Factors affecting breastfeeding practices among working women in Pakistan

In urban areas of Pakistan, women's return to work after giving birth has frequently been found to be a main contributor to the early termination of breastfeeding. This study aimed to assess workplace breastfeeding support provided to working mothers in Pakistan. In a cross-sectional survey in 2014, mothers and employers from a representative sample of 297 workplaces were interviewed using a pre-tested questionnaire. Mothers from 36 [12.1%] sites reported receiving breastfeeding breaks, and 86% of the mothers had received 3 months paid maternity leave. Provision of a lighter job and information about breastfeeding options on return to work were reported from 15% and 5% of the workplaces, respectively. Only two sites had designated breastfeeding corners. Significantly different results were found between types of employer [government or private] and type of organization [national or multinational] with regard to breastfeeding breaks, breastfeeding corners, lighter jobs and paid maternity leave. Public and multinational companies were slightly better than private and national ones in providing breastfeeding facilities

Critical care of gynecological and obstetric patients: a decade of surgical intensive care experience

Despite the emergence of therapeutic advances, the morbidity and mortality still occur in the obstetric patients, although intensive care utilization by obstetric and gynecological patient, are still rare compared to the general population. Majority of obstetric patients needed the intensive care therapy compared to gynecological patients. The aim of our study was to know the indications for the intensive care admission by obstetric and gynecological patients, length of stay and outcome of these patients. We retrospectively reviewed the medical records of all obstetric and gynecological patients admitted to our Surgical and Trauma Intensive Care Units [SICU and TICU] from February 1995 to March 2005. Indication for admission, nationality, age, and length of stay in ICU, severity of disease and outcome of these patients were recorded. Data analyzed with SPSS program. A total of 182 patients were admitted to the SICU of the Hamad Medical Corporation in Doha, Qatar, from the Women's Hospital. 159 [87%] patients were obstetric patients and 23 [13%] patients gynecological patients, 126 [69.6%] patients were admitted post Lower Segment Caesarean Section [LSCS]. The most common indication for admission was 73 [39.3%] patients obstetric hemorrhage and Disseminated Intravascular Coagulation [DIC], and then 44 [25.3%] patients of hypertensive disorder of pregnancy. The major anesthesia related indication was scoline apnea, 21[11.6%]. Total three obstetric patients died, two due to severe sepsis and multi-organ failure and one due to cerebral sinus thrombosis, giving mortality rate of 1.66%. Intensive care therapy required by gynecological and obstetric patient is less than the general population. The commonest indication for admission was obstetric hemorrhage, DIC, and hypertensive disorders of pregnancy. The mortality was due to septic shock with multi-organ failure, and cerebral venous sinus thrombosis

Blind nasogastric lube insertion: be careful

Nasogastric tubes are used in all specialties of medical practice. In critically ill patients, these feeding tubes provide enteral nutrition, which maintains enteric mucosal integrity as well as the immune system of the body, less risk of sepsis and decrease in length of intensive care stay. The insertion of nasogastric tube [NGT] is being considered as a simple blind bedside procedure but this procedure is not free of complications and can be fatal as these tubes can be malpositioned into the respiratory tract or central nervous system. Critically ill patients with endotracheal and tracheostomy tube are at particular risk for malpositioning of the nasogastric tubes due to loss of protective reflexes. Here we report three cases, two intubated and one patient with tracheostomy, in whom the enteral feeding tube was malpositioned into the respiratory system, detected early and a new one inserted in correct position, confirmed by x-ray. The aim of this report is to increase awareness about malpositioning of gastric feeding tubes, proper confirmation of their positioning, risk factors for malpositioning and its prevention

Post-operative fat embolism syndrome: a case report and review of literature

Fat embolism occurs in all patients with long bone fractures and intramedullary reaming of long bone but is usually asymptomatic. A few patients will have pulmonary, cerebral and dermal dysfunction; this triad is called fat embolism syndrome [FES]. We report a case of FES developed after intramedullary nailing of both femurs that was successfully managed in our surgical intensive care unit [SICU]

