New perspectives in the management of hypertension: role of herbal medicines

To compare the efficacy of coded herbal medicine [Hyprol] and losartan in hypertensive type II diabetic patients. Case control study. This study was carried out at the Out-patient Department of JPMC, Karachi and Herbal Clinics of Karachi from January 2014 to June 2014. This study is a case control prospective study to compare the effects of Losartan with herbal medicine [Hyprol] in type 2 diabetic hypertensive patients. 200 patients were enrolled and divided in two groups [A] [Control group] and [B] [Test group] treated with Losartan and Hyprol respectively. With ARB [Losartan] baseline to final change for SBP as well as DBP was significantly reduced i.e. 22.45% [p<0.001] and 16.84% [p<0.001] respectively and FBS was reduced by 21.85% [p<0.001] while Hyprol shows comparable results i.e. difference in SBP, DBP and FBS was 14% [p<0.001], 15.31% [p<0.001], 34.57% [p<0.001] respectively. ARBs are the first line drug of choice for hypertension since long time. Use of herbal medicine is an alternative mean of therapy to treat these patients and limit its cardiovascular and renal complications

Clinical evaluation of coded herbal medicine [hypoess] and angiotensin receptor blocker [candesartan] in essential hypertensive patients

The basic aim of this research study was to determine the comparative effect of herbal treatment in comparison with standard allopathic medicine in control and treatment of essential hypertensive patients. Prospective and comparative study. This study was carried out in Department of Pharmacology, HCM and D, FH and MS, Hamdard University, Karachi, from January 2014 to July 2014. A total of 200 patients were enrolled in study and were given Hypoess in one hundred patients while remaining one hundred patients received allopathic medicine Candesartan. In test group one hundred patients were treated with herbal drug [Hypoess] and it decreased mean systolic blood pressure of study patients with a decrease of 15.17% whereas, a reduction of 20.56% was found with allopathic medicine Candesartan Cilexetil. Similarly a decrease of 18.07% was found in mean diastolic blood pressure with herbal medicine in test group patients and a decrease of 21.65% was observed in case of allopathic drug in mean diastolic blood pressure of control group patients. The effects of herbal medicine were found statistically significant in controlling blood pressure and it has been found as an alternative option to treat essential hypertensive patients with its cost-effectiveness

Gender Wise HIV Disease Awareness among Primary School Teachers in Islamabad

To assess the level of awareness and methods of primary prevention about HIV/AIDS among primary school teachers. A descriptive cross-sectional study of 60 male and female teachers, between 25-40 years of age, teaching for at least three years in public and private schools situated in suburb of Islamabad, was conducted using a structured questionnaire. A stratified random sampling design was used to collect data. Analysis was done on SPSS version 17. The study was conducted at Golra Station suburb in Islamabad from October 2012 to December 2012. 77 percent respondents have heard about the AIDs, 40 percent believe that they should not quit good relations with the AIDs Patient, 88 percent believe it is our moral obligation to help the aids victims, 50 percent believe AIDS is a major issue, and same strength responded that it is not their problem. Most of the respondents believe that AIDS is a preventable disease. Majority of the respondents are of the opinion that Government is not solely responsible to control AIDS, all the stake holders must participate in the control of AIDS. It is inspirational to know that majority has knowledge relating to HIV/AIDS. The study emphasizes the need to educate the teaching community about the prevention methods and to endow them with the crucial information and skills to facilitate them to inculcate knowledge to the younger generation at a younger age group as this can challenge the moral and ethical issue relating with the sexual spread of AIDS. However, taboos of public discussions of sexual illness remain a key limitation towards preventive activities

observe the role of angiotension receptor blocker losartan in treating prehypertension

