Molecular occurrence of canine babesiosis in rural dog population in Pakistan

@#Canine babesiosis is an important tick-borne protozoal disease of dogs that poses major health problem worldwide. Farm dogs in rural areas are the companion animals, that not only watch the livestock herds but also guard the house of the owners. Each farmer keeps his companion dog to get all the services. In our study, a total of 450 blood samples of farm dogs from three different ecological zones (Southern, Central and Northern regions of the province; Punjab) of Pakistan, were collected to examine through microscopy and PCR. Examination of thin blood smears revealed an overall prevalence of 12.8% (58/450) of canine babesisal parasites. However, PCR analysis revealed 46.8% (211/450) and 7.3% (33/450) samples positive for B. gibsoni and B. vogeli, respectively. The amplicons of 671 bp and 590 bp were amplified for the detection of B. gibsoni and B. vogeli, respectively through PCR. The results of multivariate analysis showed that the occurrence of canine babesiosis is higher in the Central Punjab and younger age of the dogs, while breed and sex of the host were not significantly associated with the occurrence of the disease. Mixed infection of B. gibsoni and B. vogeli was observed only in 3 dogs each in district Kasur and Rawalpindi. Our study is the first report to observe the occurrence of canine babesiosis in rural dogs in Pakistan through PCR.

Studies on self-nanoemulsifying drug delivery system of flurbiprofen employing long, medium and short chain triglycerides

The aim of the study was to successfully design, formulate and evaluate self-nanoemulsifying drug delivery system [SNEDDS] of poorly aqueous soluble drug viz. flurbiprofen using long [LCT], medium [MCT] and short chain triglycerides [SCT]. The SNEDDS are thermodynamically stable lipid based drug delivery systems which consist of mixture of oil, surfactant and co-surfactant. Upon aqueous dilution, this mixture produces nano-emulsion spontaneously on slight agitation. The excipients intended to be used were screened for their potential to dissolve the drug and to form clear dispersion upon aqueous dilution. Labrafil M 1944 CS, capryol-90 and triacetin were selected as long, medium and short chain triglycerides, respectively, as lipids while tween-80 and polyethylene glycol-400 [PEG-400]/ethanol [3:1 ratio] were selected as surfactant and co-surfactant, respectively. The excipients were studied at every possible combination ratios using pseudo-ternary diagram. The LCT, MCT and SCT-SNEDDS were optimized using thermodynamic studies, percentage transmittance value, viscosity, refractive index [RI], electrical conductivity, globule size analysis and in-vitro drug release studies. The drug release profiles of optimized SNEDDS were then compared with market product at different pH mediums. The LCT-SNEDDS was considered to be superior for enhancement of the drug bioavailability when compared with other SNEDDS formulations and market product

Validation and application of high performance liquid chromatographic method for the estimation of metoclopramide hydrochloride in plasma

The objective of this study was validation of a reverse phase HPLC method for the estimation of metoclopramide HCl in plasma already validated for determination of metoclopramide HCl in tablets dosage form. A reverse chromatographic method was used for estimation of metoclopramide HCl with the mobile phase of acetonitrile, 20mM potassium dihydrogen phosphate buffer solution [pH 3.0 adjusted with orthophosphoric acid] in the ratio of 40: 60. The column used was Waters C18 3.9x300mm micro Bondapak [RP]. The flow rate of the mobile phase was 2ml/ minute. The detector was set at the wavelength of 275nm. This method validated in plasma and was found to be linear, with correlation coefficient [R[2]], value of 0.9988, in the range of 48 ng/ml-0.25ng/ml. The method modified was accurate, precise, sensitive and showed good stability results. The % RSD of the retention time and peak area of metoclopramide HCl was 0.19% and 1.44% respectively. All the parameters such as specificity, linearity, range, accuracy, precision, system suitability, solution stability, detection and quantification limits were evaluated to validate this method and were found within the acceptance limits. The method can be effectively used for estimation of metoclopramide HCl in plasma

