Barriers to exclusive breastfeeding in children under 6 months of age in district kasur

Objectives: The objectives of my study were to identify major factors which prevent mothers to breastfeed their infants in the first six months and to analyze the behavioral constraints to develop a suitable strategy for strengthening the practices of exclusive breastfeeding

Study Design: Descriptive Study

Methodology: The study was conducted on 37 subjects, who were mothers with young children under six months of age and were not breastfeeding their children due to any reason. The study was based on direct interview taken at DHQ Hospital Kasur and BHU Rao Khan Wala in the district Kasur. The interviews lasted for about half an hour with each subject. Subjects who were breastfeeding regularly or who were HIV, Hepatitis and other diseases positive were not included. The interviews were conducted in a separate room with least disturbance. Quantitative data like age was presented by mean and standard deviation while qualitative data education, profession were presented by frequency and percentages. SPSS [version 20] software was used for data analysis

Results: The mean age of infants of group [62.1%] was of 2.2 months ± 0.7 and other group of infants [37.9%] was of mean age 5.2 months +/- 0.6. The mean weight [kg] and standard deviation of the index children at birth was 3.1 [kg] +/- 0.2. Among index infants 37.8% were male infants and 62.2% were female infants. By place of birth of children, 75.6% births took place in a health facility. 32.4% mothers were illiterate. 13.5% mothers were on job. Only 83.7% females had fed colostrum to their infants. 62.1% mothers were those who never fed their infants. 27.0% were those who initially fed their infants for short period of time and then stopped feeding who fed irregularly was 10.8%. Important factor identified was insufficient milk production [65.2%] with significance of p-value = <0.05 and Sickness of mothers and consequently advised by doctor to avoid breastfeeding to their infants, was contributing [52.1%] with significance value p= <0.05 among mothers who never breastfed their infants under six months of age

Conclusion: Inadequate milk production and mothers' sickness were most commonly stated factors

Management of developmental dysplasia of hip in older children by triple procedure

Objective: To review the presentation and evaluate the radiographic and functional outcome of developmental dysplasia of hip [DDH] in older children treated by triple procedure surgery, consisted of open reduction, Salter Innominate Osteotomy [SIO], femoral shortening and derotation Osteotomy

Study Design: Observational / descriptive study

Place and Duration of Study: This study was conducted at the BMC Hospital Quetta from January 2013 to December 2015

Materials and Methods: We assess the efficacy and safety of underwent triple procedure treatment of DDH in older children. The study series comprising 22 patients [25 hips].Patients were classified pre-operatively according to the Tonnis Classification, and post-operative functional evaluation was performed using modified Mackay's scoring system, while radiographic assessment considered Severin scoring method

Results: The average age at presentation was 5.60 years and the male to female ratio was 2:46 months. While the average follow-up were 16.4 months. The final outcome was successful in 19 hips [76%] in 16 patients. Patients younger than 5-6 years of age had a better radiological and clinical outcome as compared to older children. Although in the outcome of clinical and radiological assessment there were no significant different between group-I and group-II

Conclusions: Late presentation of DDH is still common in Quetta, Balochistan, which necessitates Triple procedure operative management given frequent occurrences of best result in younger children. Early diagnosis and surgical interventions is therefore imperative in the successful treatment of patients suffering from DDH

Fixation of intertrochanteric intertrochanteric femoral fractures femoral fractures by dynamic hip screw

Objective: Aim of the study was to evaluate the results of DHS fixation union rate, complications and functional outcome

Study Design: Experimental / clinical trial study

Place and Duration of Study: This study was carried out at Bolan Medical Complex Hospital Quetta from January 2014 to December 2015

Materials and Methods: 45 patients were surgically treated with use of dynamic hip screw [DHS] to stabilize the intertrochanteric fractures. Out of total 45 patients 35 [74%] were males and 10[14%] females. Age ranged between 25 -71 years average 63.9 years. Most common mode of injury was mixed in 28 patients. All the cases were classified according to Jensen's classification. All the cases were performed under image use of 135' angle plate with hip screw

Results: Out of 45 patients 03 patients died, two in the hospital and I at home. It was observed that patients from rural areas arrived late [19.8 days] after their injuries and these from urban areas reached within two days and thus affected the reduction and operation time