The primary objective of the present study was to determine whether in patients with prehypertension six months of treatment with an angiotensin II, type I receptor antagonist [at a dose of 8mg once a day] reduces the incidence of hypertension in borderline patients Randomized, open-labeled, prospective study. This study was conducted in the department of pharmacology and therapeutics, Basic Medical Sciences institute [BMSI], Jinnah Post Graduate Medical Centre [JPMC], Karachi, from July 2007 to January 2008. This study involved eighty untreated participants between 30 to 60 years of age of either sex with blood pressure on study entry in high-normal range i.e. systolic blood pressure of 130 to 139 mmHg and diastolic blood pressure of 85 to 89 mmHg, according to the classification developed by Joint National Committee on prevention, Detection, Evaluation, and Treatment of high blood pressure [JNC-VI]. All participants were randomized and enrolled in study after baseline investigations and informed written consent. All values have been expressed in standard error of mean [ +/- SEM]. Forty patients were treated with DRI and DR2 from day 0 to day 90[th] of study period respectively. InDRI group the mean systolic BY was decreased from 138 mmHg to 125.8 mmHg from day 0 to day 90[th] In DR2 group an increase was observed in systolic BY from 128 mmHg to 136 mmHg from day 0 to day 90[th]. An average percentage decrease of 8.21% in case of DR] while, 5.52% was increased in DR2 group. In same way a decrease of 11.82% in DR] group, while, an increase of 11.5% was observed in case of DR2 group in mean diastolic blood pressure respectively from day 0 to day 90[th] of study duration. Treatment of prehhypertension with an angiotension receptor antagonist May decreases incident hypertension. Additional studies will be needed to ascertain whether this or other strategies involving early pharmacological treatment of prehypertension would positively affect clinical outcomes

Role of polymorphonuclear leukocyte in diabetic foot

To study the etiopathogenesis of foot injuries in patients of uncontrolled diabetes mellitus. Retrospective study of tissue samples received from diabetic patients clinically diagnosed as gangrene. This study was conducted in the Department of Ophthalmology, JPMC, Karachi from July 2009 to June 2011. 150 cases of uncontrolled diabetes mellitus with wounds of foot were included. 150 cases of known diabetics with peripheral neuropathy and history of loss of sensation were subjected to follow up of 2 years follow up was done on the cases. As a first step blood sugar was brought under control and broad spectrum antibiotic was given. Wound debriment was done in all cases. The specimens were subjected to H/E and Gram's staining. In H/E, liquifactive necrosis, polymorphonuclear leukocyte, mononuclear cell infiltrate, few lymphocyte plasma cells and fibroblasts were seen. New blood capillaries were few or absent. both gram positive and gram negative organisms were isolated. 79% were gram positive and 21% were gram negative. Hyperglycemia causes relative anoxia in the micro environment of the tissue due to damage of peripheral neurons. Lack of adequate circulation leads to ischemia, which is super added by infection of the subcutaneous tissue. The resultant effect is liquifactive necrosis and complete lysis of tissue. Removal of such putrefied tissue is mandatory to stop further damage to the tissue

Lab diagnosis and evaluation of fungal keratitis

This study is aimed to evaluate the usefulness of Sabouraud dextrose agar in the confirmatory diagnosis of suspected cases of fungal keratitis. Pre-designed prospective study of corneal scraping obtained after detailed slit-lamp examination and documentation from all patients seen for non-viral microbial infective keratitis. This study was conducted in the Department of Ophthalmology, JPMC, Karachi from July 2008 to June 2011. 128 cases of non-viral microbial infective keratitis. Corneal scraping of 128 patients with microbial keratitis Smears of corneal scraping were stained with Gram's Method and inoculated specimens on Sabouraud dextrose agar [SDA] and incubated for 3-4 days. In a series of suspected cases of fungal keratitis, 119/128 [75% patients] had positive results for fungus in corneal scrapings by direct microscopy using Grams staining method and culture on Sabouraud dextrose agar [SDA]. 43% males and 32% females had Candidial keratitis and 11% males and 7% females had Fusarium infection. Other samples showed presence of Gram positive cocci on smears and were negative for SDA. Fungal keratitis continue to be an important cause of ocular morbidity, since it becomes difficult to clinically diagnose and differentiate between bacterial and mycotic keratitis in complicated cases. It is better to use a standard culture medium like Sabouraud agar [SDA] when confirming ocular mycosis

To study the efficacy of losartan on urinary uric acid excretion in thiazide induced hyperuricemic and hypertensive patients