Prophylactic use of gabapentin to reduce postoperative nausea and vomiting in patients undergoing diagnostic gynecological laparoscopy

Introduction: Postoperative nausea and vomiting [PONV] occurs in patients during the first 24 hours of the surgery. Many drugs have been used for the prevention and treatment of PONV. In this trial, we used gabapentin to evaluate its prophylactic effect in reducing the severity and incidence of PONV in patients undergoing diagnostic laparoscopic gynecological surgery

Methodology: This, double blind randomized controlled trial, was done in operation theatre complex over a period of six months. 140 patients undergoing diagnostic gynecological laparoscopic surgery were selected. Two groups were formed and 70 patients were recruited in each group using lottery method as method of randomization. Group C [control group] was given placebo medication orally two hours before surgery and group G [gabapentin group] received 600 mg of gabapentin orally two hours before the procedure. Standard general anesthesia technique was used in all patients and incidence and severity of postoperative nausea and vomiting [PONV] was recorded in these patients till 24 hours of laparoscopy

Results: Severity of PONV was graded from mild to severe. There was no PONV in 25 patients [35.7%] in group C and 47 patients [67.1%] in group G. It was mild in severity in 8 patients [11.4%] in group C and 5 patients [7.1%] in group G, moderate in 31 patients [44.3%] in group C and 15 patients[21.4%] in group G and severe PONV was seen in 6 patients [8.6%] in group C and 3 patients [4.3%] in group G [P=0.003]. Postoperative nausea and vomiting within 24 hours after procedure was present in 45 patients [64.3%] in group C and 23 patients [32.9%] in group G. Results were significant between two groups after statistical analysis with p value of 0.001

Conclusion: Administration of 600 mg of gabapentin two hours before diagnostic gynecological laparoscopy decreases the frequency and severity of PONV

Frequency of positive exercise tolerance test for silent myocardial ischemia in asymptomatic uncomplicated type 2 diabetic patients

Objective: To determine the frequency of positive exercise tolerance test [ETT] for silent myocardial ischemia in asymptomatic uncomplicated type 2 diabetic patients

Study Design: Descriptive- cross sectional study

Place and Duration of Study: Department of medicine, Pakistan Navalship [PNS] Shifa Karachi from November 2011 to May 2012

Material and Methods: A total of 135 patients with type 2 diabetes mellitus of more than five years duration were included in the study without any history of chest pain and having no evidence of complications [neuropathy, nephropathy, retinopathy] using non probability-consecutive sampling technique. Relevant history and investigations were done to exclude other risk factors for ischemic heart disease such as smoking, obesity, hyperlipidemia and hypertension. ETT was used as the main tool to detect silent myocardial ischemia. Data was collected through a pre-designed proforma and analyzed using SPSS version 11

Results: The study revealed that frequency of positive ETT for silent myocardial ischemia in uncomplicated asymptomatic type 2 diabetic patients was 35.56% [n=48] while 64.44% [n=87] had no findings of silent myocardial ischemia

Conclusion: The frequency of positive ETT for silent myocardial ischemia in our study was 35.56%. Thus, ETT being non-invasive should be performed as a preliminary investigation for detection of silent myocardial ischemia in every patient of type 2 DM of more than 5 years duration

Diagnosis of hydatid cyst parotid gland by fine needle aspiration cytology [FNAC]

Fine Needle aspiration of parotid gland swellings is commonly done as a first line investigation. Fine needle aspiration of one such cystic lesion in a 45 years old female was performed. The cytopathological appearance of the aspirate turned out to be typical of Hydatid Cyst. The case is reported with review of literature

Frequency of undiagnosed hypertension in patients presenting with stroke

Objective: To determine the frequency of undiagnosed hypertension [HTN] in patients presenting with stroke

