significantly high in HEV compared to HAV infection (2060.2±1036.7 versus 1730.7±957.5 IU/L) (P=0.04). Conclusion: Acute HAV was more prevalent. Those who are male, 6-10 years of age, from lower and middle socioeconomic status, and using underground drinking water were more affected by acute viral hepatitis. The clinical and biochemical presentation of HAV and HEV did not differ significantly.

Background: Early neonatal deaths in Pakistan account for 7% of global neonatal mortality rate, with perinatal asphyxia being responsible for 23% of these cases. Controversy exists in the literature regarding role of magnesium sulphate administration on reducing in-hospital mortality in newborns with perinatal asphyxia. Objectives: To determine the effect of intravenous magnesium sulphate on in-hospital mortality in neonates with perinatal asphyxia. Methods: This prospective cohort study was conducted at the Department of Pediatric Medicine, Nishtar Hospital Multan over a period of six months from January 2022 to June 2022. A total of 183 consecutive full-term neonates, weighing ≥ 2500 grams, with Apgar score < 7 at 5-minutes after birth, presenting within 48-hours of life were included in the study. Neonates presenting within 6-hours after birth received intravenous magnesium sulphate (MgSO4) – exposed group and neonates presenting after 6-hours did not get MgSO4 – unexposed group. Baseline characteristics and survival outcome was recorded. Binary logistic regression analysis was run and Kaplan-Meier survival curve is constructed for the assessment of mortality. Results: There were 90 neonates in exposed group and 93 in unexposed group. Males constituted 53% of the study population. Overall mortality rate was 15.8% (n=29). Severe asphyxia (RR 8.5, 95% CI 4.0 – 18.0; p < 0.001) and spontaneous vaginal delivery (RR 1.8, 95% CI 1.1 – 2.9; p = 0.02) were the independent predictors of mortality. Mortality (7.8% vs. 23.6%, p-value 0.003) was significantly higher in unexposed group compared to exposed group. In exposed group the median survival time was 16 days (95% CI- 8.7 – 23.3) compared to 11 days (95% CI 9.9 – 12.0) in unexposed group (Log-rank test: χ2 = 6.03, df -1, p = 0.01). Conclusion: Magnesium sulphate was effective in lowering neonatal mortality due to moderate-severe perinatal asphyxia. In order to further validate its impact on mortality, multi-center studies are suggested.

Wilson disease is an autosomal disorder with wide-ranging clinical expressions. It mainly impinges on liver, brain, kidney and cornea. Objectives: The primary objective was to determine the frequency of Wilson disease; it’s clinical, biochemical features and outcome. The secondary objective was to compare children diagnosed with Wilson disease to those with non – Wilson etiology. Study Design: A comparative cross-sectional hospital-based study. Setting: Department of Pediatric Medicine Nishtar Hospital Multan. Period: From January 2017 to December 2017. Material & Methods: Children age 1 – 15 years presenting with hepatic manifestations (jaundice, bleeding, ascites and encephalopathy) were included in the study. Final diagnosis, clinical and biochemical features along with outcome were noted. We calculated mean and standard deviation for continuous variables and frequency and percentages for categorical variable. Results: Total 84 children with hepatic manifestations were admitted during study period. Mean age was 7.21 years (± 3.21). Males comprised 63.1% (53/84) of the study population. Wilson disease was diagnosed in 27 (32.14%) patients. Infective etiologies included Hepatitis A, B, C and E. Most common clinical presentation was that of chronic liver disease in 58.3% (49/84). Most common sign and symptom was Jaundice (97.6%).  Mean age was higher in children with Wilson disease compared to non – Wilson group (9.3 vs. 6.2). Mean serum ceruloplasmin in children with Wilson disease was 15.93 mg/dl (± 4.66) whereas mean urinary copper (µg/24 hr.) before and after Vistamine challenge were 131.1 (±47.66) and 1250.4 (± 194.43). Kayser – Fleischer rings were present in 11 (40.74%) children with Wilson disease. Mortality rate was 7.1 % (6/84) in study population and 11.1% (3/27) in children with Wilson disease. Conclusion: Wilson disease is not an infrequent diagnosis in our setup but has multiple masquerading presentations. A high index of suspicion is required to consider and investigate for Wilson disease as a possible and the treatable cause of hepatic manifestations.

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.