The precise relationship of Hyperuricemia found in hypertensive patients is still obscure; this study is a urinary uric acid lowering intervention with Losartan in hypertensive patients induced by Thiazide diuretics. A number of pharmacological agents like loop diuretics, similarly low doses of aspirin [<3g daily] aggravate Hyperuricemia. The effect of Losartan on urinary uric acid excretion In Hypertensive patients with Thiazide induced Hyperuricemia were investigated in the Department of pharmacology and therapeutics, Basic Medical Sciences Institute Jinnah Postgraduate Medical Centre Karachi. It was randomized, open label, prospective, comparative study. Total 60 hypertensive Hyperuricemic patients were enrolled one by one in this study, selected from medical OPD and wards of Jinnah Postgraduate Medical Centre, Karachi. Patients were divided in three groups. Group-1 patients were treated with Thiazide 50 mg/day, Group-2 with Losartan + Thiazide 50 mg/day, and Group-3 with Losartan 50 mg/day. The effect on urinary uric acid level was measured, after every fortnightly. Treatment with Thiazide + Losartan group and Losartan group showed significantly increase in urinary uric acid excretion. Whereas, Thiazide group decrease in urinary uric acid level. In contrast to Thiazide and Losartan alone Thiazide + Losartan led to a greater increased in urinary uric acid excretion. The average percentage increase in urinary uric acid excretion in Thiazide + Losartan group was -13.27% and the average percentage increased in urinary uric acid excretion was 6.7% in Losartan group. Thus it can be concluded from the present study that urinary uric acid excretion was more increased in combination therapies. Ultimately Losartan decrease serum uric acid level and uricosuric effect of Losartan might be particularly useful in Hyperuricemic patients those on Thiazide diuretic [for hypertension and heart failure]

To evaluate the feasibility of treating prehypertension with an angiotension receptor blocker candesartan cilexetil

Prehypertension is considered a precursor of stage 1 hypertension and a predictor of excessive cardiovascular risk. The trial of preventing hypertension [TROPHY] was an investigator-initiated study to examine whether early treatment of prehypertension, defined for this study as systolic blood pressure of 130 to 139 mmHg and diastolic pressure blood pressure of 89 mmHg or lower and systolic pressure of 139 mmHg or lower, might prevent or delay the development of subsequent incident hypertension. The primary objective of the present study was to determine whether in patients with prehypertension six months of treatment with an angiotensin II, type I receptor antagonist [at a dose of 8mg once a day] reduces the incidence of hypertension in borderline patients

Comparison of propofol and sevoflurane for laryngeal mask airway insertion [LMA] in adults

To compare the effects of Porpofol and Sevoflurane in Laryngeal Mask Airway insertion. This study was quasi experimental was carried out in the Department of Anesthesiology, Surgical Intensive Care and Pain Management, Dow Medical College and Civil Hospital Karachi, Dow University of Health Sciences. The duration of the study was six months. In this study 60 patients schedule for elective surgery were enrolled which were divided into two groups. The average age of the patients was 25.1 +/- 10.6 years [95% CI; 23.7-29.0]. Out of 60 patients, 28 [46.6%] were males and 32 [53.3%] were females with 1:0.8 male to female ratio. Gender difference was not statistically significant between the groups [Chi-Square= 0.601; P=0.44]. The average age, weight and LMA insertion time were not statistically significant between groups. Induction time was significant between groups. Induction time was significantly higher in porpofol group [B] than in the sevoflurane group [A]. Condition of LMA insertion of 24 [80%] patients were excellent [score = 18] and 6 [20%] patients were satisfactory [Score between 16 to 17] in group A while condition of LMA insertion of 28 [93.3%] were excellent and 2 [6.7%] were satisfactory in group B. This study concludes that porpofol is a better anesthetic agent for insertion of LMA as compared to sevoflurane by using loss of eye lash reflex as the end point for induction

role of verapamil in long-term management of opioid dependence

To determine the effectiveness of calcium channel blocker, verapamil in long-term management of patients with chronic dependence on opioids. Patients were admitted for 10 days in hospital. No treatment was given during first three days of admission after abrupt termination of opioid to observe the acute opioid withdrawal signs and symptoms. Then the verapamil was given orally to each patient in a dose 40 mg twice daily from day 4 to day 10 of admission. Then patients were discharged on the same treatment and advised to attend OPD weekly for further 12 weeks. The treatment was continued till the 8[th] week and then the dose of verapamil was gradually tapered off during next two weeks that is weeks 9 and 10. During last two weeks that is week 11 and 12 patients were assessed without given any treatment. The intensity of signs and symptoms were recorded by using objective opiate withdrawal scale and modified subjective opiate withdrawal scale respectively. The physiological parameters were also recorded throughout the study. Urine analysis for opioids was done on day 1 and day 10 of admission and then on 4[th], 8[th] and 12[th] weeks of follow up. Verapamil significantly decreased the intensity of signs and symptoms of protracted opioid withdrawal from day 4 to week 12. There were no undesirable variations in physiological parameters. Urine analysis for opioids was positive on day 1 while zero on day 10, weeks 4, 8 and 12. Verapamil significantly decreased the intensity of signs and symptoms of protracted opioid withdrawal during long-term management of opioid dependence

