Assessment of thyroid dysfunction in children with celiac disease

Celiac Disease [CD] is an immune response to ingested wheat gluten and related proteins of rye and barley that leads to inflammation, villous atrophy and intestinal crypt hyperplasia. 1,2 CD was considered as a rare malabsorption syndrome in the previously that can only occur in children, now it is a common condition that may be diagnosed at any age.3 The aim of this study was to assess the thyroid functions in Celiac Disease patients by measuring serum levels of free thyroxine [fT4] and thyroid stimulating hormone [TSH]. Anti thyroid peroxidase antibodies [Anti TPO] were also measured to assess the autoimmune nature of thyroid disease. Patients and Methods: It was an analytical cross sectional study, on 50 patients of celiac disease and 25 apparently healthy non celiac children were included in the study. CD patients were already diagnosed by elevated levels of serum anti tissue transglutaminase [IgA class] antibodies [>15X ULN]. CD was ruled out in control group by normal levels of serum anti tissue transglutaminase [IgA class] antibodies. TSH and fT4 were performed on Vitros ECIQ immunodiagnostic system and anti-TPO Antibodies were performed by manual ELISA technique. Mean age of the patients included in the study was 5.3 +/- 3.3 [range, 1.5-13] years. Mean age of individuals in control group was 5.8 +/- 2.5 [range, 2.0-12] years. Statistically significant increase levels of TSH and Anti TPO Antibodies were observed in the patient group. No statistically significant difference was observed between means of fT4 in patients and control group. Subclinical hypothyroidism was noticed in 10% patients of celiac disease while anti TPO Antibodies were positive in 16% patients. The present study showed an increased occurrence of thyroid dysfunction and serological evidence of thyroid autoimmunity in patients with CD. Assessment of thyroid function in patients of celiac disease is recommended at regular intervals

Incidence and etiology of neonatal seizures

To determine the incidence of seizures in admitted neonates and establish the etiological diagnosis. During the study period, 4.8% [97 cases] cases among admitted neonates, having seizures either at presentation or during their stay in the hospital, were included. Hypoxic ischemic encephalopathy was found to be the commonest cause [44.3%] of neonatal seizures, followed by hypoglycemia [19.5%] and hypocalcemia [12.3%] cases. Subtle seizures [41.2%] were the most frequently observed type of seizure, followed by tonic [32.9%] and clonic [20.6%] seizures. Nearly 55% cases had seizures during the first 48 hours of life. Cases of hypoxic ischemic encephalopathy were associated with higher mortality [39.5%] as compared to cases with metabolic seizures. Neonatal seizures were found as a common neurological disorder and presented most commonly as subtle type. Birth asphyxia was the commonest aetiology of neonatal seizures, followed closely by the metabolic seizures

Haematological screening in diagnosis of neonatal sepsis

Neonatal sepsis is a clinical syndrome haracterized by bacteremia and clinical symptoms caused micro-organisms or their toxic products Diagnosis is confirmed by growth of micro-organisms in body fluid cultures. When available, blood culture positivity is approximately 40% and takes as long as 48-72 hours. In order to determine the predictive value of simple to performs hematological tests for neonatal sepsis, a prospective randomized study was carried out in 100 neonates who had strong clinical suspicion of sepsis. Thirty normal neonates served as controls Role of TLC, DLC, Absolute Neutrophil Count ANC, I:T ratio, platelet counts and degenerative morphological changes was determined. Out of 100 clinically suspected cases, 40 neonates were proved to be septic by blood culture and 60 neonates were of probable sepsis [strong clinical suspicion despite negative culture]. An abnormal ANC was found to be the most sensitive [67%], single parameter for prediction of neonatal sepsis followed by elevated LT ratio and thrombocytopenia Derangement of either ANC or I:T ratio had sensitivity of 80% higher sensitivity was found in cases of late onset sepsis. Combination of abnormal ANC and elevated I:T ratio scents reasonable as a surrogate parameter for neonatal sepsis especially in the late onset type