Assessing health staff practices that influence continuity of breastfeeding

Summary: Baby Friendly practices that support breastfeeding initiation and continuity save lives. The aim of this study is to assess the factors affecting the warm chain for supporting breastfeeding continuity. A survey for Baby Friendly practices was conducted in 7 maternity services, 5 of which were previously designated as Baby friendly in the early 1990s. Both staff and mother were interviewed. The results showed that although some practices related to early separation and prelacteal feeding have been maintained, yet they do not fully meet the global BFHI criteria. Absence of prolonged skin to skin contact and prevailing infant milk formula feeding practices in neonatal and pediatrics wards are the challenges that face success in these hospitals. It is concluded that achievement of full support for successful breastfeeding depends on identifying the loops in the warm chain for breastfeeding support. This chain begins with antenatal preparation in primary health care then initiation in maternity wards and continues to the support provided in neonatal and pediatric wards then in primary care during vaccination and growth monitoring. The chain can break at any point by the uncontrolled marketing practices of infant milk formula companies

assessment of mother friendly in maternity services in Egypt

The aim of the study was to assess mother friendly practices and satisfaction of mothers with services they received in maternity facilities. The study was conducted in 5 hospitals with 1145 mothers and 120 staff who attend labor. Overall findings revealed that mothers were not allowed to have preferred family companion at birth, non-pharmacological pain relief methods were ho encouraged and mothers were not allowed to assume position of her choice at birth. This reflected on mothers1 dissatisfaction with the quality of services. It is concluded that there is a need to encourage mother friendly practices at birth

Fungal sinusitis with intracranial extension in immuno-competent patients: surgical planning according to relation to eloquent neurovascular structures

To evaluate the results of combined neurosurgical and ENT surgical management for patients with fungal sinusitis with intracranial extension. We managed 10 cases with fungal sinusitis with intracranial extension. This included 7 females and 3 males. Four patients presented with unilateral proptosis, 2 with deterioration of level of consciousness due to meningitis, 2 with chronic headache, one with epilepsy and one patient presented with trigeminal pain. All cases had long history of chronic headache and nasal obstruction. CT was done in all cases, MR in 8 patients, CT angiography and conventional cerebral angiography in one patient. Surgical intervention was decided according to the relation of the fungal granuloma to eloquent intracranial structures. Endonasal approach alone was used when the granuloma was not related to the optic nerve, internal carotid artery or cavernous sinus [n=3]. Combined subfrontal and endonasal approach was used when the granuloma was closely related to one or more of these structures [n=5]. Transcranial approach alone was done for 2 patients with isolated sphenoid fungal sinusitis that was associated with a mycotic internal carotid artery aneurysm in one patient and with a temporal lobe abscess in the other. In addition, antifungal treatment was used for 8-12 weeks. Patients were followed up clinically and radiologically for 6-36 month period. No morbidity related to the operative procedures was recorded in the study group. One patient died two month post-operatively due to fungal meningitis. In survivors [n=9]: headache and nasal obstruction improved, proptosis was corrected, epilepsy and trigeminal pain were controlled by medication. Follow-up CT showed eradication of the fungal granuloma in all survivors. Histopathological results showed mucormycosis [n=2], aspirgillosis [n=4], and no fungus [4 patients. Team work by ENT and neurosurgical staff and early diagnosis are mandatory in the management of fungal sinusitis with intracranial extension in immune-competent patients. Surgical planning according to the relation of fungal granuloma to eloquent neurovascular structures is the cornerstone for save removal of granuloma

Histopathologic variants of minimal change nephrotic syndrome among Egyptian children: clinical significance and long-term evolution

It is widely accepted that minimal change nephrotic syndrome [MCNS] is the most common cause of nephrosis in children. Minimal change disease typically shows no abnormalities in light microscopy. However, there are some minor light microscopic abnormalities that are considered to be MCNS variants. The aim of this study was to investigate the clinical importance and long-term outcomes of some minimal change variants. This retrospective study included 124 children with idiopathic MCNS, diagnosed between 1998 and 2001 at the Urology and Nephrology Center, Mansoura University. Their clinical records, follow up data and renal samples were reviewed. Among them 76 were males and 48 were females, and their age ranged from 2 to 12 years [median 4.2 years]. They were classified into three subgroups: nil disease [62 patients], mild mesangial hypercellularity [MMH] [38 patients], and mild mesangial thickening [MMT] [24 patients]. Patients with MMH had significantly higher age at onset and significantly higher number of relapses prior to biopsy compared to the nil disease group [p: 0.02 and p: 0.09, respectively]. Patients with MMH had significantly higher serum creatinine, and significantly lower creatinine clearance than those with MMT [p=0.011 for both]. There was no significant difference between the groups as regards the incidence of permanent remission, steroid dependence, steroid resistance, infrequent relapses or frequent relapses over the four years after renal biopsy. Serial creatinine clearance done yearly for four years showed insignificant differences among the three groups. Mild mesangial hypercellualrity may differ initially from other minimal change variants as regard age of onset frequency of relapses, and renal function, but follow-up for 4 years revealed insignificant differences between these groups clearance