Comparing the effects of verapamil and moxonidine in treatment of acute opioid abstinence syndrome

To compare the effectiveness of calcium channel blocker, verapamil and alpha two agonist, moxonidine in treatment of acute opioid withdrawal syndrome in patients with chronic dependence on opioids. Patients were divided into two groups. Group 1 had 27 patients, treated with verapamil 40 mg BID. Group 2 had 19 patients, treated with moxonidine 0.2 mg OD. All Patients were admitted for 10 days in hospital. Placebo was given during first three days of admission after abrupt termination of opioid to observed the acute opioid withdrawal signs and symptoms. Then the treatment was given to each patient daily from day 4 to day 10 of admission. The intensity of signs and symptoms were recorded by using objective opiate withdrawal scale and modified subjective opiate withdrawal scale respectively. The physiological parameters were also recorded daily throughout the patients stay in hospital. Urine analysis for opioids was done on day I and day 10 of admission. Verapamil and moxonidine both significantly decreased the intensity of signs and symptoms of acute opioid withdrawal from day 4 to day 10 of admission without any significant side effect but verapamil was found to be more efficacious than moxonidine. There was no undesirable variation in physiological parameters. Urine analysis for opioids was positive on day 1 while zero on day 10. Verapamil was found to be more effective than moxonidine for the treatment of acute opioid abstinence syndrome in indoor patients

Factors causing non-breastfeeding in children under six months of age in district Nowshera, Pakistan

In developing countries bottle feeding has emerged a big public health problem while in developed countries the trend is opposite. Prevalence of breast feeding in Pakistan is 90-98% but in some subgroups of population it is as low as 60-80%. The objectives of the study were to determine the causes of non breast feeding in children less than six months of age in district Nowshera, and assess practice of starting first breast feeding to the newborn. A cross sectional study was conducted in ten union councils of district Nowshera. A total of 305 children under six month age were selected by simple random method. Data was collected on pre-designed questionnaire and analysed by descriptive statistics. The study included 198 children from rural and 107 from urban areas. Mothers/guardians of 71.8% children were uneducated. Causes of non breast feeding included perception of mothers of having insufficient milk [45.9%], working mothers [18.4%], mothers with chronic diseases [13.1%], children with congenital or acquired diseases [17%], mothers having next pregnancy [3.61%] whose mothers have been died [0.98%] and twin babies [0.98%]. On the other hand, 61% babies started breast feeding on first day, 19% on second, 10.8% on third and 3.9% after third day while 5.2% babies got no breast feeding at all. Main causes of non-breastfeeding in less than six month age are perception of having insufficient milk, working women and twin babies

Comparative effect of candesartan cilexetil and atenolol on glucose metabolism in essential hypertensive patients

To compare the changes on Glucose metabolism in essential hypertensive patients. Randomized, open-labeled, prospective comparative study. The study was carried out in the department of pharmacology and therapeutics, Basic Medical Sciences Institute [BMSI], Jinnah Post Graduate Medical Centre [JPMC], Karachi, from January 2007 to December 2008. In this study [80] newly diagnosed essential hypertensive patients were enrolled and divided into two groups [DR1] and [DR2] respectively. DRI patients received Candesartan 16 mg once a day and DR2 patients received Atenolol 50mg once a day for 3 months duration. At the end of study period the parameters examined were fasting and random blood glucose levels. The results have been expressed as mean +/- SEM [Standard error of Mean]. The mean fasting blood glucose level was decreased [from 90.22+ 1.34 mg/dl to 89.20 +/- 1.70 mg/dl; for DR1] versus DR2 in which mean fasting blood glucose level was increased [from 91.82 +/- 1.34 mg/dl to 97.91 +/- 1.22 mg/dl; p<0.001]. A reduction of 1.13% in case of DR1 and an increase of 6.63% were observed in case of DR2 group. The mean random blood glucose level was decreased for DRI group [from 151.12 +/- 0.99 mg/dl to 149.36 +/- 0.80 mg/dl] versus DR2 in which mean random blood glucose level was increased from [155.47 to +/- 0.96 mg /dl to 168.83 +/- 0.81 mg/dl; p<0.001]. A reduction of 1.16% was observed in case of DR1 group while and increase of 8.59% was observed in case of DR2 group, respectively. Candesartan cilexetil is a newer and safer alternative for the treatment of diabetic hypertensive patients in comparison to Atenolol treatment

