Detection of acute dengue infection using NS1 rapid test on blood donors of Rawalpindi

Background: During recent years, many cases of dengue virus transmission, through blood transfusion have been reported, including two cases from Karachi, Pakistan. NS1 antigen detection in blood donors can serve as a rapid mean for detection of acute dengue infection thus could prevent transmission through blood donation by affected individuals

Objectives: The aim of this study was to screen high risk blood donors for active dengue infection during an outbreak in the city of Rawalpindi and rejection of NS1-positive donors to save patients from dengue infected transfusions

Subjects and Methods: After approval from the IRB Shaikh Zayed Hospital, high risk blood donors during the outbreak were identified in blood banks of selected government hospitals. The objective of the study was explained and an informed consent was obtained from each participant. Blood sample of 3cc was drawn at the time of cross-match. Serum was separated and analyzed for dengue NS1 Ag. Data was entered and analyzed using SPSS version 20.0

Results: Overall 600 blood donors were included in the survey with the majority of male participants [n=583] than female participants [n=17]. Most of the blood donors [57.8%] were falling in the age group of less than 30 years and highest donations were from [B] positive blood group followed by [O] positive and [AB] negative with least donations. None of the sample screened positive for NS1 antigen

Conclusion: Blood of high risk asymptomatic donors taken were having no dengue NS1 Ag positivity

Hepatitis E virus seroprevalence in pregnant women in Pakistan: maternal and fetal outcomes

Hepatitis E virus [HEV] is endemic in Pakistan. Although otherwise asymptomatic, HEV infection becomes fatal in pregnancy, with considerable maternal and fetal morbidity and mortality. We conducted a descriptive study from April to October 2015 in 10 tertiary care hospitals throughout Pakistan to determine maternal and fetal morbidity and mortality in HEV-positive pregnant women with acute jaundice or raised liver function tests. Twenty-one of 135 women were HEV positive and in 3rd trimester except for 1 in 1st trimester. Overall prevalence of HEV in pregnancy was 0.19%. Ten women were artificially induced, 3 had premature labour, 4 delivered spontaneously [full term], 3 died and there was 1 intrauterine death. One woman had a home abortion before coming to hospital. There were 7 perinatal infant deaths: 4 intrauterine, 3 stillbirths and 1 abortion. Maternal mortality was significantly associated with delivery, as 17 mothers who lived went into labour spontaneously or were artificially induced, whereas 3 women who continued their pregnancy and did not deliver, died. Case fatality rate of HEV infection in pregnancy was 14.2%

review of vitamin D in Pakistani population

Vitamin D is a secosteroid which has an important function in bone metabolism and immunomodulation. Decreased levels of vitamin D are associated with many critical diseases like cardiovascular, cancer, diabetes, tuberculosis and osteoporosis. Low vitamin D can cause obesity and restrict bone growth and bone health in children and adults. Despite being near to equator, Pakistani citizens suffer from low vitamin D levels making them prone to many diseases and there is no guidelines for the treatment of vitamin D deficiency in general and diseased population of Pakistan. This review highlights the prevalence of vitamin D in different disease as well as healthy groups of Pakistani citizens through literature search. Further it also reviewed the literature available on knowledge of clinicians about vitamin D deficiency and its affects

Vitamin A deficiency among school going children affected by flood

Background: Vitamin A deficiency increases the risk of night blindness and death due to common childhood illnesses that are prevalent during emergencies like floods. The relief diet provided to flood victims is often deficient in micronutrients and minerals including vitamin A. There is a need to assess the levels of vitamin A among flood affected children to prevent morbidity and mortality caused by malnutrition

Objective: To assess the frequency of Vitamin A deficiency among school going children [8-14 years] affected and unaffected by floods of 2010 in district Nowshera

Subjects and Methods: Study was conducted in Government-registered schools situated in flood affected and unaffected areas of district Nowshera of KPK Province of Pakistan. A total of 353 children [8-14 years] were registered for study, including 190 from flood affected and 163 from unaffected areas. A questionnaire was filled for each child which included the demographic information. Three milliliter blood was drawn from each child which was processed for the estimation of vitamin A levels. Data was entered and analyzed using SPSS 20.0

