Background: Down’s syndrome (DS) is the phenotypic manifestation of trisomy 21. The individuals with Down’s syndrome are at increased risk for thyroid dysfunction. Hypothyroidism is most common, occurring in almost one third of Down’s syndrome patients. This can be due to lack of the thyroid gland activity at birth (congenital hypothyroidism) or as a consequence of various immune mechanisms. Congenital hypothyroidism has been reported about 30 times more common in newborns with Down’s syndrome than in healthy newborns Objective: The aim of the study was to assess the thyroid functions in Down syndrome patients by measuring serum levels of free thyroxine (FT4), free triidothyronine (FT3) and thyroid stimulating hormone (TSH). Anti Thyroid peroxidase antibodies (Anti TPO) were also measured to assess the autoimmune thyroid disease and to correlate them with thyroid hormone levels. Subjects and Methods: Eighty patients of Down Syndrome (DS) already diagnosed by chromosome analysis were included in the study. These patients were selected from the outpatient department of Medical Genetics at Children Hospital Lahore. Serum FT4, FT3 and TSH were performed by Ortho-Clinical Diagnostic Kits on Vitros ECIQ immunodiagnostic system. Anti TPO was performed by commercially available ELISA kit. Results: The mean age of patients included in the study was 7.64 ± 5.8 years (range 6 months to 18 years). Raised TSH was found in 28 (35%) patients while remaining 52 (65%) had normal TSH levels. The mean FT4 and FT3 levels were 1.17 ng/dl±0.30 (range 0.46 – 2.13) and 4.55 pg/ml ± 0.75 (range 2.48 – 6.17) respectively. Mean anti-TPO level was 48 + 178 mg/dl (range 0.10 -1139) and six (7.5%) patients had positive anti-TPO. Conclusion: The results of this study show raised levels of TSH and anti TPO in DS patients. Subclinical hypothyroidism is found in significant number of patients. Assessment of thyroid function in patents of Down syndrome is recommended at regular intervals.

Our Patient, a 11 year old girl presented to us with a rare congenital anomaly of complete duplication of Bladder, Urethra, Vagina, Uterus and Rectum with crossed fused renal ectopia and some skeletal defects. She complained of occasional passage of fecal matter through left vagina without any urinary complaints. She also had scoliosis of lumber spine, equinus of right foot and mild right jaw protrusion. These congenital anomalies are even rarer in girls and this case allowed us to evaluate these anomalies and their management in detail.

ABSTRACT HCV infection in children is different from the adult infection in many ways like natural course of the disease; duration, therapeutic response and side effects profile of the drug therapy; and prognosis. Special considerations include what is the appropriate time to investigate a suspected child, when to institute drug therapy and how to prevent vertical transmission. Although, over the past one decade, many landmark studies have greatly increased our insight on this subject, we are far from developing a consensus statement. In this article, a concise yet comprehensive review of HCV infection in children – diagnosis and treatment - is given followed by suggested recommendations at the end. It is hoped that these recommendations will help develop local guidelines on this subject. Feedback to help improve/modify these recommendations by those experienced in dealing with the children will be welcome. (Review Article).

Objectives: To determine the disease pattern and outcome of neonatal admissions. Design: Descriptive study Place and Duration of Study: This study was conducted at Children Hospital Chandka Medical College (CMC) Larkana from 1st Jan to 31st Dec 2007. Materials and Methods: Data of all neonatal admissions was analyzed for age at admission, sex, weight, gestational age, reason for admission and outcome. Calculations were performed with statistical software package SPSS (15v). P-value <0.05 was considered statistically significant. Result: A total of 1973 neonates were admitted during study period. Majority of the patients [1208 (61.5%)] were brought in 1st 24hours of life. Majority of these [1383 (70%)] were males. Mean weight was 2.38 + .89. Almost half [947 (49.4%)] were low birth weight. 1697 (86%) were full term. Commonest reason for admission was birth asphyxia 982 (49.8%), other common reasons were neonatal infections in 507 (25.7%) cases and prematurity / Low Birth Weight (LBW) in 378 (19.15%) cases. Other reasons for admission were: neonatal jaundice 57 (2.9%), respiratory distress syndrome (RDS) 3 (0.15), meconium aspiration syndrome (MAS) 26 (1.3%) congenital anomalies 20(1.01%), haemorrhagic disease of newborn 9 (.6%) and infant of diabetic mother 7 (.3%). Majority of patients [834 (42.2%)] were discharged, 686 (34.8%) Expired and 553 (23%) left against medical advise (LAMA). Conclusion: Birth asphyxia, neonatal infection, prematurity / low birth weight were main reasons for admission as well as deaths and majority improved. Proper antenatal care and early referral of complicated pregnancies to tertiary care hospital and provision of neonatal intensive care facilities are necessary for decreasing morbidity and mortality in neonates.