Necrotizing fasciitis and its association with Diabetes Mellitus

To analyze the different presentation, types of infection, predisposing factors [particularly diabetes mellitus] of necrotizing fasciitis; a rare potentially fatal rapidly progressing necrotizing infection of subcutaneous tissue and superficial fascia with secondary necrosis of overlying skin, the medical records were reviewed retrospectively of 94 patients [71 male; 23 female,] admitted to the surgical intensive care unit of Hamad General Hospital, Qatar, between January 1995 and February 2005. Fifty-three patients [56.4%] were diabetic with a mean age of 55 years compared with 40.2 years in non-diabetic patients. Type 1 necrotizing fasciitis, especially of the perineal and genital regions, was more common in diabetic patients whereas type 2 necrotizing fasciitis, especially of torso and upper limbs, was more common in non-diabetic patients. Overall 63.4% of cases were type 2 necrotizing fasciitis. E.coli was the most common bacterium isolated from necrotic tissue of diabetic patients and streptococci were the most common cause of necrotizing fasciitis in non-diabetic patients. Fifteen [16%] patients died but there was no significant difference in mortality between the groups, eight [15.1%] diabetic, seven [17.1%] non-diabetic, although diabetic patients were significantly older

Peripartum cardiomyopathy: report of two cases and review of literature

Peripartum cardiomyopathy [PPCM] is a rare condition affecting women in late pregnancy or up to five months of the postpartum period. The signs, symptoms and treatment of PPCM are similar to that of heart failure. Early diagnosis and proper management are the cornerstones for a better outcome for these patients. We report two cases of peripartum cardiomyopathy which were treated in the surgical intensive care unit [SICU] of Hamad General Hospital, Qatar

Fatal headache of pregnancy: a case report and review of literature

Due to its variable clinical presentation cerebral venous sinus thrombosis [CVST] is a rare, potentially fatal and challenging condition that is more common in females, with pregnancy, puerperium and the use of oral contraceptive being the risk factors identifiable in up to 80% of cases. Hereditary prothrombotic conditions such as protein C and S, antithrombin III deficiency, and anticardiolipin antibodies are responsible for the condition in many patients. Severe headache is the presenting symptom in most cases. A high index of suspicion is needed for diagnosis although newer imaging procedures have led to earlier diagnosis and management with improved outcomes; magnetic resonance imaging with venography is the investigation of choice. The first line of therapy is intravenous heparin and local thrombolysis can be done in cases deteriorating despite adequate heparinization. Decompression craniotomy may be helpful. Here we report a fatal case of CVST in a pregnant lady with severe headache and anticardiolipin antibody syndrome

Regional necrotizing fasciitis and its outcome

Necrotizing fasciitis, a devastating progressive destructive infection of subcutaneous tissue and fascia, is a surgical emergency with a high mortality and morbidity. To analyze the location of necrotizing fasciitis, mode of presentation, microbiological characteristics, comorbid conditions, morbidty and mortality, records were reviewed retrospectively of all ninety-five patients admitted with necrotizing fasciitis to the surgical intensive care unit of Hamad General Hospital between January 1995 and February 2005. Fifteen patients died [15.1%]. All patients had leucocytosis and fever on admission with a mean SOFA score varying from 8 to 10.3 according to the type of necrotizing fasciitis involved [Type 1 or 2] and the regions affected. All received aggressive fluid replacement therapy and all underwent debridement at least twice. The most common comorbid condition was Diabetes mellitus. Type 1 necrotizing fasciitis was common in gluteal, cervical and perineal regions; Type 2 was common in chest, axilla, leg and foot regions. Necrotizing fasciitis of the chest, axilla and gluteal regions had the highest mortality while necrotizing fasciitis of the perineum and genitalia had the lowest mortality

Critical illness polyneuropathy in an obstetric patient: a case report and review

Recently it has been found that many critically ill patients develop secondary neuromuscular disorders following admission to intensive care units [ICU]. One of these is critical illness polyneuropathy [CIP], a widespread symmetrical disorder affecting the peripheral nervous system and often associated with sepsis and multi-organ dysfunction. Two percent of all intensive care patients and as many as 80% of septic patients develop critical illness polyneuropathy which leads to a considerably increased risk of in-hospital mortality. The exact etiology of the condition is not known but various risk factors, differential diagnosis, treatment, management and prognosis are discussed in this report of woman who, following caesarian section, developed CIP, septic shock, multi-organ failure and subsequently died