Fate of kyphosis in dorsolumbar fractures after pedicle-screw fixation

Using pedicle-screw fixation for the management of spinal fractures in the dorsolumbar junction is widely used. Despite the proper insertion of the pedicle screws, progressive kyphotic deformity may develop post-operatively. Study of different factors related to pedicle-screw fixation in cases with dorsolumbar spinal fractures trying to find out the underlying causes of progressive kyphotic deformity after fixation. This retrospective study includes 52 patients with traumatic fractures of the dorsolumbar junction. All cases were managed by pedicle screw fixation and decompressive laminectomy. Two-level fixation [one above and one below the fractured vertebra] was done in 41 patients, 3 level-fixation in 8 patients, and 4-level fixation in 3 patients. Mean follow up period was 28 months [range from 12-39 months]. Fifteen cases developed post-operative progressive kyphotic deformity. Four of these 15 patients had malposition of pedicle screws and were excluded from the study. The other 11 patients [group A] had two-level fixation and had proper position of the screws as documented by CT scan. Patients in group A were compared to the group of patients who were also operated by two-level fixation but they did not develop postoperative progressive kyphosis [group B, n = 26]. Comparison included number of spinal columns fractured, disruption of facet joints, percentage reduction in the height of the anterior border of vertebral body by the fracture, presence of vertebral body fracture in the coronal plan dividing the body into anterior and posterior segments, presence of anterior dislocation or translation, degree of canal compromise, and presence of associated fracture in the vertebral body adjacent to the injured vertebra. The remaining 11 patients [group C] had 3 or 4 level fixation and did not develop this progressive post-operative kyphosis. Our results showed that the incidence of the following findings were significantly higher in group A than in group B: reduction in the height of the anterior border of vertebral body of 50% or more [82% and -15% respectively], body fracture in the coronal plan [73% and 19% respectively], associated adjacent vertebral body fractures [73% and 27%]. No significant difference was observed between the two groups in the other aspects of comparison. The results of this study indicate that the presence of: more than 50% reduction in the anterior body height, body fracture in the coronal plan, and/or associated adjacent body fracture would indicate a higher degree of spinal instability in patients with fractures of the dorsolumbar junction. It also infers that 2-level fixation is not enough to avoid post-operative progressive kyphosis in such patients

Early experience with surgical management of cerebral aneurysms: report of 32 cases

To review the results of surgical intervention in 32 patients with cerebral aneurysms aiming to find out the pitfalls and lessons one can learn from this early experience with aneurysm surgery. The clinical, radiological and operative data of 32 patients operated for cerebral aneurysms were correlated with 3-month clinical outcome. Clinical data included: age, gender and clinical grading according to the World Federation of Neurological surgeons classification. Radiological data included site, size, neck size of the aneurysm, and the presence of associated vasospasm, intracerebral hemorrhage, and/or hydrocephalus. Operative data included brain swelling, intraoperative aneurysm rupture, temporary clipping of parent vessels, and difficult clipping. Outcome was assessed according the Glasgow outcome score [GOS]. Out of 32 patients, 25 [78.1%] had favorable outcome [GOS 3 and 4], and 7 [21.9%] had unfavorable outcome [GOS 0, 1 and 2]. All early-operated grade 4- and 5-patients died [n=4]. On the other hand, unfavorable outcome was observed in 22% of grade 3-patients and in 5% only of grade 1- and 2-patients. Meanwhile, the following factors were associated with unfavorable outcome: brain edema [40%], vasospasm [33.3%], temporary clipping [55.5%], intraoperative rupture of aneurysm [57%]. These factors were frequently observed in early-operated grade 3-, 4- and 5-patients. In grade 3-, 4- and 5-patients, unfavorable outcomes associated with early- and late-surgery were 83% and 14%, respectively. When early-operated grade 3-, 4- and 5-patients were eliminated from the analysis, the incidence of unfavorable outcome decreased to less than 8%.In order to minimize the postoperative morbidity and mortality in newly-developed neurovascular centers, it would be recommended to avoid early surgical intervention for patients in grade 3, 4 and 5