Objective: To evaluate the frequency and severity of hearing loss in children treated with cytotoxic chemotherapy. Study design: Descriptive Setting: The study was carried out jointly by The departments of Paediatric Audiology and Paediatric Oncology, The Children’s Hospital & The Institute of Child Health, Lahore. Duration: October 2003 to December 2006. Material and methods: Hearing assessment was carried out prospectively for fifty-six patients with various malignancies aged between 38 days and 14 years. Subjects were at different stages of treatment with cytotoxic chemotherapy was carried out prospectively. Standard doses of known ototoxic agents included Cisplatin 80mg/m2 and Carboplatin 500mg/m2 per cycle. Repeat audiology assessment was done after 6 months of therapy. Audiology assessment was done using pure tone audiometry (PTA), otoacoustic emission analysis (OAE), auditory brainstem response (ABR), distraction test, and visual reinforcement audiometry (VRA). Results: Of the 56 patients studied, 24 (42.8%) developed hearing impairment. Sensorineural hearing loss was the more frequent, seen in 23.2% of children during the course of chemotherapy. Patients treated with platinum compounds had significantly higher ototoxicity compared to the ones who did not receive these compounds. Graded according to severity, 12 (50%) developed mild hearing loss, 7 (29.2%) had moderate, 1 (4.2%) had severe and 4 (16.7%) had profound degree hearing loss. Conclusions: Sensorineural hearing impairment was commonly found in children on chemotherapy, particularly those on platinum compounds. Hearing impairment was reversible over 6 months in patients who were not treated with platinum agents.

Epidermal nevus syndrome is a kind of neurocutaneous syndrome that is associated with epidermal nevus and a variety of congenital CNS disorders. Epidermal nevi (EN) are congenital hamartomas of embryonal ectodermal origin. An estimated one third of the individuals with EN have involvement of the other organ system. Clinical presentations include seizures, paresis, mental retardation, and developmental delay. We report a case with Mental retardation, seizures and developmental delay.

In the electronic media television, movies, and video games and for last decades internet is increasingly contributing to the physical, mental and social health of the children and adolescents. Many published data has documented that major part of this media is a risk factor for obesity, substance abuse, anxiety, sleep Problems and sexual risk behavior in children. Pediatricians generally are the first observers of the unto word effects of media on children thus they should be well equipped with the knowledge of clinical manifestations of media impact on children. Currently media education is not part of any undergraduate curriculum or postgraduate pediatric residency program. (Editorial)

Objective: To assess pre and post workshop knowledge of medical students enrolled in the final year of their medical education at Hamdard University Hospital. Design: Cross sectional comparative study Place & duration of study: Hamdard University Hospital., Karachi. Pre and post test was conducted after a one day training workshop. Methods: A questionnaire regarding different aspects of breastfeeding was given to 79 students to assess their knowledge before and after the workshop. Statistical analysis was done by independent t-test through SPSS Version 15. Results: Questions were categorized into four groups: knowledge about new born; mothers physique & diet, breast feeding; advantages of breast feeding; and colostrum. The mean pre workshop score was 1o.19 and the mean post workshop score was 11.54. The highest possible score was 16. Following the workshop there was significant improvement in knowledge of the trainees regarding three groups of questions namely; mothers physique & diet; advantages of breast feeding and advantages of colostrums (p-value <0.05). Conclusions: The study shows that the workshop helped improve students’ knowledge on several though not all, aspects of breast feeding.

