FREQUENCY OF HYPOTHYROIDISM IN CHILDREN WITH CELIAC DISEASE AT A TERTIARY CARE HOSPITAL

Background; The prevalence of thyroid disease is likely increased among children with celiac disease (CD). In addition, exposure to gluten-free treatment may be associated with a risk of thyroid disease, but this association remains controversial. This study was conducted to determine frequency of hypothyroidism in these children as there is no such study done in our local population of Southern Punjab. Objective; The objective of this study is to determine the frequency of hypothyroidism in children with celiac disease at a tertiary care hospital.  Material and methods; A total of 115 children with celiac disease were registered in this cross - sectional study which was conducted at department of pediatric medicine, Nishtar Hospital Multan from June 2015 to December 2016. These children were screened for their thyroid hormone levels to diagnose hypothyroidism. Results; Of these 115 study cases, 49 (42.6%) were male patients and 66 (57.4%) were female patients.  Mean age of our study cases was 6.31 ± 2.05 years. Of these 115 study cases, 59 (51.3%) belonged to rural areas while 56 (48.7%) from urban areas, 45 (39.1%) were from poor families while 70 (60.9%) were from middle income families. Of these 115 study cases, 31 (27 %) were from urdu speaking families, 38.3 % Punjabi, 30 (26.1%) Saraikis and 10 (8.7%) were Baloch.  Of these 115 study cases, mothers were illiterate in 75 (65.2%) and literate in 40 (34.8%). Mean disease duration was 5.27 ± 2.11 months and 69 (60%) had disease duration up to 6 months and 46 (40%) had more than 6 months. Mean T3 level was 86.43 ± 26.25 ng/dl, mean T4 level was 5.02 ± 1.69 µg/dl and mean TSH level was 3.80 ± 1.21 IU/ml and hypothyroidism was present in 44 (38.3%). Conclusion; High Frequency of hypothyroidism was noted in children with celiac disease in our study. Hypothyroidism was significantly associated with age, ethnicity and prolonged disease duration. Clinicians treating children having celiac disease should monitor thyroid hormone levels so as to decrease disease morbidity which will save them future hardships and improve quality of life of such patients. Keywords; Celiac disease, hypothyroidism, thyroid dysfunction

IDENTIFICATION OF CAUSATIVE ORGANISMS OF SPONTANEOUS BACTERIAL PERITONITIS IN PATIENTS WITH LIVER CIRRHOSIS AND THEIR SENSITIVITY PATTERNS

Background; Spontaneous bacterial peritonitis is a common bacterial infection in patients with cirrhosis and ascities with in-hospital mortality rates ranging from 20 to 30%. Early diagnosis and a prompt antibiotic therapy have considerably decreased the mortality rate and this study was done to determine drug resistance pattern among causative organisms of SBP. Results; Of these 183 study cases, 103 (56.3%) were male patients while 80 (43.7%) were female patients. Mean age of our study cases was 51.73 ± 9.28 years. Previous history of use of antibiotics before 72 hours was noted in 103 (56.3%), anti – HCV was positive in 103 (56.3%) while HBs Ag was positive in 13.7% of our study cases. Among these study cases, E.coli was noted in 135 (73.8%), Staph. Aureus in 17.5% and Klebsiella was noted in 8.7%. Chloramphenicol was resistant in 24 (13.1%), ampicillin was resistant in 143 (78.1%), co – trimoxazole in 61.2%, ciprofloxacin in 55.7%, Ofloxacin in 56.3%, Cefotaxime was resistant in 78.1% and amoxicillin was resistant in 74.9%. Conclusion; Our study results have indicated that E.coli was major causative organisms among patients with spontaneous bacterial peritonitis having cirrhosis of liver followed by staphylococcus aureus and klebsiella. High degree of drug resistance was observed among  these strains in our study which points towards well directed efforts of our health policy makers to adopt certain guidelines regarding use of these drugs in our population. Keywords; Cirrhosis, spontaneous bacterial peritonitis, E. coli