Results: Among flood affected children frequency of vitamin A deficiency was 18.9%, whereas among flood unaffected children it was 6.1% showing strong association with children affected by floods [p < 0.001].Among illnesses during floods, children who had acute respiratory infection were on an average 3.5 times more likely to have vitamin A deficiency as compared to those who did not suffer from this disease [p = 0.037]

Conclusion: Vitamin A deficiency was substantially higher among children affected by floods and those who had acute respiratory infection

Knowledge, attitude and practices regarding dengue fever in Lahore, Pakistan

Background: Dengue fever is a major public health problem whose epidemiology and ecology is strongly linked with human lifestyle and activities

Objectives: To identify the knowledge, attitude and practices about dengue fever in Lahore and identify the gaps between knowledge and practices

Subjects and Methods: On the basis of 154 existing Union Councils [9 towns and DHA] of Lahore, sample size of 800 houses was selected. One member over 18 years from each house was selected to give interview making 800 respondents. A proforma, was filled for each study participant after obtaining written informed consent. The information included knowledge, attitude and practices about dengue fever. The answers about knowledge and practices were marked with numbers. An aggregate of >70% was taken as sufficient, between 40-70 as moderate and <40 as insufficient

Results: About 98% of participants had heard of dengue fever. Though 67% respondents had sufficient knowledge about dengue but only 3.7% were actually practicing them. Preventive practices were predominantly focused on prevention of mosquito bites through using mosquito coils [70.4%] rather than eradication of mosquito breeding sites. Television [91%] was the major source of information about dengue fever

Conclusion: There was a major gap between having information and applying it and this needs to be addressed on priority to prevent future outbreaks of disease

Haematological parameters and recurrent aphthous stomatitis

To find out the relationship between recurrent aphthous stomatitis [RAS] with deficiencies of haemoglobin, haematocrit, serum vitamin B12, serum Ferritin and red blood cells [RBC] Folate level. An analytical cross-sectional study. Department of Oral Health Sciences, Shaikh Zayed Federal Postgraduate Medical Complex, Lahore, from February to July 2008. Sixty consecutive subjects with active RAS were taken as the aphthous group; 60 age and gender matched subjects without RAS were as the Non-Aphthous group. Five milliliter blood was taken from both groups to evaluate the levels of serum B12, and RBC Folate through radio immuno assay and serum ferritin with enzyme linked immuno-sorbent assay tests. Complete blood count was carried out to determine the level of haemoglobin and haematocrit in both groups. Proportion of subjects with lower values was compared using 2 text of proportions with significance at p < 0.05. Serum Ferritin [p = 0.001], haematocrit [p < 0.001], RBC Folate [p < 0.001] and serum B12 [p < 0.001] were significantly lower in the RAS group. Combined deficiency state [haemoglobin, serum Ferritin, haematocrit, RBC Folate and serum B12] was identified in 13% [n = 8] RAS patients. Frequency of haematinic deficiencies was high in RAS patients. Serum B12 and RBC Folate were significantly low in aphthous group