Study Design: Descriptive cross sectional study

Place and Duration of Study: Department of medicine, Combined Military Hospital [CMH] Kohat from June 2011 to June 2012

Material and Methods: A total of 190 patients with stroke were included in the study with non-probability, consecutive sampling. Written informed consent and demographics of patients were obtained and permission of the hospital ethical committee was taken. Detailed past history was obtained especially focusing on whether a known hypertensive patient or using any antihypertensive medication. All the patients were subjected to detailed physical examination. Blood pressure [BP] was measured by using standard mercury sphygmomanometer on two different occasions 10 minutes apart and the patient was labeled as hypertensive if both readings showed equal to or more than 140/90mmHg of blood pressure

Results: The mean age of patients was 46.31 +/- 15.30years. There were 126 [66.3%] males and 64 [33.7%] females. The mean systolic BP of patients was 125.59 +/- 19.97mmHg while diastolic BP was 86.32 +/- 12.62 mmHg. In this study, there were 64 [33.7%] cases who had undiagnosed HTN before stroke. The difference was insignificant among different age groups and both genders [p-value>0.05]

Conclusion: The frequency of undiagnosed HTN is high in patients presenting with stroke which calls for a proper screening program to diagnose and treat HTN at early stage to prevent such deadly complications

Transabdominal and transvaginal repair of vesicovaginal fistula

Objective: To evaluate the results of surgical repair of VVF through transabdominal and transvaginal routes

Study Design: Prospective study

Place and Duration of Study: This study was carried out in Teaching Hospital, Ghazi Khan Medical College, DG Khan from June 2009 to May 2014

Patients and Methods: Total 26 patients of VVF with age range of 22-60years were included in the study.Fistulas had two types, simple and complex, according to site, size and aetiology . Simple VVFs were repaired through the vaginal route and complex ones through abdominal route. Patients were assessed at an interval of twoto three weeks to start with, twice after three-months and thereafter depending oncomplaints

Results: Sixteen [61%] patients had simple fistulas, while 10 [38%] patients had complex fistulas and one of the patients had complex fistula associated with rectal communication who was excluded . The most common cause was trauma during obstructed labour in 12[47%] patients, whereas the other common cause was hysterectomy. Sixteen [61%] patients were approached through transvaginal route, out of them 9 had supratrigonal and 7 trigonal fistulas. Ten [38%] patients with complex fistulas were approached by abdominal route. Duration of the surgery, blood loss, pain after surgery and stay in hospital was found to be shorter in transvaginal surgery. Two patients have failed repair with significant complications, a success rate of 92% was achieved. At a follow-up of one year 24 women had uneventful, active sexual life while 2 of them had some degree of pain during sexual intercourse

Conclusion: It's concluded that both the routes of VVF repair has a similar successrate

Changes in P-wave amplitude and axis after treatment of chronic obstructive pulmonary disease exacerbation

To compare the change in P-wave amplitude and axis before and after 24 hours of the treatment of chronic obstructive pulmonary disease exacerbation.Quasi-experimental study. Department of medicine, PNS Shifa Karachi from Dec-2010 to June-2011 [six months]. A total of 93 subjects were included in the study. Their pre-treatment and post treatment ECGs were evaluated by measuring P-wave amplitudes in leads II and aVF and P-wave axes were calculated. The differences in terms of changes in P-wave amplitude and axis were compared. Mean age of patients was 53.09 +/- 7.20 years. Before treatment P-wave amplitude in lead II was 2.36 +/- 0.34 mm and after treatment it was 1.73 +/- 0.29 mm [p < 0.001]. P-wave amplitude in lead aVF before treatment was 2.446 +/- 0.334 mm while after treatment it was 1.556 +/- 0.329 mm [p < 0.001]. P-wave axis before treatment was 72.67[degree] +/- 4.67[degree] and after 24 hours of treatment it was 63.75[degree] +/- 3.95[degree] [p < 0.001]. Sigruficant changes in terms of reduction of P-wave amplitude and left ward rotation of P-wave axis occur after effective treatment of acute exacerbation of COPD. These findings provide valuable objective evidence in evaluating patient's response to treatment and recommended to be used in clinical practice

