The aim of this study was to determine the prevalence and complications as well as to correlate maternal and fetal outcome with glycaemic control, in a community of Pakistani women. This was a retrospective study of 6830 deliveries over a 5‐year period in a tertiary care hospital in Karachi. Either a 75 g glucose tolerance test or a screening 50 g glucose challenge was administered depending on risk factors for Gestational Diabetes Mellitus (GDM). Case records of deliveries during this period were analysed for presence of GDM or pre‐existing diabetes; glycaemic control and complications were ascertained for those with diabetes. During this period 267 (3.9 %) of the 6830 deliveries were identified as diabetic pregnancies. Of these 223 (3.3 %) had GDM and 44 (0.6 %) women had pre‐existing diabetes mellitus. Overall maternal complications were high; pre‐eclampsia (19 %), polyhydramnios (4.6 %), and threatened abortion (3.4 %). Fetal complications of macrosomia (13.1 %), intrauterine growth retardation (7.1 %), intrauterine deaths (5.3 %) were noted. Complications were higher in poorly controlled groups. We conclude that the prevalence of GDM in Pakistani women in our study was comparable to their Western counterparts but complication rates were higher, possibly due to poorer glycaemic control.

Heparin-induced thrombocytopaenia (HIT) is a life-threatening complication of exposure to heparin. It is mediated by autoantibodies to platelet factor-4 causing platelet activation, destruction and thrombosis. Given their rich arterial supply and a single central vein, the adrenal glands are particularly susceptible to congestive haemorrhage following venous thrombosis. We report a case of bilateral adrenal haemorrhage (BAH) associated with HIT following prophylactic use of unfractionated heparin for venous thromboembolism causing adrenal insufficiency. BAH is a life-threatening paradoxical complication associated with HIT, a prothrombotic state. The resulting adrenal insufficiency can lead to haemodynamic collapse if unrecognised. Early diagnosis, in the wake of vague symptoms, and prompt treatment primarily aimed at repletion of glucocorticoids and close monitoring of enlarging haemorrhage is of utmost importance. Likewise, early identification of HIT is important to prevent potential complications including adrenal haemorrhage.

The article highlights the pioneering efforts towards establishment of a family clinic as a model for provision of primary health care to the community at family level in Libya. Home visits were undertaken by health teams to introduce the clinic and record demographic and sociomedical data. Families were invited to attend the clinic for a complete health examination. It was largely a young population with an average family size of 7.1. The houses were generally overcrowded. The majority of the heads of families had no formal education or skilled occupation but 98.1% had gainful employment. The vital statistics of the population, though comparable to the national figures, reflect a better health status. The infant mortality rate of the reference population was 25.9 per 1000 live births compared with 32.8 for the whole of Libya. Most reproductive age women (81.5%) breast fed their children for six months or more and 4% used contraceptives. The overall morbidity rate was 255 per 1000 population and the morbidity pattern, with a predominance of infections, was typical of a developing country. Each case diagnosed during the survey was appropriately treated and those with chronic diseases are being followed up. It is felt that such family based comprehensive health care units will go a long way in providing primary health care throughout Libya.

Objectives: To determine the association of family structure and family environment with aggressive behavior of children (6-8years) in a rural community of Gadap town, Karachi, Pakistan Subjects and Methods: This is a questionnaire based cross sectional survey to determine the association of family structure and environment with aggressive behavior of children (6-8years). Aggressive behaviour is defined as sudden, explosive outbursts of anger and has been reported as a clinical problem in approximately 23% -40% of children in some communities. The information was collected by interviewing parents regarding their family structure, family environment and aggressive behavior of children in school and at home. This quantitative assessment was made on a validated Performa. The data was analyzed on SPSS windows version 16. Results:Total numbers of respondents were 384. The impact of aggressive behavior in children were anger 32.8%, violence 36.5%, lack of tolerance for minor disputes 32.3%, respectively. The reliability statistics table had the actual value for Cronbach's alpha at 89.1%. The association of aggressive behavior in children has been rooted in the family size in 34.4%, family type 27.6%, family environment 23.7% and intimate partner violence in 30.2%. Conclusion:One third of school children had aggressive behaviour directly related to family size and family environment in a rural area. The significant major risk factors were age, family size 34.4%, family type 27.6%, family environment 23.7% and intimate partner violence in 30.2%.