Aetiology and types of neonatal seizures presenting at ayub teaching hospital Abbottabad

Neonatal seizures [NS] affect approximately 1% of neonates. Clonic, tonic, myoclonic and subtle seizures are the common types. Birth asphyxia, sepsis, metabolic derangements, intracranial bleed, kernicterus, tetanus and 5[th] day fits are the common aetiologies. This study was planned to evaluate the types and causes of neonatal seizures. It was a descriptive case series conducted at Ayub Teaching Hospital, Abbottabad from 12[th] December 2006 to 25[th] September 2007 on eonates having seizures. Serum chemistry, blood counts, cerebrospinal fluid examination and cranial ultrasound were done in all patients. Blood culture, renal and liver function tests, computerised tomography scan, metabolic and septic screening was done in selected patients. Descriptive statistics were applied for analysis. Tonic clonic seizure was the commonest type [28%] followed by multi-focal clonic, and focal tonic seizures [25% each]. Birth asphyxia was found to be the main aetiology [46%].Tonic clonic seizure was the commonest type and birth asphyxia the main aetiology identified in the majority of neonatal seizures.

Hypoxic ischemic encephalopathy in neonates

Birth anoxia remains an important cause of mortality and morbidity in neonates. Hypoxia/ischemia can lead to permanent brain damage and also affects other tissues of the body. It results from lack of oxygen before, during or after birth. The study was designed to assess the risk factors of birth asphyxia, common presentations and association of Apgar score with grades of hypoxic-ischemic encephalopathy. The study is descriptive, prospective and carried out in the Paediatric Department of Ayub Teaching Hospital, Abbottabad from September 2007 till September 2008. A total number of 181 neonates [144 males and 37 females] who showed the neurological signs of hypoxic-ischemic encephalopathy were included in the study. Maternal history was taken, Apgar scoring was done and neurological grading was done for the assessment of brain damage. Out of 181 neonates 77.9% were full term, 8.8% were premature, 5.2% were having intra uterine growth retardation and 6.1% were post mature. 38.7% were diagnosed as having grade-3, 38.7% as grade-2 and 22.6% as grade-1 encephalopathy. Mortality due to hypoxic ischemic encephalopathy in our unit was 16%. 52.5% of the mothers were primigravida, 50% of the multigravid mothers had history of perinatal deaths, and 6.1% had ante-natal examination. Antenatal factors like lack of antenatal examinations, toxaemia of pregnancy and prolonged labour were major contributors to the mortality of neonates. Primigravid mothers, maternal anaemia, lack of antenatal examination, toxaemia of pregnancy and prolonged labour were the major contributors to the hypoxic ischemic encephalopathy. Early recognition of the risk factors and public health awareness needs to be addressed. Improvements in maternal health and regular antenatal checkups should be emphasised

Haematological findings in relation to clinical findings of visceral leishmaniasis in Hazara division

Visceral Leishmaniasis [VL] has worldwide distribution including Pakistan. The disease is characterized by a spectrum of clinical features along with serious complications in untreated cases. This study describes the correlation between clinical manifestations with haematological changes of VL in Hazara Division. This cross sectional study was carried out in the children wards of Women and Children Hospital an Ayub Teaching Hospital Abbottabad. Seventy cases were included in this study, Sign, symptoms, complications and haematological parameters were recorded in detail and their comparison was carried out. Majority of the patients [98.57%] presented with fever followed by abdominal distension [47%] Pallor, [44%] weight loss [43%] diarrhoea [17%], vomiting [15%] and epitasis [8%] and hepatosplenomegaly was found in about 83% along with lymphadenopathy [20%] purpura [13%] and peripheral oedema [11%]. Laboratory findings revealed anaemia in all the cases followed by neutropenia 43%, lymphocytosis 86% with thrombocytopenia 79%. Bone marrow in most of these cases showed myeloid hyperplasia with increased megakaryocytosis. There exists a new focus of visceral leishmaniasis in Hazara Division. The disease mainly affects children below 5 years and is more common in males than in female children. Bone marrow examination provides a reliable and simple tool for diagnosis of visceral leishmaniasis and the condition can be affectively managed with Sodium stibogluconate or meglumine antimoniate