Newborn screening for congenital hypothyroidism in a public sector hospital

Congenital hypothyroidism if left untreated results in growth failure, irreversible mental retardation, and cretinism. National neonatal screening programs are therefore, launched to diagnose congenital hypothyroidism and manage it timely. To screen newborns for congenital hypothyroidism in two public sector hospitals of Lahore. Cross sectional descriptive study conducted at departments of Gynae/Obs and Pediatric Shaikh Zayed Hospital and Jinnah Hospital, Lahore from February 2010 to November 2011. Awareness brochures for congenital hypothyroidism were developed and attached with the antenatal card of each pregnant case attending antenatal clinic at Gynae/Obs OPD. Newborns who had stayed in hospital for more than 24 hour, and whose parents consented for heal prick were tested for blood spot thyroid-stimulating hormone. Results were reported within four days and thyroid-stimulating hormone >/= 20mIU/L was taken as high value. Parents of those neonates who had high value were contacted to give a fresh sample for confirmation. Confirmed results were provided within next 4-5 days to the parents and treating pediatrician for appropriate treatment. A total of 1357 samples were screened using blood spot thyroid-stimulating hormone and out of these 1330 were normal [< 20mIU/L] while 27 had high levels [>/= 20mIU/L]. These 27 neonates were further tested using confirmatory tests for serum thyroid-stimulating hormone, T3 and T4. After confirmatory tests only one case had congenital hypothyroidism who was referred for treatment. Three cases were suspected to have subclinical hypothyroidism and these were retested after six months which, picked another case of confirmed subclinical hypothyroidism who was referred for treatment. The incidence of congenital hypothyroidism was 2 out of 1357 cases. The screening could pick 2 cases of hypothyroidism from a total of 1357 cases which is high when compared to global rates. Routine screening of neonates for thyroid disease can pick the disease early and thus prevent later complications

Levels of 25-OH vitamin D in healthy asymptomatic adults: pilot study

The deficiency of Vitamin-D has been reported in all age groups in developing countries; in spite of adequate sun light required for the production of 25-hydroxyvitamin D. To determine the levels of vitamin D among healthy asymptomatic adults. Hospital based analytical study, conducted at Sheikh Zayed Medical Complex, Lahore. Healthy subjects between 40-60 years, who were either the staff of the hospital or attendants of the patients were included. Those who were taking vitamin supplement, using sun screen and lactating mothers were excluded. A proforma including the demographic information, exposure to sun, diet intake and BMI was recorded for all subjects. 5cc of blood was taken from all, serum separated, stored at -20[degree sign]C. 25-hydroxyvitamin D levels were done within 48 hours using ELISA method. A value between 75-250 nmol/L was taken as normal using international standards. Eighty healthy adults were enrolled whose mean age was 47.2 +/- 6.3 years. The levels of vitamin D ranged between 13.1- 77.5 nmol/L. Levels were deficient in 25% subjects and insufficient in 73.7% giving an overall low level in 98.7% of the respondents. Only 1.3% had sufficient 25-hydroxyvitamin D levels. The levels did not show any significant difference between genders, skin pigment or dietary intake. The levels for the 56-60 yrs age group were significantly higher when compared with those in the age groups of 40-45 yrs and 46-50 yrs [p<0.041 and 0.038 respectively]. The association of 25-hydroxyvitamin D with exposure to sunlight was significant [p<0.001]. Respondents with BMI >30 had significantly lower 25-hydroxyvitamin D levels than those who had BMI between 18-25 [p<0.036]. Low levels of vitamin D were found in 98% of the apparently healthy population

Perception of ethical issues, encountered in under graduate medical and dental education

Bioethics has recently gained importance in the developing world. It's teaching in Medical Schools needs careful attention. The aim of this study was to assess the conceptual knowledge for adequacy of the current system of bioethics education and to identify the learning needs of Pakistani medical and dental students. The present study included 114, third year medical students, who had been provided introductory course on bioethics in 1[st] and 2[nd] years. A questionnaire containing 20 clinical situations was answered and assessed against standards. Thirty six percent of participants had forgotten the term bioethics. Patient's opinion and life saving research was recognized as most important where as performing surgery and informing patients about doctor's mistakes was considered as not worthy of obtaining consent. A wide range of gap in knowledge and attitude was identified in bioethics

Association of vitamin B12, serum ferritin and folate levels with recurrent oral ulceration