Lidocaine 4% spray is better than intracuff lidocaine 2% for reducing the incidence of post-extubation cough in patients undergoing total abdominal hysterectomy

Cough at extubation and postoperative sore throat are common complications in patients receiving general anesthesia with trachea! intubation. Different strategies have been used to reduce these effects. In this double blind controlled trial, we evaluated the effects of lidocaine sprayed onto the larynx and injected into tracheal tube cuff to decrease the incidence of cough at extubation and postoperative sore throat in patients undergoing total abdominal hysterectomy [TAH] under general anesthesia. One hundred women, aged 40-60 years, scheduled for TAH under general anesthesia were included in this randomized double blind prospective study. After induction of general anesthesia, just before tracheal intubation, glottus was sprayed by 4% lidocaine or 0.9% saline through a syringe with 4 ml volume. After tracheal intubation, the tracheal tube cuff was filled with 4 ml of 2% lidocaine solution or 0.9% saline. In this way four groups were formed; spray-cuff group [lidocaine spray and lidocaine in cuff], spray-saline group [lidocaine spray and saline in cuff], saline-cuff group [saline spray and lidocaine in cuff], and saline-saline group [saline spray and saline in cuff], having 25 patients in each groups. The primary outcome was the incidence of cough at extubation. The incidence and severity of sore throat was recorded at 15 min, 60 min and 24 hrs post-extubation using visual analogue scale [VAS, 0=no pain, 10= worst pain imaginable] as a secondary outcome. All patients completed the study. Cough was noted in 20%, 16%, 76%, and 84% of patients in the spray-cuff group, spray-saline group, saline-cuff group and saline-saline group respectively. The spray of lidocaine onto the larynx resulted in decreased incidence of cough at extubation [P value < 0.001]. But the intracuff lidocaine did not show any decrease in the occurrence of cough or reduction in the incidence and severity of sore throat as it remained low in all groups. Use of lidocaine spray onto the larynx resulted in significantly decreased incidence of cough at tracheal extubation in patients undergoing TAH. However, the use of lidocaine into endotracheal tube cuffs had no effect on the incidence of cough or sore throat

Pattern of skin malignancies in patients presenting to dermatology department Hayatabad Medical Complex Peshawar

This study was conducted to determine the pattern of cutaneous malignancies among patients attending the skin out-patient department Hayatabad Medical Complex Peshawar. This was descriptive analysis of skin cancers carried from January 2011 to December 2011. Histologically diagnosed skin cancers were reviewed and analyzed according to age, gender, site of distribution and histological types. Hundred histologically diagnosed skin malignancies were reported during the period under review. Sixty cases [60%] were males and 40 cases [40%] females with a male to female ratio of 1.5:1. Age ranged from 22 years to 86 years. Mean age was 57.05 +/- 11.39 SD. Mean duration of disease in months were 16.78 +/- 9.07SD. Basal cell carcinoma [BCC] was the most common malignancy consisting of 32[32%] cases followed by Squamous cell carcinoma [SCC 18%] with 10 [10%] cases of melanoma and 9[9%] cases of Mycosis Fungoides. Actinic Keratosis, Kaposi's sarcoma, Bowen's disease, Dermatofibroma, Atypical fibroxanthoma constituted the remaining. The most common skin malignancy was BCC followed by SCC and melanoma. Larger studies should be conducted to ascertain the actual prevalence of skin tumors

Safety of ultrasonic dissection versus conventional electrocautery dissection during laproscopic cholecystectomy in terms of gall bladder perforation

