OBSERVANCE OF WHO TEN STEPS TOWARDS SUCCESSFUL BREASTFEEDING; A SURVEY FROM POSTPARTUM MOTHERS.

BACKGROUND: Breastfeeding is a physiological phenomenon; nonetheless, this act is a learned behaviour that requires continuous active support to make it successful. This study determines the frequency of mothers practicing successful breastfeeding according to the WHO ten steps at tertiary care hospital. METHODS: A descriptive cross sectional study was conducted in the Obstetrics department of Military Hospital, Rawalpindi over six month duration from July to December 2014. Booked mothers aged 15-49 years, having given birth to healthy, singleton baby were included in the study. Questions were asked after taking written informed consent from the mothers after delivery. Data was entered and analysed on SPSS version 20. RESULTS: Out of 148 mothers, 35 (23.7%) mothers were following successful breastfeeding, i.e., knew 7 or more steps. A total of 100 (67.6%) mothers received support for breastfeeding by healthcare staff during their stay in hospital while 19 (12.8%) mothers started breastfeeding within one hour. About 71% had started formula milk along with breastfeeding. About 127 (85.8%) reported that they fed their children on demand and 144 (97.3%) did not use dummies. Statistically significant difference was observed as housewife mothers gave no top feed (p = 0.005) and multiparous mothers started breastfeeding within one hour of delivery (p = 0.04). CONCLUSION: The steps to achieve successful breastfeeding are followed to a small extent among mothers. Delayed initiation of breastfeeding and increasing trend towards use of formula feed was observed. Employed, primiparous mothers are the most sensitive group to be focused during antenatal period.

Aetiology and types of neonatal seizures presenting at Ayub Teaching Hospital Abbottabad.

BACKGROUND: Neonatal seizures (NS) affect approximately 1% of neonates. Clonic, tonic, myoclonic and subtle seizures are the common types. Birth asphyxia, sepsis, metabolic derangements, intracranial bleed, kernicterus, tetanus and 5th day fits are the common aetiologies. This study was planned to evaluate the types and causes of neonatal seizures. METHODS: It was a descriptive case series conducted at Ayub Teaching Hospital, Abbottabad from 12th December 2006 to 25th September 2007 on neonates having seizures. Serum chemistry, blood counts, cerebrospinal fluid examination and cranial ultrasound were done in all patients. Blood culture, renal and liver function tests, computerised tomography scan, metabolic and septic screening was done in selected patients. Descriptive statistics were applied for analysis. RESULTS: Tonic clonic seizure was the commonest type (28%) followed by multi-focal clonic, and focal tonic seizures (25% each). Birth asphyxia was found to be the main aetiology (46%). CONCLUSION: Tonic clonic seizure was the commonest type and birth asphyxia the main aetiology identified in the majority of neonatal seizures.

An audit of morbidity and mortality of hospitalised neonates in neonatal care unit of a tertiary care hospital in Abbottabad.

BACKGROUND: Perinatal as well as neonatal mortality record in our country is one of the highest in the world. Home deliveries, lack of adequate facilities, poverty and lack of education are sonme of the important known causes. The present study was planned to determine neonatal mortality in Hazara. METHODS: Hospital records of neonatal admissions at Ayub Teaching Hospital (ATH) Abbottabad from 1st January 2007-31st December 2007 were analysed retrospectively. Percent neonatal mortality was calculated from the record, along with the causes of neonatal mortality. RESULTS: A total of 1705 neonates were admitted in the study period at the department of neonatology Ayub Teaching Hospital Abbottabad. Out of 1,705 neonates 947 (56%) were males while 857 (44%) were females with a male to female ratio of 1.24:1 . Majority, 1,411 out of 1,705 (83%), of the neonates was admitted during the 1st week of their life, mean age 6 days. Asphyxia, sepsis and prematurity were the three most common causes of neonatal admissions contributing 27%, 26% and 24% respectively. Overall mortality was 11%. CONCLUSION: Neonatal mortality is an important contributing factor to infant mortality in Hazara Division. Majority of patients was admitted in the first week of life which indicates that good antenatal and natal care can reduce the mortality and morbidity of our neonates. Improvement in the prenatal, natal and nursery care as a whole can reduce the neonatal mortality in preterm as well as full term neonates.