Objective: To determine the role of parenting and socioeconomic factors in juvenile delinquency. Study Design: Descriptive study of 100 imprisoned delinquent juveniles. Place and Duration of Study: The study was conducted from 03-5-2005 to 03-03-2006 in Borstal Institution and Juvenile Jail Bahawalpur. Patients And Methods: In this study 100 children under the age of 18 years imprisoned for juvenile crimes were included. Detailed history was taken from the delinquents, and it was recorded on a proforma that contained general description, role of parenting and influence of socioeconomic factors. Parents and caretaker were also interviewed. The data of these children was recorded on a proforma and was analyzed using SPSS version 10 on the computer. Results: Out of 100 juveniles included in this study, 74% were living with their both parents in their homes,13% were living with single parent and others were living alone at different places. In the study only 11 % parents were having anti social behaviour. Fifty nine percent of the delinquent juveniles belonged to medium sized families (5-8 members). In current study 92% parents had loving attitude to their children and only 8% had rough attitude. In this study 49% Juveniles belonged to very poor families and 34% belonged to middle class families. While only 17% belonged to upper class. Fifty percent juveniles were imprisoned in murder case. Rests of the juveniles were imprisoned for different crimes. Conclusion: Socio-economic factors are very important in etiology of Juvenile delinquency. Other factors like delinquent peer association and exposure to media violence have significant role.

Objectives: To evaluate the pattern of childhood renal disease seen in a tertiary care teaching hospital of Lahore. Design: Descriptive study Setting: Division of Pediatric nephrology/ Department of Pediatrics, King Edward Medical University / Mayo Hospital Lahore. Study Period: 1st Jan 2008 to 31st July 2008. Material & Methods: The data were obtained by analyzing case files of patients admitted in the division of nephrology during the study period. Evaluation of the children included history, physical examination and relevant investigations. Statistical analysis included estimation of mean with standard deviation, median and percentages to determine frequencies. Results: Ninety-four patients of renal disease were admitted during the study period. Mean age was 8+15.286 (S.D.) years, median 7.864. Nephrotic syndrome (51.1%) was the most common diagnosis followed by chronic renal failure (14.9%), acute renal failure (8.5%) and renal stones (7.4%). Urinary tract infections accounted for 4.3% of admissions. During this period there were three deaths (2 cases of chronic renal failure and 1 of acute renal failure) and 2 patients left against medical advice. Conclusions: Renal diseases are fairly common in pediatric age group, early detection and proper management can make a remarkable difference to the outcome

Objectives: To determine frequency and type of valvular lesions in children below 12 years of age with Rheumatic Heart Disease. Design: Analysis of all children undergoing echocardiography for possible Rheumatic Heart Disease (RHD) in a single centre from October 2005 to December 2008. Setting: This study was conducted at Paediatric Cardiology Department, Ch. Pervaiz Elahi Institute of Cardiology Multan- Tertiary referral centre for paediatric and adult cardiac services in South Punjab. Material and Methods: The data on all children below 12 years of age undergoing detailed transthoracic two-dimensional echo and doppler studies was reviewed. Only new cases of RHD were studied for age of presentation, gender, type and severity of valvular lesions. The data was analyzed with SPSS 11 version. Results: Out of 3905 new echocardiograms during the study period, 455 (11.65 %) patients were diagnosed as RHD. Male to female ratio was equal (1.02:1). Mean age was 10 years (range: 4 -12). Mitral regurgitation (MR) was the predominant valvular lesion affecting 429 (94%) patients. Of these, 37 (08 %) had mild MR, 106 (23 %) had moderate MR, 129 (28.4%) had moderate to severe MR and 157 (34.5%) patients had severe MR. Aortic regurgitation (AR) was present in 272 (60%) patients and almost always (98%) in combination. Of those, 131 (29 %) had mild AR, 79 (17.4 %) had moderate AR, 40 (08.8%) had moderate to severe AR and 22 (05 %) patients had severe AR. Mitral stenosis (MS) was noted only in 68 (15%) patients, of which 11(2.4 %) had isolated MS and rest were in combination with MR or AR. Severe MS (isolated or combined) was observed in 40 patients (9 %). Out of combined lesions, MR+AR were found in 52 % cases, MS+AR in 9.2% and MR+ MS in 9.5 % of cases. Conclusion: The prevalence of RHD in a tertiary care cardiology referral center was 11.65% of all children under 12 years presenting for echocardiography. Most of the patients had more than one valves involved. The most common lesion was mitral regurgitation followed by aortic regurgitation. Mitral stenosis was present in 15% of the patients at such young age.