Time lapse between the injury and operation was 11.7 days. Overall union time was 20.02 weeks

No nonunion was seen

Complications were seen in 12 patients

Conclusion: Excellent to good results were achieved in 96% of cases which concludes that DHS is bio-mechanically stronger and better implant for fixation of intertrochanteric fractures

Temporary hemodialysis; taurolidine lock to prevent catheter-related blood stream infections

Catheter related blood stream infections [CRBSI] in patients undergoing hemodialysis frequently results in significant morbidity and mortality. Attempts at prevention of CRBSI by catheter lock antibiotics, antibiotic combinations or solutions including Taurolidine have emerged over years. Objectives: To determine the role of taurolidine lock in presentation of Catheter related infection in hemodialysis. Design: Multicentre un-builded, r and omized controlled, non-inferiority trail. Period: Jul 2012 to Dec 2013. Setting: Department of Nephrology, Fatima Memorial Hospital UHS Lahore. Methods: It was a multicentre, un-blinded, r and omized controlled, non-inferiority trial. Results: Out of 95 patients, total of 38 patients were r and omized into two groups. In group A catheters were locked with Taurolidine 2% and Heparin [5000IU/ml] equal to the catheter volume according to the protocol. In group B [control] catheters were locked with Heparin alone. 36 patients completed the study protocol. For primary end point analysis [30 days] the mean duration of catheter days was 27.25 + 5.5 days [median 30 days]. During this period of follow up only one patient from Group B had CRBSI resulting in a point incidence of CRBSI of 2.7%. Conclusions: Catheter lock with Taurolidine 2% in combination with heparin compared to heparin alone had no additional benefit in prevention of CRBSI. This however needs to be evaluated in a larger study using non cuffed temporary vascular access [TVA]

Suprapubic fecal fistula due to Richter's inguinal hernia: a case report and review of literature

We encountered a 55-year-old man, who presented with an orifice in the suprapubic region, through which fecal material was discharged. On physical examination, the patient was unstable. After resuscitation, thorough evaluation, and laboratory and imaging investigations, he underwent an exploratory laparotomy. The ileum was entrapped at the deep inguinal ring, and there was some pus in the pelvic cavity. The purulent material was cleaned, and anastomosis was done after the resection of the defective ileal segment. In view of the rarity of this presentation and the paucity of published articles, this case is reported here

effectiveness of botulinum toxin in the management of benign essential blepharospasm and hemifacial spasm

To determine the effectiveness of Botulinum toxin in the treatment of Benign Essential Blepharospasm [BEB] and Hemifacial spasm [NFS] at a tertiary care hospital. Neurology Department, Bolan Medical Complex Hospital, Quetta. 30 months from 15 March 2010 to August 2012. Quasi experimental study. All patients referred to neurophysiology laboratory for Botox [BTX] injection were enrolled in the study after taking written consent. Botox injection 1.25 units was used for BEB and 3.0 units used for HFS given in the laboratory. Patients were observed for any immediate complications and then followed at two weeks for start of improvement and side effects and then at one, three and six months for duration of lasting improvement and any side effects. In this hospital based study we enrolled 30 patients with the diagnosis of BEB and HFS. The average age of the patients was 52.47 +/- 11.59. Out of 30 patients 57% were male and 43% were female with 1.3:1 male to female ratio. Blepharospasm was observed in 53.3% patients and hemifacial spasm was observed in 46.7% patients. In 50% of patients the onset of improvement was within 4-7 days. 93.4% of patients had improvement at the end of one month and 80% patients had improvement at 3 months follow up. Total duration of benefit lasted for up to 4-5 months in 46.6% of patients, 30% patients had benefit lasting for more than 5 months. 16.7% patients noticed benefit for up to 3 months and only 6.7% patients had benefit of only 2 months. Side effects such as Ptosis, diplopia, photophobia, redness of eyes, dry eyes and facial weakness occurred in 23% of patients in first week and up to one month while only 6.7% patients continued to have side effects at 3 months. This is the first study of its kind in our local population. This study concludes that the BTX is highly effective in the management of BEB and HFS and it is well tolerated