Primary glomerulonephritis and hydrocarbon exposure: a case - control study

This is a case-control study which examines the hypothesis of whether cumulative exposure of hydrocarbons have a contributory role, or not, in the development of Idiopathic glomerulonephritis [IGN]. The study groups included Gr.I composed adult IGN cases, Gr.II composed of patients with kidney disease of known atiology [international control group], and Gr. III composed of subjects with normal kidney function [external control group]. The catchment areas of the 3 groups are the same. Cumulative exposure to hydrocarbons was estimated using a life time hydrocarbon exposure score [LHES]. Odds ratio of having IGN and being exposed to hydrocarbons was calculated as 3.02 compared to the internal control group [p<0.05], and 8.44 compared to the external control group [p<0.0001]. The 3 groups differed in the mean values of LHES. After examination of confounders, only family history of renal disease, cigarette smoking, and holding of blue-collar jobs were found to be different across the study groups. As for type of biopsy of IGN cases, membranoproliferative glomerulonephritis was the most prevalent type in hydrocarbon exposed IGN cases, followed by focal segmental glomerulonephritis. However, all known pathologies of IGN were represented. Finally, two measures of cumulative hydrocarbon exposure were compared: the LHES and the hydrocarbon exposure code [HEC] with the conclusion that HEC which is simpler can be used for easier estimation of exposure, bearing in mind its sensitivity and specificity as a screening tool

Deformity in rheumatoid arthritis- an epidemiological study

The records of 1169 rheumatoid arthritis [RA] patients were reviewed to try to find out the pattern of deformities among Egyptian patients and also to assess the role of some patient's and disease characteristics in their development. We have noticed that the commonest type of deformities were that of hands and wrists [31.4 percent], followed by deformities of elbows and shoulders [23.9 percent and 13.9 percent respectively]. Study of the simultaneous effect of different factors, by logistic regression analysis, on deformities development in RA, revealed that the factors which have the most significant effect are in order, the articular index score, the duration of illness and the age of the patient

Histopathological and histochemical studies of the ovary and uterus of the female dog after ligation of the supplying arteries

The present study was undertaken to study the histopathological and histochemical studies of the ovary and uterus of female dog after ligation of the supplying arteries. Twelve adult female dogs were divided into three groups. Unilateral ligation of the internal iliac, uterine and ovarian arteries was done in group I, II and III, respectively. All animals were sacrificed one month after the operation. Samples were taken from the ovaries and uterine horns of both the ligated and nonligated sides for histological and histochemical studies. Unilateral ligationof either internal iliac, uterine or ovarian arteries was followed by histopathological changes in the uterine horns of both sides. However, the degenerative changes were more marked at the horns of the ligated sides. The endometrial glands of both uterine horns showed negative PAS and alkaline phosphatase activies after unilateral ligation of the internal iliac or uterine arteries. However, after ligation of the ovarian artery, the endometrial glands of the ligated side showed weak PAS reaction and moderate alkaline phosphatase activity. Those of the contralateral side showed a strong activity. Concerning the ovary, unilateral ligationof the internal iliac or uterine arteries was followed by marked degenerative changes in the ipsilateral ovary and the contralateral ovary was normal in appearance. However, ligationof the ovarian artery was followed by atrophic changes in the ovary of the ligated side. That of the contralateral side showed compensatory hypertrophy of the graafian follicles. Ligation of the internal iliac or uterine arteries was followed by strong activity of the alkaline phosphatase enzyme in the growing follicles and corpus lutii of both ipsilateral and contralateral ovaries. There was also a strong activity of the alkaline phosphatase in the hypertrophied follicles of the contralateral ovary following ligation of the ovarian artery

Effects of ambilhar on the pregnant female rats and their neonates

The present work was undertaken to study the effect of ambilhar [antibilharzial drug] on the pregnant female rats and their necnates. Ten pregnant female rats were used in this work. They were divided into five experimental and five control animals. From the eighth till the fourteenth day of gestation, the experimental animals were given a daily oral dose of 6 mg Niridazole [ambilhar] dissolved in normal saline. All the rats were allowed to deliiver. The mothers and their neonates of both the experimental and the control groups were killed on the first day of delivery. The heart, liver, kidney and spleen were tajen for the histological and histochemical studied. Administration of ambilhar were followed by marked degenerative changes in the organs under investigation. Thansplacental passage was also proved in the present study as many histopathological changes were observed in the fetal organs. There were also a decrease in the activity of the alkaline phosphatase enzyme and the reaction of PAS. The significance of these findings was discussed