The pathophysiology of recurrent aphthous stomatitis or aphthous ulcers remains obscure but malnutrition is one of its contributory factors. There is some role of vitamin B12, ferritin and folate in the development of these lesions. To determine the relationship between recurrent aphthous stomatitis and levels of ferritin, folate and vitamin B12. This case control study was conducted at Immunoassay lab, NHRC and Department of Dentistry, Shaikh Zayed Hospital, Lahore. Patients and Sixty patients of all ages and both genders having history of recurrent ulcers over the past period of 3-6 months. Similar number of healthy controls were chosen who were either attendants of the patients or staff of the hospital and did not have any history of aphthous ulcers. Proforma was filled for each participant and 5ml blood was drawn and tested for complete picture blood by Sismex, serum ferritin by ELISA [Biocheck], vitamin B12 and RBC folate by IBL kits from USA. Fifty seven [57] age and gender matched patients with recurrent aphthous ulcers and 57 normal healthy controls were studied. Anemia was present in 24[42.1%] patients and 18[31.6%] controls. Hematocrit levels were normal in 45[79%] patients and 40[70.2%] controls. Low levels of RBC folate was seen in 26[45.6%] patients and 26[45.6%] controls. Vitamin B12 deficiency was present in 29[50.1%] patients and none of the controls. The low levels of ferritin was seen in 6[10.5%] patients and 18[31.5%] controls. Patients with recurrent aphthous ulcers had more hematinic deficiencies, particularly of vitamin B12 as compared to controls

Association of diet with hirsutism in females of reproductive age

Causes of hirsutism range from minor illnesses like fever, nausea, headache to severe conditions like adrenal hyperplasia and polycystic ovarian syndrome while, in some cases the cause remains obscure and dietary factors are placed under this heading. To study the role of dietary factors in causing hirsutism. Department of Dermatology, NHRC, Sheikh Zayed Medical Complex, Lahore from Dec 2008- Dec 2009. Fifty clinically confirmed cases of hirsutism and 50 healthy females aged between 12-20 years were studied. A modified Ferriman-Gallwey [FG] score was used to determine the severity of hirsutism which were graded into 4 grades. Cases with virilism, post menopausal, menopause cushing's syndrome were excluded. Informed consent was obtained from all participants and their demographic data, height and weight and dietary pattern was recorded on specially designed performa. All 50 healthy controls had grade 1 or no hirsutism, while among hirsute females, 10[20%] had grade 2, 28[56%] grade 3 and 12[24%] grade 4 hirsutism. Consumption of red meat and broiler chicken was more in hirsute females whereas, intake of milk and vegetables was more in healthy controls. Dietary habits also appear to play some role in hirsutism in females

Effect of G.O.1 on prolonged routine coagulation parameters [prothrombin and activated partial thromboplastin time] in rabbits

George Ohsawa One [G.O.1] is a natural product [macrobiotic] made up of powdered carbonized aubergine and unrefined sea salt in a ratio of 3:1, and is extremely inexpensive and easy to make. It is claimed that G.O.1 is an anti-hemorrhagic agent that can be used in accidents, trauma, rectal and internal hemorrhages

Study Objectives: The objective of this study was to assess the sample size for large scale study to find effect of G.O.1 and to verify the effectiveness of dosage of G.O.1, Warfarin and Heparin in rabbits

Study Design: Randomized Control trial

Sample Size: 8 male rabbits, 6 - 10 weeks of age, with an average weight of 1300 to 1500 grams were selected to see the effect G.O.1

Study Setting: Department of Pharmacology, Federal Post Graduate Medical Institute and National Health Research Complex, PMRC, Shaikh Zayed Hospital Complex, Lahore

Results: In group 1 rabbits, warfarin was given for 7 days; more than double the baseline values of PT were achieved. The prolonged prothrombin time in the experimental group [group 1A], came down successively after the first and second dose of G.O.1, indicating that G.O.1 did have some effect on bringing down the raised prothrombin time after administration of warfarin. In group 1B, the control group rabbits, where normal saline was used in place of G.O.1, the prothrombin time remained elevated to more than double the baseline value. Thus, normal saline had no effect on prothrombin time raised by warfarin. Mean PT values for Group 1 given warfarin in Interventional group [1 A] given G.O.1 was 12.75+/- SD 4.6. In control group given normal saline [1 B], it was 17.0 +/- SD 2.0. In group 2, the activated partial thromboplastin time was raised to almost three times the baseline value after administration of heparin for 7 days. In both, group 2 A, the experimental group and 2B the control group, both G.O.1 and normal saline had no effect on raised activated partial thromboplastin time. Mean APTT value for Group 2 given heparin in interventional group [2A] given G.O.1 was 29.3 +/- SD 9.3. In control group given normal saline [2B], it was 36.5 +/- SD 2.0