Proposed model for healthcare waste management

The objective of this manuscript is to propose a Healthcare Waste Management [HWM] model for the safe disposal of healthcare waste which should be comprehensive, environment friendly and in an integrated form. This descriptive analytical study was done and based upon the factors associated with the poor handling of healthcare waste at Shalamar Hospital Lahore from November, 2008 to December, 2010 in healthcare facilities [HCFs] situated in Punjab, Pakistan, a model has been proposed. Five stages for the management of the waste [a] Planning the outline, [b] Implementation of action plan, [c] Classifying job descriptions, [d] disposal method and [e] Skill Development have been evolved. This model can be applied in any healthcare facility situated in Pakistan

Outcome of 7-S, TQM technique for healthcare waste management

To assess the present waste management system of healthcare facilities [HCFs] attached with Shalamar Hospital, Lahore by applying the 7-S technique of Total Quality Management [TQM] and to find out the outcome after imparting training. Interventional quasi-experimental study. The Shalamar Hospital, Lahore, Punjab, Pakistan, November, 2009 to November, 2010. Mckinsey's 7-S, technique of TQM was applied to assess the 220 HCFs from Lahore, Gujranwala and Sheikhupura districts for segregation, collection, transportation and disposal [SCTD] of hospital waste. Direct interview method was applied. Trainings were provided in each institution. After one year action period, the status of four areas of concern was compared before and after training. The parameters studied were segregation, collection, transportation and disposal systems in the 220 HCFs. Each of these were further elaborated by strategy, structure, system, staff, skill, style and stakeholder/shared value factors. Standard error of difference of proportion was applied to assess significance using 95% confidence level. There was marked improvement in all these areas ranging from 20% to 77% following a training program of 3 months. In case of disposal of the waste strategy, structure and system an increase of 60%, 65% and 75% was observed after training. The 7-S technique played a vital role in assessing the hospital waste management system. Training for the healthcare workers played a significant role in healthcare facilities

Managing the healthcare solid waste in selected districts of Punjab, Pakistan

Hospital and other health care facilities [HCFs] are known to generate lot of waste for which its management is a matter of considerable public health and environmental concern. The study was undertaken to describe the current practices, gaps and quantify the load of health care solid waste. Out of one hundred and fifty health care facilities [HCFs] in Punjab, the largest province of Pakistan, a sample of fifteen [HCFs] was taken from a few selected Districts, to include six large hospitals and nine without indoor facilities. Only 40% of studied institutions had some program to dispose-off the waste. Even these programs were deficient in many areas and could hardly be considered as scientific. One third of institutional personnel interviewed had proper awareness or existence of a training program. Only one institution had some concept of taking safety steps from infectious materials. The process of solid waste collection, storing, transporting and final disposal was highly inefficient in almost all the institutions. No regulatory body or system of waste was in place in any of the hospitals. There was no allocated budget in 27% of the hospitals for covering the cost of waste disposal. An average of 0.3 kg/bed/day of solid unsafe waste demands a systematic program of its disposal, failing which serious environmental hazards would develop for within and surroundings communities

Early clinical symptoms associated with occupational lead toxicity

An epidemiological study of occupation hazard of exposure to lead was made in 184 workers in a Printing press, Benghazi, Libya. The subjects were divided into three group I [32] working close to source of fumes and/or dust, group II [108] working a little distance a way but breathing in the same hall atmoshere, group III [44] clerks in the neighbouring administrative building. They were compared with group IV [145] workers of a Pepsi-Cola factory, Their history and clinical symptomatology relating to gastrointestinal, muscoloskeletal and neurological systems were obtained. Blood lead [Pb B] levels were estimated from randomly selected workers of each group using atomic absorpion spectrophotometry. They mean Pb.B. levels of the exposed groups I and II were 26.16 and 25.60 micro g/dl respectively. Group III and IV showed 15.69 and 21.85 micro g/dl respectively, which are lower than the accepted toxic levels. There was preponderance of gastrointestinal symptoms in group I workers in comparison with other groups. The relative frequencies of muscoloskeletal and neurological symptoms are discussed. There appears to be no correlation between the blood lead level measured and the degree of morbidity observed in the cases studied. Taking early clinical symptoms as a guide of lead toxicity, possible preventive measures to minimize this hazard are suggested