Association of ABO blood group with COVID-19 severity, acute phase reactants and mortality.

INTRODUCTION: Coronavirus disease 2019 (COVID-19) is the ongoing pandemic with multitude of manifestations and association of ABO blood group in South-East Asian population needs to be explored. METHODS: It was a retrospective study of patients with COVID-19. Blood group A, B, O, and AB were identified in every participant, irrespective of their RH type and allotted groups 1, 2,3, and 4, respectively. Correlation between blood group and lab parameters was presented as histogram distributed among the four groups. Multivariate regression and logistic regression were used for inferential statistics. RESULTS: The cohort included 1067 patients: 521 (48.8%) participants had blood group O as the prevalent blood type. Overall, 10.6% COVID-19-related mortality was observed at our center. Mortality was 13.9% in blood group A, 9.5% in group B, 10% in group C, and 10.2% in AB blood group (p = 0.412). IL-6 was elevated in blood group A (median [IQR]: 23.6 [17.5,43.8]), Procalcitonin in blood group B (median [IQR]: 0.54 [0.3,0.7]), D-dimers and CRP in group AB (median [IQR]: 21.5 [9,34]; 24 [9,49], respectively). Regarding severity of COVID-19 disease, no statistical difference was seen between the blood groups. Alteration of the acute phase reactants was not positively associated with any specific blood type. CONCLUSION: In conclusion, this investigation did not show significant association of blood groups with severity and of COVID-19 disease and COVID-19-associated mortality.

Hypoxic ischemic encephalopathy in neonates.

BACKGROUND: Birth anoxia remains an important cause of mortality and morbidity in neonates. Hypoxia/ischemia can lead to permanent brain damage and also affects other tissues of the body. It results from lack of oxygen before, during or after birth. The study was designed to assess the risk factors of birth asphyxia, common presentations and association of Apgar score with grades of hypoxic-ischemic encephalopathy. METHODS: The study is descriptive, prospective and carried out in the Paediatric Department of Ayub Teaching Hospital, Abbottabad from September 2007 till September 2008. A total number of 181 neonates (144 males and 37 females) who showed the neurological signs of hypoxic-ischemic encephalopathy were included in the study. Maternal history was taken, Apgar scoring was done and neurological grading was done for the assessment of brain damage. RESULTS: Out of 181 neonates 77.9% were full term, 8.8% were premature, 5.2% were having intra uterine growth retardation and 6.1% were post mature. 38.7% were diagnosed as having grade-3, 38.7% as grade-2 and 22.6% as grade-1 encephalopathy. Mortality due to hypoxic ischemic encephalopathy in our unit was 16%. 52.5% of the mothers were primigravida, 50% of the multigravid mothers had history of perinatal deaths, and 6.1% had ante-natal examination. Antenatal factors like lack of antenatal examinations, toxaemia of pregnancy and prolonged labour were major contributors to the mortality of neonates. CONCLUSION: Primigravid mothers, maternal anaemia, lack of antenatal examination, toxaemia of pregnancy and prolonged labour were the major contributors to the hypoxic ischemic encephalopathy. Early recognition of the risk factors and public health awareness needs to be addressed. Improvements in maternal health and regular antenatal checkups should be emphasised.

Obesity as a predictor of self-rated health.