Conclusion: The prolonged prothrombin time in experimental group, was successively reduced after the first and second doses of G.O.1, indicating that G.O.1 did have some effect on bringing down the raised prothrombin time after administration of warfarin. G.O.1 did not have any effect on prolonged activated partial thromboplastin time

Dental phobia in patients seeking dental treatment

Phobia against dental procedures is recognized as an important factor in inhibiting patients from seeking dental treatment. To study the types and levels of dental phobia in patients seeking dental treatment. Fatima Memorial Dental College Hospital, Lahore from August, 2008 to January, 2009. All adult patients coming for dental scaling, extraction, filling and root canal treatment who consented to participate in the study were included, while those with impaction, extensive periodontal treatment and edentulous were excluded. All patients were interviewed regarding their fears about dental procedures using structured questionnaire. The information was classified into 3 scales as strongly negative [phobic] moderately negative and neutral. A total of 76 patients were selected for the study. Dental phobia presenting as lack of confidence to ask questions from the dentist was observed in 30% patients while 96% had some previous bad experience at a dental clinic. Varying levels of phobia were noted for all other types of services as well as for the dentist's attitude towards the patients. Dentists should recognize the existence of dental phobia in patients coming for treatment and need to develop skills in minimizing phobia. To reduce fear and phobia dentists need to communicate more with the patients before undertaking any treatment

Significance of total and free thyroid hormones in relation to serum proteins in chronic hepatitis B patients and normal controls

Hepatitis B destroys the liver cells. Proteins [albumin, pre albumin and thyroid binding globulin] produced by liver cells play an important role in metabolism and transport of thyroid hormones, therefore liver dysfunction is likely to disturb the transport of thyroid hormones resulting in disease. To determine the significance of thyroid hormones in relation to serum proteins in Chronic Hepatitis B patients. It was a cross sectional study conducted at National Health Research Complex [NHRC] and department of Gastroenterology Sheikh Zayed Medical Complex Lahore. One hundered Chronic Hepatitis B patients diagnosed by Polymerase Chain Reaction were matched with 100 healthy persons, served as control, were selected for total and free thyroid hormones using ELISA, while serum proteins were estimated spectrophotometrically. Serum total protein levels were within the normal range in both Chronic Hepatitis B patients and controls with mean value of 6.55g/dl and 7.2g/dl respectively, however serum albumin levels were lower in Chronic Hepatitis B patients [mean 2.69g/dl] as compared to controls [mean 4.1g/dl]. Serum globulin was increased [4.09g/dl] in patients as compared to controls [mean 3.1g/dl].Albumin globulin ratio was <1[mean 0.73] in Chronic Hepatitis B patients while in controls it was >1[mean13.5]. Consequently, increased globulin resulted in more binding of T4 [mean 194nmol/L] in Chronic Hepatitis B patients as compared to controls [mean 123nmol/L]. Conversion of T4 to T3 in Chronic Hepatitis B cases was also disturbed resulting in slight decrease of total T3 [mean 1.77nmol/L] as compared to controls [mean 2.3nmol/L].Free T3 [mean 3.56pmol/L] and Thyroid Stimulating Hormone [mean 0.68mIU/ml] also showed slight decrease when compared with controls [mean 4.5pmol/L, mean 1.52mIU/ml].FT4 remained within normal range in both the groups. In Chronic Hepatitis B related liver disease and cirrhosis, serum albumin levels go down while globulins go up and these changes alter the binding of thyroid hormones and Thyroid Stimulating Hormone resulting in disturbance in thyroid hormone levels