To compare the safety of ultrasonic and electrocautery method of dissection in terms of gallbladder perforation. This randomized controlled trial included 128 patients, which were divided into two groups, ultrasonic dissection [A] and electrocautery dissection [B]. GB perforation [if any] was noted intraoperatively, and all the data was recorded on a structured questionnaire. Data was analyzed using SPSS. The incidence of GB perforation was significantly lower in ultrasonic dissection [10.9%] than electrocautery methods of dissection [29.7%], hence the safety of ultrasonic dissection in terms of gallbladder perforation, was significantly higher than electrocautery dissection [89.1% vs. 70.3% p-value=0.007]. Ultrasonic dissection is safer modality of dissection in terms of gall bladder perforation and its use should be encouraged as routine method of dissection during LC

Safety of single layer continuous extra mucosal gut anastomosis in emergency

To evaluate the safety and complications of a single layer continuous extra mucosal gut anastomosis in emergency. This descriptive study was conducted in emergency department of Lady Reading Hospital Peshawar over a period of ten months from September 2007 to July 2008. Study comprised of fifty consecutive patients after fulfilling the inclusion and exclusion criteria. The safety of anastomosis technique was analysed by postoperative complications of morbidity and mortility. Among 50 patients 80% were male and 20% were female, mainly young adults. Patients with anastomotic leakage were 8%. The rate of wound infection was 34%. Mean hospital stay was 7.22 days. Mortality was 8% due to septicemia and hypovolemic shock. Single layer continuous extra mucosal anastomosis is safe and with less anastomosis-related morbidity and mortality

Radiological evaluation of the stability of crossed-pins versus lateral-pins fixation in displaced supracondylar fractures of humerus

To compare the radiological evaluation of stability of closed reduction of supracondylar fractures of humerus treated by percutaneous two-crossed-pin fixation and 2-lateral pin fixation. Randomized controlled trial. Orthopedic Unit Hayatabad Medical Complex Peshawar, from January 2008 to July 2009. Fifty patients with displaced supracondylar fracture of humerus presented between ages 1-12 year were randomly allocated in two groups of 25 patients each and were subjected to crossed-pin fixation and 2-lateral pin-fixation. Primary outcome measure was determined with the help of Baumann angle. Secondary outcome measure was determined with the help of Metaphyseal-Diaphyseal [MD] angle. Mean age of patients was 7.02 +/- 2.25 year. Mean loss of Baumann angle and Metaphyseal Diaphyseal angles were 5.360 +/- 2.220 and 2.420 +/- 1.250 respectively. The mean Baumann angle loss in the two cross pins fixation group and the 2-lateral pins fixation group were 5.56° +/- 1.80° and 5.16° +/- 2.64° respectively. The mean MD angle loss in the two crossed pins fixation group and the 2-lateral pins fixation group was 2.440 +/- 1.220 and 2.400 +/- 1.230 respectively. When loss of Baumann and Metaphyseal-Diaphyseal angles were compared between two methods of fixation using Student t test, no significant difference in the stability of two methods of pin fixation was observed. Radiological analysis showed that both the techniques were effective in terms of stability

Effect of gabapentin on opioid requirements in patients undergoing total abdominal hysterectomy

Gabapentin possesses antihyperalgesic and antiallodynia properties and has a definite role in neuropathic pain relief. In this study, we tried to determine whether preemptive use of gabapentin can result in reduction of intra and postoperative pain and narcotic [nalbuphine] requirements in patients undergoing total abdominal hysterectomy [TAH]. In this randomized, double-blind controlled trial, 35 patients [study group] undergoing TAH received gabapentin 1200 mg and 35 patients [control group] received placebo orally two hours before induction of anesthesia. Intra-operatively, an increase in blood pressure and heart rate were taken as an indicator of pain during surgery and nalbuphine at 0.05-mg/kg body weight was administered as a rescue analgesia. Postoperatively, for the initial 24 hours, pain was assessed on a Visual Analogue Scale [VAS score 1-10, score 1-3 considered mild pain, 4-7 moderate pain and 8-10 as severe pain]. If score was more than 3 a top up dose of nalbuphine 0.05 mg/kg was administered intravenously. Total nalbuphine consumption during the intraoperative period and initial 24 hours postoperative period was recorded for each patient. Thirty four patients in the gabapentin group [study group] and 35 patients in the Placebo group [control group] completed the study. Overall, pain scores in the gabapentin group were significantly lower as compared to the Placebo group. The total nalbuphine consumption was 13.2 +/- 4.7 mg [mean +/- SD] in the gabapentin group versus 24.3 +/- 9.2 mg in the Placebo group [P < 0.001]. Preemptive use of gabapentin resulted in reduction of intra and postoperative narcotic [Nalbuphine] requirements in patients undergoing total abdominal hysterectomy