Anti hypertensive efficacy of cardioselective beta-blocker atenolol and amlodipine in essential hypertensive patients

High blood pressure increases the risk of cardiovascular disease for millions of people worldwide and there is evidence that the problem is only getting worse. In the past decade, age adjusted rates of strokes incidence have risen. The incidence of end stage renal disease and the prevalence of heart failure have also increased. A major contributor to these trends is inadequate control of blood pressure in the population. The variety of treatments has been established with the passage of time from older to newer class. Researchers with passage of time proved on one side beneficiary drugs but also contraindicated in various types of patients. Keeping in view the necessity of treatment of hypertension at its initial stages in essential hypertensive patients to prevent cardiovascular complications in essential hypertensive patients. In present study the objective was to compare blood pressure lowering effects of cardio selective beta blocker Atenolol with calcium channel blocker Amlodipine in essential hypertensive patients

Comparison of Losartan and Amlodipine in hypertensive type-II diabetic patients

The present study assesses whether Losartan and Amlodipine, alone or in combination, prevent microalbuminuria in hypertensive type II diabetic patients. Department of pharmacology, Basic Medical Sciences Institute [BMSI], Jinnah Post Graduate Medical Centre, Karachi from June 2006 to January 2007. In this study 60 hypertensive diabetic patients were divided into 3 groups having 20 each. Group 'N' patients were kept as control, group 'A' patients were treated with Losartan, 50 mg once daily, group 'B' with Amlodipine 10 mg once daily and Group 'C' patients were given a combination of both the drugs i.e. tab losartan and tab amlodipine. Tablet Glibenclamide 5 mg was given according to the glicemic control. Although all the three groups showed a comparable effect in lowering both the systolic and diastolic blood pressure but the effect on proteinuria was variable. Losartan treated patients in Group 'A' shows marked reduction of proteinuria but non-significant change in creatinine clearance. In Group 'B' the patients who were treated with Amlodipine showed significant reduction in creatinine clearance, but non-significant change in proteinuria and Group 'C' patients showed countable reduction in proteinuria but a non-significant increase was observed in creatinine clearance. The results suggest that in hypertensive type II diabetic patients Losartan is worthwhile reducing both systolic and diastolic blood pressure and proteinuria significantly

Ventricular tachycardia; prevalence and prognosis

Frequent or complex patterns of ventricular ectopic activity, whether occurring during routine activity or induced by exercise, are often a marker for serious heart disease and a harbinger of sudden death. The detection of such arrhythmias is thus an important responsibility of the physician. To find the prevalence, associated characteristics and prognostic significance of exercise induced non-sustained VT in a representative population. Nishtar Hospital, Multan. 1000 patients. Two years. Descriptive, analytical study. Convenient probability sampling done. Ten subjects, 7 men and 3 women, with exercise induced VT were identified, representing 1.1% of those tested; only 1 was young than 65 years. All episodes of VT were asymptomatic and non-sustained. In 9 of 10 subjects, VT developed at or near peak exercise. The longest run of VT was 6 beats; multiple runs of VT were present in 4 subjects. Two subjects had exercise induced ST segment depression, but subsequent exercise thallium scintigraphic results were negative in each. Compared with a group of age and sex matched control subjects. those with asymptomatic, non-sustained VT displayed no difference in exercise duration, maximal heart rate, or the prevalence of coronary risk factors or exercise induced ischemia as measured by electrocardiography and thallium scintigrahy. Over a mean follow period of 2 years, no subject has developed symptoms of heart disease or experienced syncope or sudden death. Thus, exercise induced VT in apparently healthy subjects occurs almost exclusively in the elderly, is limited to short, asymptomatic runs of 3 to 6 beats usually near peak exercise, and does not portend increased cardiovascular morbidity or mortality rates over a 2 year period of observation. Exercise induced VT in apparently healthy subjects occurs almost exclusively in the elderly, is limited to short, asymptomatic runs of 3 to 6 beats usually near peak exercise, and does not show increased cardiovascular morbidity or mortality rates over a 2 year period of observation

Variant angina; comparison of patients with and without fixed severe coronary artery disease