OBJECTIVE: To report on the relationship between self-rated health and obesity. METHODS: Computer-assisted telephone survey of 5001 randomly selected individuals aged 18 years and over residing in California and Texas. RESULTS: Obese individuals have a 3-fold greater odds of reporting reduced health. After controlling for the effect of demographic factors, health care utilization, chronic disease, and lifestyle behaviors, this relationship persists (OR:2.33; 95% CI: 1.7, 3.2). CONCLUSION: Results suggest that obesity is a statistically significant predictor of reduced self-rated health. Directly affecting change in people's self-rating of health would be difficult; however, addressing its correlates, such as obesity, may improve self-rated health status over time.

Haematological findings in relation to clinical findings of visceral Leishmaniasis in Hazara Division.

BACKGROUND: Visceral Leishmaniasis (VL) has worldwide distribution including Pakistan. The disease is characterized by a spectrum of clinical features along with serious complications in untreated cases. This study describes the correlation between clinical manifestations with haematological changes of VL in Hazara Division. METHODS: This cross sectional study was carried out in the children wards of Women & Children Hospital an Ayub Teaching Hospital Abbottabad. Seventy cases were included in this study, Sign, symptoms, complications and haematological parameters were recorded in detail and their comparison was carried out. RESULTS: Majority of the patients (98.57%) presented with fever followed by abdominal distension (47%) Pallor, (44%) weight loss (43%) diarrhoea (17%), vomiting (15%) and epitasis (8%) and hepatosplenomegaly was found in about 83% along with lymphadenopathy (20%) purpura (13%) and peripheral oedema (11%). Laboratory findings revealed anaemia in all the cases followed by neutropenia 43%, lymphocytosis 86% with thrombocytopenia 79%. Bone marrow in most of these cases showed myeloid hyperplasia with increased megakaryocytosis. CONCLUSION: There exists a new focus of visceral leishmaniasis in Hazara Division. The disease mainly affects children below 5 years and is more common in males than in female children. Bone marrow examination provides a reliable and simple tool for diagnosis of visceral leishmaniasis and the condition can be affectively managed with Sodium stibogluconate or meglumine antimoniate.

Organisms causing urinary tract infection in pediatric patients at Ayub Teaching Hospital Abbottabad.

BACKGROUND: Urinary tract infection (UTI) is common in pediatric practice and an important cause of morbidity and mortality in children. Infected urine stimulates an immunological and inflammatory response leading to renal injury and scarring, ultimately leading to end stage renal failure. The present study identifies the micro organisms causing urinary tract infection in children presenting with UTI at Ayub Teaching Hospital, Abbottabad. METHODS: One hundred patients of either sex, ranging from neonatal period to fifteen years of age were studied at the Pediatric units of Ayub Teaching Hospital, Abbottabad. Urine colony count and culture were done on the suspected cases. RESULT: Urinary tract infection was common among females, except in the neonatal period. Escherichia coli was the most common organism isolated (71.0%), followed by Klebsiella (13%), Proteus (11%), Staphylococcus (4%) and Pseudomonas (1%). Proteus was isolated from the males only. CONCLUSION: UTI is a significant problem in the children and requires a large scale study at regular intervals in order to identify organisms from time to time and recommend prompt treatment to reduce UTI related morbidity and mortality in children.

Clinical presentation of urinary tract infection among children at Ayub Teaching Hospital, Abbottabad.

BACKGROUND: Urinary tract infection (UTI) is still common among children all over the world and a cause for significant number of out patient visits. Keeping in view the high incidence of UTI in children with associated morbidity and mortality, it is imperative to diagnose the urinary tract infection early and to treat the infection. We carried out this study to look into the clinical profile of UTI in children presenting at Ayub Teaching Hospital. METHODS: One hundred patients of diagnosed UTI, from 0 to 15 years of age admitted in the Pediatric units of Ayub Teaching Hospital Abbottabad were included in the study. A proforma was used to record the clinical and laboratory presentation of these patients. RESULTS: Fever was the commonest clinical presentation (92%) followed by dysuria (68%) and failure to thrive (31%). CONCLUSION: Clinical profile of urinary tract infection in children in this study was not significantly different from that of other developing and developed countries, however it will help us a lot in speedy diagnosis of our Paediatrics patients.