External fixation: daily versus weekly pin site care

To determine whether there were any differences in the frequency and severity of pin site infections by performing pin site care daily or once a week. cross sectional descriptive study. This study was carried out at Department of Orthopaedics and Traumatology, Khyber Teaching Hospital, Peshawar during the period from Dec 2011 to Jun 2013. This study included 96 patients who were selected by convenient [non probability] sampling technique. Patients were divided into two groups. The mean infection rate during the study in group 1 was grade I in 16% and grade II in 7%, grade III in 1% versus grade I in 12% and grade II in 5%, grade III in 5% in group 2. No grade IV-VI infections were noted. Antibiotics were prescribed for a mean of 60 days [SD 15] in group 1 and 45 days [SD 30] in group 2. The relative risk [RR] of positive cultures at the proximal pin sites was 1.5 [95% CI 1.2-1.9] No difference was found between the groups. No differences between daily and weekly pin site care were observed as regards the severity of infections, frequency of infection rate, of positive cultures, except in week 6, and in use of antibiotics or analgesics

Short term effects of rosuvastatin on plasma concentration of high sensitivity c-reactive protein in patients with chronic stable angina

To determine the short term effects of rosuvastatin on elevated base line high-sensitivity C-reactive protein [hs-CRP] in patients with chronic stable angina. This Quasi-experimental comparative study was conducted in Cardiology department, Lady Reading Hospital Peshawar, between March 2010 and February, 2011. We selected 44 consecutive patients age 40 years or above, of any gender having hs-CRP levels >/= 1.2mg/l with chronic stable angina. Base line levels of hs-CRP, total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, and creatine phosphokinase [CPK] were measured in fasting status. These patients were treated with rosuvastatin 20 mg once daily at night and followed up for one month. Using SPSS version 16 data was analyzed. Mean age was 53 +/- 7.2 and 50% were females. Following treatment with rosuvastatin 20mg for one month the mean hs-CRP levels reduced from 4.08 +/- 2.56 to 2.72 +/- 2.40 [95%CI, 0.41 to 2.29, p=0.006]. Similarly mean total cholesterol levels decreased from 185.88 +/- 37.62 to 147.45 +/- 38.35, [p=0.0001]. LDL cholesterol decreased from 118.34 +/- 31.31 to 86.63 +/- 35.72 [p= 0.0001]. But mean HDL cholesterol had no significant increase from baseline levels i.e. from 32.18 +/- 9.93 to 33.95 +/- 7.65 [p=0.174]. TGs levels reduced from 240.11 +/- 123.66 to 197.43 +/- 88.24 [p=0.008]. Mean CPK levels did not differ significantly from base line at follow up, from 101.43 +/- 58.63 to 96.22 +/- 55.10 [p=0.646]. Short term treatment with rosuvastatin significantly decreases elevated hs-CRP levels in patients with chronic stable angina