Thyroid dysfunction and autoimmunity in females in goitre endemic area

To study thyroid dysfunction and thyroid autoimmunity among females with and without goitre in goitre endemic area. A cross sectional survey was carried out during the year 2007 in Chakar, district Muzafarabad. A group of 100 females 18-65 years of age were included; among them 50% having goitre were included in group I as cases and 50% asymptomatic females were included in group II as asymptomatic controls. Goitre was graded according to World Health Organization recommended criteria. For each study participant thyroid function status was assessed by T3, T4, thyroid stimulating hormone levels and thyroid autoimmunity by anti thyroid peroxidase and anti thyroglobin antibody levels. Data was analyzed using SPSS 12. Mean thyroid stimulating hormone levels were found higher [18.0 +/- 7.4] in cases [group I] than in asymptomatic controls [group II] [3.2 +/- 1.6]. On the basis of thyroid stimulating hormone, among cases 32 [64%] were primary hypothyroid, 11 [22%] were subclinical hypothyroid and 7 [14%] were euthyroid, whereas among asymptomatic controls it was 10 [20%], 13 [26%] and 27 [54%] respectively. Mean thyroid stimulating hormone decreased from 27.3 to 13.0 mIU/ml in goitre and from 5.6 to 1.2 mIU/ml in non-goitre at 16-65 years of age. Frequency of anti thyroid peroxidase and anti thyroglobin antibody was found 22 [44%] and 18 [36%] among cases, while 16 [32%] and 15 [30%] among asymptomatic controls respectively. No association was found between age and presence of goitre with anti thyroglobin or anti thyroid peroxidase positive antibodies [p>0.05], whereas association between anti thyroglobin and anti thyroid peroxidase antibodies with high thyroid stimulating hormone levels among study groups was found significant [p<0.05]. High proportions of anti thyroid peroxidase and anti thyroglobin positive cases were found between ages 26-45 years. The frequency of thyroid dysfunction and autoantibody in females of goitre endemic area was high, but showed no relation with the presence of goitre. Thyroid stimulating hormone had an inverse relationship with age among goitre and non-goitre cases. Positive anti thyroid peroxidase and anti thyroglobin antibodies were not age related, however they were found to be associated with elevated levels of thyroid stimulating hormone

Role of CA-125 as an ovarian tumor marker

The incidence of ovarian cancer varies in different geographic locations. In Asia, the incidence appears to be somewhat higher than in the West. This study was designed to evaluate the utility of CA-125 measurement for the detection of ovarian cancer in local subjects. To assess the role of cancer antigen 125[CA-125] as an aid in the diagnosis of ovarian tumor. A descriptive case control study was carried out. Cases and control were taken from the Gynecology out patient department, Shaikh Zayed Hospital, Jinnah Hospital and Institute of Nuclear Medicine and Oncology Lahore. Laboratory investigations were carried out at Pakistan Medical Research Council, Immunoassay laboratory, National Health Research Complex, Shaikh Zayed Medical Complex, Lahore from August 2005 to January 2006. Fifty women having confirmed ovarian malignant tumors of ages 22-67 years with a mean age of 44.1 years having a histologically confirmed diagnosis of ovarian tumor were matched with fifty women without disease who had CA-125 done for exclusion of disease. These controls had other gynecological problems. At a cut off value of 35 IU/ml, the CA-125 levels were sensitive in 34[68%] of the cases and specific in 45[90%]. The levels increased with age and duration of disease among cases. No false positivity was found with advancing age in controls. The diagnostic accuracy was 79% and a positive predictive value of 87%. CA-125 is a non invasive tumor marker for diagnosing ovarian tumor

Hypoglycemic evaluation of panax ginseng [radix rubra] in normal and alloxan diabetic rabbits

Background: the present study was planned to observe the hypoglycaemic effect of Panax ginseng C.A. Meyer [Radix rubra] a traditional Far Eastern medicinal plant. This research was performed to study the possible role of medicinal plants in the treatment of Diabetes mellitus type