Multidisciplinary management of ductal carcinoma in situ: a 10-year experience.

BACKGROUND: Two ductal carcinoma in situ (DCIS) treatment controversies are (1) what is the preferred margin for patients undergoing lumpectomy plus radiation, and (2) is there a subgroup that can be safely treated with lumpectomy alone? A multidisciplinary team was established to evaluate these issues. METHODS: Patients with DCIS who were candidates for breast-conservation were divided into 2 groups. Group 1 had a minimum 5-mm margin and received radiation, and group 2 had a minimum 10-mm margin and received no radiation. RESULTS: One hundred fifty-two patients (153 cancers) met the inclusion criteria. The median follow-up was 8.2 years. Overall, there were 6 recurrences (3.92%); 1 of 71 recurred in group 1 (1.40%), and 5 of 82 recurred in group 2 (6.01%). CONCLUSION: Five-millimeter margins plus radiation results in low rates of recurrence. A subgroup of DCIS patients can be identified in which radiation can be safely avoided. The multidisciplinary team approach to managing DCIS enhances the potential for improved outcomes.

Risk of angiosarcoma following breast conservation: a clinical alert.

Approximately 100 cases of angiosarcoma following breast-conserving therapy have been reported. The prevalence of angiosarcoma following breast conservation has not been accurately established and optimal treatment has not been defined. The goal of this article is to clarify both issues. The Fisher's exact test was used to compare the prevalence of postirradiation angiosarcoma seen in our private practice to the prevalence reported from the two largest national database studies. A literature review was performed to determine optimal treatment guidelines. The results of the comparison indicated that the prevalence of postirradiation angiosarcoma seen in our practice was significantly higher than that reported in the two national database studies at p-values of 0.0124 and 0.0080. Also, results from the literature review suggest that early detection and aggressive treatment lead to improved outcomes. The data are insufficient to draw firm conclusions, but suggest that the current literature underestimates the prevalence of angiosarcoma following breast-conserving therapy. Since elderly women derive less benefit from radiation and may be more prone to develop postirradiation angiosarcoma, confirmation of our findings could lead to a reappraisal of the management of elderly patients with early stage breast cancer.

Azithromycin versus doxycycline for genital chlamydial infections: a meta-analysis of randomized clinical trials.

BACKGROUND: Azithromycin and doxycycline are recommended for treatment of genital Chlamydia trachomatis infection. A systematic review comparing these antibiotics could affect treatment guidelines. GOAL: The goal was to perform a meta-analysis to evaluate the efficacy and tolerance of azithromycin versus doxycycline for genital chlamydial infection. STUDY DESIGN: Studies were identified by searching computerized English-language databases for the period 1975 to August 2001, supplemented by a manual bibliographic search. Criteria for inclusion were (1) randomized trial design; (2) regimens of oral doxycycline (100 mg twice daily for 7 days) and oral azithromycin (1 g once); (3) males >15 years of age and nonpregnant females >15 years of age; (4) and evaluation of microbial cure at follow-up. Data were extracted on diagnostic assay, follow-up time, study design, sponsorship, patients' characteristics, adverse events, attrition rates, and outcomes. RESULTS: Twelve trials met the inclusion criteria; 1543 patients were evaluated for microbial cure and 2171 for adverse events. Cure rates were 97% for azithromycin and 98% for doxycycline. Adverse events occurred in 25% and 23% of patients treated with azithromycin and doxycycline, respectively. After pooling of the data, differences in efficacy and risk were computed. The efficacy difference for microbial cure (0.01; 95% CI, -0.01-0.02) and the risk difference for adverse events (0.01; 95% CI, -0.02-0.04) between the two drugs were not statistically significant. CONCLUSION: Azithromycin and doxycycline are equally efficacious in achieving microbial cure and have similar tolerability. Further head-to-head trials comparing these antibiotics are unnecessary.