Follicular dendritic cell sarcoma of the neck with pulmonary metastases

We present a case of follicular dendritic cell sarcoma in a 48 years old Saudi female who reported with slowly progressive right sided extranodal neck mass associated with pulmonary metastasis. Clinical examination, histopathologic features including distinct immunostains combine together to make the rare diagnosis of follicular dendritic cell sarcoma. This entity is often misdiagnosed due to non-consideration in differential diagnosis of sarcoma. It carries a significant potential for regional as well as distant spread and hence categorized as intermediate risk malignancy. Clinical, histopathological and immunohistochemical aspects and therapeutic options of this unusual case are discussed

Relationship between sialic acid and microvascular complications in type 2 diabetes mellitus

Serum total sialic acid is a marker of acute phase response. Elevated levels have also been associated with several risk factors for diabetic vascular disease

Objective: to study relationship between sialic acid and metabolic variables in type 2 diabetic patients with and without microvascular complications

Material and Methods: this study included 200 subjects of which 50 were of diabetes mellitus with nephropathy 50 patients of type 2 diabetes mellitus with retinopathy50 patients of type 2 diabetes without any complication and 50 healthy individuals without diabetes mellitus. [Control subjects]. Tl1e subjects aged 15-60 years were selected for study. Fasting venous blood samples were taken from all these 200 subjects. Simultaneously urine sample were also collected from each of them. All blood samples were analyzed for fasting and postprandial glucose, total cholesterol triglyceride [TG], low .density lipoprotein [LDL], high density lipoprotein [HDL], creatinine, HbAlc on fully automated analyzer. Serum and urine sialic acid along with micro albumin levels were also estimated

Results: serum total sialic acid concentrations were significantly higher among all diabetic subjects with or without complications compared to control subjects. In diabetics patients there was a significantly increasing trend of serum and urinary sialic acid with severity of nephropathy [P<0.001] and with degree of urinary albumin excretion [p<0.001]. Elevated serum sialic acid concentrations were also associated with several risk factors for diabetic vascular disease: diabetes duration HbAlc, serum triglyceride, serum cholesterol, and HDL and LDL concentrations. Significant correlations were found between sialic acid concentrations and cardiovascular risk factors like LDL and TG in diabetic patients

Conclusion: the main finding of this study is that elevated serum and urinary sialic acid and micro albumin concentration were strongly related to the presence of microvascular complications like diabetic nephropathy and retinopathy and cardiovascular risk factors in type 2 diabetes patients

Maternal factors associated with intrauterine growth restriction

Intrauterine growth restriction is a major neonatal health issue. Maternal factors have been found to have greater impact on IUGR. Studying these factors can help in reducing the mortality and morbidity associated with IUGR. This Case-control study was conducted at the department of Paediatrics Post-graduate medical institute Lady Reading Hospital Peshawar from March 2008-April 2009. Small-for-gestational age [SGA, i.e., IUGR cases and n=200] live born babies were compared with appropriate-for-gestational age [AGA, i.e., controls and n=200] babies. Information regarding socio-demographics of mothers, gestational age and birth weight of baby, maternal clinical characteristics, and medical and obstetric complications during pregnancy was recorded on a predesigned proforma. Data analysis was done through SPSS-16. To find the maternal factors associated with the intrauterine growth restriction, multivariable logistic regression was used. We also did two different sets of logistic regression analysis for Symmetric and Asymmetric SGA babies as Cases. After adjusting for other variables in the multivariable model we found that the mothers of IUGR babies were of younger age [OR=0.8, CI=0.7-0.9], were poor [OR=2.5, CI=1.4-4.4] and underweight [OR=3.5, CI=1.1-5.7] and had anaemia [OR=2.7, CI=1.3-5.4] in the index pregnancy, and had history of Previous IUGR birth [OR=9.7, CI=3.3-18.3] and placenta previa [OR=3.2, CI=1.1-6.6]. There was an interaction between pregnancy induced hypertension and parity of mother with a primary-para mother with pregnancy induced hypertension [PIH] having an increased risk for IUGR babies [OR=10.1, CI=1.0-23.2]. The studied factors need special attention in hospital based settings in order to improve the perinatal outcome in IUGR babies