Duchenne muscular dystrophy with associated growth hormone deficiency

A patient with Duchenne muscular dystrophy [DMD] and growth hormone [GH] deficiency is described who had no clinical evidence of muscular weakness before initiation of GH replacement therapy. Treatment with human GH resulted in appearance of symptoms of easy fatigability and proximal muscle weakness. Thorough investigations including serum creatinine phosphokinase [CK] levels is recommended in every patient with GH deficiency before starting GH replacement therapy

Neonatal hypoglycemia

Neonatal hypoglycemia was studied in 2876 neonates born in Military Hospital Rawalpindi, over a period of 6 months. On selective screening [plasma glucose concentratioin less then 2.6 mmol/l] was detected in 100 cases having an incidence of 3.5% in total births. In preterm and small for date babies, it was 8% and 6% respectively reflecting an increased risk of having hypoglycemia in these babies. 43 cases of hypoglycemia were symptomatic while 57 cases were asymptomatic. Asymptomatic hypoglycemia had occurred at a relatively earlier postnatal age as compared to symptomatic hypoglycemia. More than 70% of these 100 hypoglycemic babies had one or more risk factors. 30% were small for dates babies and 23% were preterm babies. 5% of hypoglycemic cases were large for gestational age babies, 10% were cases of respiratory distress and 5% were infants of diabetic mothers. Most frequent symptom in symptomatic hypoglycemia was lethargy [53.5%], jitteriness in 29%, cyanosis 19%, hypotonia 16% and seizures 9%, pallor and tachypnoea were noted 7% in each, while poor feeding. high pitched cry and apnoea was 2% of each. Seizures due to hypoglycemia had occurred at blood glucose level of less than 1.5 mmol/l. We did not find any case of persistent hypoglycemia in these 100 cases

Idiopathic juvenile osteoporosis

A case of Idiopathic Juvenile Osteoporosis is reported in a 09 years old boy Diagnosis was made radio-logically and confirmed by bone biopsy. Patient was given 4G calcium and 02 mg of 25 Hydroxycholecalciferol daily alongwith physiotherapy. After 8 months of regular therapy he started recovering clinically as well as radio logically