ABSTRACT
Cesarean Section [C-S] is one of the most commonly performed operations in the world.1 Diet and nutrition play a vital role in post operative recovery. The objective of the study was to assess the trends and practices about "Early Initiation of Oral Maternal Feeding after Cesarean Section [C-S] under Regional Anesthesia [RA]" and to analyze it in the context of evidence based medicine [EBM]. The study was a multi center cross sectional survey conducted from August 2009-September 2010. Closed ended self administered questionnaires were filled in by 398 respondents of obstetric specialty. In response to the questionnaire 31.3% of the study participants were in favor of early initiation of maternal feeding 2-4 hours; while 84.6% preferred to delay it up to 6-12 hours; 61.6% had the perception that early start of solid diet may lead to ileus and wound dehiscence; whereas 3.4% feared burst abdomen; while only 35.1% said that it would have no effect on wound. About 57% respondents said that early maternal ambulation after an uncomplicated C-S can help in early recovery, while 43% participants thought that it may lead to hypotension, giddiness and spinal headache. The responses of the participants regarding early initiation of maternal oral feeding after C-S under RA illustrate fears and old conventional trends rather than practices based on scientific evidence. Awareness programs and multi center clinical trials in the local context may change this practice and give them enough experience and confidence. The evidence shows that initiation of early oral maternal feeding [MF] results in greater maternal satisfaction, less gastro intestinal and wound complications and is also cost effective
ABSTRACT
To determine the frequency of clozapine induced neutropenia and its associated clinical features among the patients suffering from schizophrenia. Cross sectional, comparative study. The study is based on the blood count reports from various centres in Pakistan using Clozapine during a period 1992-2005. The medical records of 917 patients with a diagnosis of schizophrenia, aged 18 years and above were reviewed. Patient's profile was evaluated consisting of gender, dose of clozapine, duration of treatment and complete blood count [CBC] findings including white blood cell [WBC] count or absolute neutrophil count [ANC], before starting the treatment. The case records showing WBC count below 3000 and ANC count less than 500 were identified and details of the clinical and sociodemographic variables were recorded on a proforma. Thirty eight patients [4.1%] developed clozapine induced neutropenia. Median duration of clozapine treatment in these patients was 6.0 years that was significantly higher than Median = 1 year of those patients who did not develope neutropenia [p < 0.001]. An inverse correlation [r = -0.046] was observed between ANC and duration of clozapine induction. Median dose [mg] of clozapine induced neutropenia patients was higher [200 vs. 150, p = 0.262], however statistically insignificant. The incidence of clozapine induced neutropenia of our study is comparable with that of worldwide reported incidence. Prolongation of treatment also increase the incidence