Acute pancreatic nine years of surgical lCU experience

Acute pancreatitis has a variety of presentations from self-limiting abdominal pain to development of local and systemic complications resulting in sepsis, multi-organ dysfunction, extended intensive care stay and death. Very good quality of life in survivors justifies an optimal therapy in an intensive care setup. The records of 91 patients with acute pancreatitis were reviewed retrospectively. There was a significant difference [p<0.001] between those with edematous pancreatitis and those with necrotic pancreatitis as regards the length of ICU stay and severity scores: Ranson and SOFA [Sepsis-related Organ Failure Assessment]. The most common cause of pancreatitis was biliary [70.3 percent] followed by hyperlipidemia [12.1 percent], post ERCP [5.5 percent], trauma [4.4 percent], idiopathic [6.6 percent] and in one case, ascariasis. Common associated diseases were hypertension [33 percent] and diabetes mellitus [25.3 percent]. Six patients with necrotic pancreatitis died. It is concluded that acute pancreatitis treated in an intensive care unit has a favorable outcome and that a combination of Ranson and SOFA scores with CT index helps in establishing the prognosis

comparative study on the contractile behavior of enervated skeletal muscles of rat and uromastix

Studies regarding the effects of disuse on the skeletal muscles of rat and uromastix were made in view of the differences already reported in the contractile characteristics of the normal skeletal muscles of uromastix [Azeem and Shaikh,1987]. The left hemi - dia phragm of white albino rat and the left gastrocnemius muscles of uromastix were chronically denervated for 21 days In rats, the twitch and tetanic tensions of the denervated muscles showed significant decreases. However, other time dependent parameters were found to be increased significantly. In case of uromastix however, the muscles were not found to be affected by chromic denervation. The contractile behaviour of the denervated muscles of these animals are discussed in terms of morphological and mechanical contraction differences

new analysis of isometric tension curves obtained from hypothermic and hypothermic studies on single skeletal muscle: removal of possible fatigue effect

A new analytical method has been designed for isometric tension curves obtained from hypothermic and hyperthermic studies on single skeletal muscles for the removal of possible fatigue effect. For this purpose, rat diaphragm strips were subjected to hypothermia and the results were compared with a previous study [Shaikh et al., 1979a] to determine whether the previously observed decrease in tetanic tension was temperature dependent or that it was due to fatigue. The results showed that under hypothermic conditions, the twitch and tetanic activity was optimal at 18°C and 30°C respectively with the twitch/tetanus ratios being lower at higher temperatures and vice versa. The new method of analysis designed for the present and the previous isometric tension curves, obtained from muscles subjected to hypothermia and hyperthermia, has demonstrated the actual effect of temperature while excluding the possible fatigue effect

Independence of force velocity relationship of skeletal muscles to denervation at higher temperatures

Effect of chronic denervation and temperature was studied on the force velocity relationship of rat diaphragm muscle. The muscles were denervated for 15 - 20 days and force of contraction and velocity of shortening were calculated according to Hill [1938] using isotonic contraction data. The results showed that the force velocity relationships were not altered at 35°C to 25°C. However, a change in this parameter was observed in the denervated muscles at 15°C. It is suggested that the velocity of shortening is independent of changes in the series elasticity of the denervated muscle at higher temperatures

Factors affecting the maximum yield of non protein nitrogen from skeletal muscles

Attempt was made to study the factors that affect maximum yield of nonprotein nitrogen from various skeletal muscles. The results showed that sonification was the most effective method out of the various extraction procedures used for the extraction of NPN, while the use of tungstic acid as protein precipitant was most suitable. The pH studies showed that pH 2 gave the optimal yield of NPN. Results of the coloured sample dilutions showed exponential relationship between optical densities and the concentrations of NPN used. The results are discussed in terms of the factors affecting maximum yield of NPN along with the significance of the term half optical density dilution