Study Design: it is a comparative and non interventional study

Study Period: from May 2004 to December 2004

Setting: Department of Pharmacology FPGMI

Subjects and Methods: 96 rabbits were divided into two main groups. Group1 of normal rabbits was further subdivided into 6 subgroups [A-F] of 8 animals each. Subgroup A served as control and received 5 ml of water only. Subgroups B,C and D were administered ginseng root powder in aqueous solution, in doses of 25, 50, 100 mg/kg body weight per 5 ml of distilled water. Subgroup E and F were administered 5 mg of glibenclamide and 250 mg of metformin each dissolved in 5 ml of distilled water respectively. The alloxan diabetic rabbits [Group 2] were also subdivided into 6 subgroups [G-L] on the same pattern. The blood glucose levels were estimated before and 2,4, 8, 10, 12, 14 and 16 hours after administration of the aqueous solutions of ginseng, glibenclamide and metformin

Results: the aqueous solution of Panax ginseng exerted a significant hypoglycaemic action [P value <0.5] at 2 hours with the 50mglkg dose continuing till 4 hours with the 100 mgkg body weight dose in the normal rabbits. In the alloxan diabetic rabbits there was statistically significant hypoglycemic action [P value <0.5] with the 50 mg/kg dose at the 12th hour proceeding till the 14th hour with the 100mgkg body weight dose. The doses used did not show acute toxicity or result in behavioral changes

Conclusion: from this study, it maybe concluded that the powdered Panax ginseng [Radix rubra] root has a significant, mild and short lived hypoglycemic action in both normal and in alloxan induced diabetic rabbits

Pathogenesis of recurrent aphthous stomatitis: a review of literature

Recurrent aphthous stomatitis represents a very common chronic but poorly understood mucosal disorder, affecting 10% to 20% of the world population. They occur in men and women of all ages, races and geographic regions. It is estimated that at least 1 in 5 individuals has at least once been afflicted with aphthous ulcers. There are 3 clinical subtypes that is minor, major, and herpetiform on the basis of their size and number. Minor aphthous ulcers are the most common subtype, representing 80% to 90% of all recurrent aphthous ulcers. There are-four stages of the lesion, these includes premonitory, preulcerative, ulcerative, and healing stage. Clinically, RAS present as extremely painful, shallow ulcerations with an erythematous halo on unattached oral mucosa. Attacks may be precipitated by local trauma, stress, food intake, drugs, hormonal changes and vitamin and trace element deficiencies. Local and systemic conditions and genetic, immunological and microbial factors all may play a role in the pathogenesis o recurrent aphthous stomatitis. The primary differential diagnosis is herpes simplex

Role of thyroid peroxidase antibodies in the outcome of pregnancy

To assess the prevalence of Thyroid peroxidase [TPO] auto antibodies among pregnant women and its relation with their pregnancy outcome. Cross-sectional analytical study. The study was carried out at Zayed Medical Complex, Lahore, in the department of Obs/Gynae and NHRC from July 2000 to July 2002. The study included 1500 Euthyroid pregnant women, ages 18 - 40, registered for antenatal care at Obs/Gynae department. Previous fertility history was recorded and thyroid peroxidase antibody level was assessed by ELISA method. A cut off value of TPO antibody of upto 100U/ml was considered negative and more than 100 U/ml was considered positive.The cases were followed for the outcome of their pregnancy and compared with TPO antibody levels. A comprehensive proforma was used to collect the data. The prevalence of positive TPO autoantibodies was found to be 11.2%. The raised TPO autoantibodies were found to have higher risk of abortion [O.R 49.2] and prematurity [O.R.8.1]. The complications were found to be significantly raised among positive TPO autoantibodies cases, when analysed by parity and age of mother at time of registration. Thyroid autoimmune diseases among euthyroid pregnant women may contribute to low-birth-weight of neonates and high abortion rate in all pregnancies. Raised levels of TPO autoantibody is a good marker to assess early hypothyroidism state and should form a screening modality in Pakistan