The syndrome of variant angina occurs in patients with a wide spectrum of coronary artery obstructions, ranging from normal coronary arteries to severe 3-vessel coronary artery disease [CAD]. Treatment of these patients is, in large part, determined by the extent and severity of the underlying fixed coronary obstructions. To determine the clinical features of variant angina with and without fixed severe coronary artery disease. Nishtar Hospital, Multan. Two years. Descriptive, comparative analytical study. Sample size 108 patients. Sampling technique: Convenient probability sampling done. 43 patients with variant angina who had less than 50% fixed coronary luminal diameter narrowing [group-I] were compared with 65 patients with variant angina who had 70% or greater diameter narrowing [group-II]. Statistically significant differences were found in 3 clinical features between group-I and group-II i.e. [1] a more than 3 months history of angina at rest before diagnosis [80% vs 23%, P <0.001]; [2] an abnormal electrocardiogram at rest [19 vs 48%, P <0.01]. [3] an abnormal stress test [26% [8 of 30] vs 84% [15 of 18], P <0.01. However, these features were not clinically reliable in separating patients with variant angina with and without fixed severe obstructions because of overlap between the two groups. No difference was found between the 2 groups in age, sex, predominant symptoms at the time of catheterization, history of exertional angina, syncope with angina, prolonged angina, previous artery disease. Coronary arteriography should be performed to define the underlying coronary anatomy and to determine optimal therapy in patients with variant angina

Risk factors of coronary heart disease at tertiary care hospital

Coronary heart disease [CHD] is the single most common cause of death in the developed world. The incidence rate, risk factors prevalence and mortality vary widely among the countries. To identify risk factors associated with clinical evidence of CHD. This retrospective study was carried out in Cardiology ward, Nishtar Hospital, Multan during the period from January 2004 to January 2005. A total number of 100 patients were included in the study, attending OPD and emergency. Out of these, 60 were male and 40 were females. Age range was 40-80 years. Out of 100 patients 45 [45%] were smoker and 55 [55%] were non-smoker. Diabetes mellitus was also a contributed risk factor for CHD, 75 [75%] patients were diabetic as shown in. hypertension was found in 65 [65%] of cases. Higher age, being male, heredity, family history of CHD, hyperlipidemia, and hypertension were associated with CHD

Incidence of ischemic heart disease in patients with type-II dependent diabetes mellitus

Hyperlipidemia appears to be a risk factor for atherogenesis. Diabetic patients have increased platelet adhesiveness and response to aggregating agents. These changes are also likely to favour atherogenesis. Patients with diabetes mellitus have a higher prevalence of atherosclerotic heart disease and ad higher incidence of myocardial infarction than the general population. To find out the incidence of IHD in patients with NIDDM and too evaluate the pattern of clinical presentation of IHD in diabetic patients like with typical/atypical symptoms, evidence of silent ischemia and myocardial infarction. This study was carried out in Nishtar Hospital, Multan from June 2004 to July 2005. A total of 100 patients were included in the study. Study design is non-probable purposes. The 100 patients selected for study were between 30-80 years old. Majority of them belonged to 30-45 years of age. Mean age was 48.7 +/- 11.2 years. History of disease duration was also noted and 100 patients included had disease from 1 month to 30 years. Out of 100 patients, 70 [70%] were male and 30 [30%] were female. Among these 17 had evidence of IHD. Typical symptoms of IHD were found in 6 patients. Majority of them had more than one symptom and in one patient, dyspnea was the only symptom. Moreover 5 patients [29.5%] of those who had IHD had dyspnea apart from other atypical symptoms. The incidence of IHD is higher in diabetic patients as compared to non-diabetics

Iron deficiency anemia as a cause of breath holding spells

To assess the efficiency of iron therapy in reducing the frequency of breath holding spells. Material and This was a prospective, interventional study conducted in the department of Pediatrics, Hayatabad Medical Complex, Peshawar. A total of 50 patients between the ages of 6 months and 5 years with breath holding spells and mild to moderate iron deficiency anemia were studied. After giving them iron therapy for 8 weeks, they were assessed for the improvement in their anemia and its impact on the frequency of breath holding spells. Fifty children with iron deficiency anemia and breath holding spells were studied prospectively. Thirty-one [62%] cases were males and 19 [38%] females. The mean age was 27 months [SD '12.6]. The mean baseline hemoglobin was 9.79gm/dl. After 4 weeks of iron therapy it was 10.54gm/dl and after 8 weeks it was 11.23gm/dl. There was a statistically significant rise in the hemoglobin level with 8 weeks of iron therapy [p<0.001]. This rise in the hemoglobin level was associated with a statistically significant fall in the frequency of breath holding spells with 8 weeks of iron therapy [p<0.001]. It appears that treating iron deficiency anemia is effective in reducing the frequency of breath holding spells