The practice of exclusive breastfeeding: its socio-demographic determinants in Kashmir, North India

Background: Breastfeeding is a well-established and recommended intervention for the improvement of child nutrition. Formula feeding is a major public health problem. Objective of the current study was to know the significance of demography, socioeconomic, parental education and employment and mode of delivery on exclusive breast-feeding Kashmir, North India.Methods: A prospective hospital-based study, carried out in the Department of Pediatrics, G.B Pant Hospital Srinagar Kashmir India over the period from 2014 July to June 2015. A teaching, research and tertiary care hospital at Srinagar Kashmir North India. All the mothers who were having infants in the age group 0 to 6 months were included in study. Procedure of this variables recorded were modes of feeding, demographics, socioeconomic status, literacy level, mode of delivery, place of delivery etc.Results: A total of 600 mothers were included in study. Less than 35% of mothers were exclusively breast feeding their infants. Exclusive breast feeding was significantly high in babies born by normal vaginal delivery, more than 3 antenatal visits, mother knowing advantages of breast feeding and higher parental education.Conclusions: Exclusive breast feeding is very low (less than 35%) in this part of world and formula feeding is a major public health problem.

Severe hyperparathyroidism versus parathyroid carcinoma: a clinical dilemma

No clinical or laboratory data allow a preoperative diagnosis of parathyroid carcinoma and only occasionally does a definitive finding differentiate an adenoma from a carcinoma. We present a case of primary hyperparathyroidism presenting with severe elevation of parathyroid hormone and serum calcium as well as complications. We go on to discuss the case in the light of a literature review. The severity of the elevation of the parathyroid hormone, other biochemical alterations, the presence of skeletal and renal complications and of a neck mass should alert the clinician to a possible parathyroid carcinoma. Radical surgery is the only effective therapy for parathyroid carcinoma, and should always be performed if a preoperative suspicion is entertained

Determinants of in-hospital cardiac catheterization in acute coronary syndrome patients in Kuwait

Clinical trials and practice guidelines have established the efficacy of early invasive strategy for high risk acute coronary syndrome [ACS] patients. This analysis was undertaken to detect the predictors of in-hospital cardiac catheterization [prior to hospital discharge] in patients with ACS in Kuwait and to assess if this use of early catheterization was according to published guidelines. We analyzed data from a prospective registry of 2054 consecutive patients admitted to all 7 general hospitals in Kuwait with the diagnosis of ACS over a period of 6 months in 2004. Citizens were more likely to receive in-hospital catheterization than expatriates [52.1% vs 38.6%; odds ratio 1.7; 95% confidence interval [CI], 1.4 to 2.2; p<0.001]. Patients with recurrent ischemia were more likely to undergo in-hospital catheterization than patients without recurrent ischemia [55.9% vs 12.2%; odds ratio 11.2; 95% CI, 8.6 to 14.5; p<0.001]. two coronary artery disease risk factors [hyperlipidemia and positive history] were associated with high rate of in-hospital cardiac catheterization [respectively, odds ratio 1.3; 95% CI, 1.2 to 2; p<0.001 and odds ratio 1.5; 95% CI, 1.3 to 2.3; p<0.001]. Although high risk patients benefit the most from an early invasive strategy after ACS, this strategy was persrvered for those with recurrent ischemia and citizens. Other risk factors were not determinants of in-hospital cardiac catheterization. Thus, there is substantial opportunity to improve the use of this effective therapy in high risk patients

Perception of the educational environment by medical students undergoing a curricular transition in Kuwait

The aim of this study was to measure the students' perceptions of the educational environment in a medical school undergoing curricular transition from a traditional to a problem-based learning [PBL] program in the academic year 2006-2007. The Dundee Ready Education Environment Measure [DREEM] was used to evaluate perception of the educational environment. Multivariate logistic regression models were used to identify the factors related to educational environment perception that differ between students following a traditional curriculum to those following a PBL program at Kuwait University Medical School. Mean DREEM score was 53%. When students moved from the traditional curriculum to the PBL system, Academic Self-Perception deteriorated, while Perception of Atmosphere improved. Academic Self-Perception deteriorated because conventional strategies of learning were perceived as no longer useful, while Perception of Atmosphere improved because of increased relevance of the studies. Our findings suggest that curricular changes require careful planning and thinking, with particular attention upon how they influence the educational climate. When new teaching strategies are introduced, new factors that may lead students to develop an adverse perception of their educational environment may be introduced as well. Identification of such factors can lead to an improved educational outcome

Efficacy of Intra Articular Injection of Hyaluronic Acid in the Treatment of Knee Osteoarthritis

This study was conducted to evaluate the efficacy of intraarticular injection of hyaluronic acid for the treatment of knee osteoarthritis. Patients with knee osteoarthritis were followed for a period of six months to assess the efficacy of intra articular injection of hyaluronic acid given three times in three consecutive weeks. Fifty patients were reviewed at two, eight and 24 weeks post injection. The average age was 60.9 years and female to male ratio was 3:1. Patients were assessed using the Lequesne Algofunctional Index for function, and the visual analogue score for pain and side effects. We found that the knee pain reduced and the function improved in most patients and these beneficial effects maintain till the last follow up. The only side effect noted was one case of acute non septic joint effusion after the 3rd injection. We concluded that intra articular injection of hyaluronic acid can produce pain relief and functional improvement for up to 6 months.

Familial mineralocorticoid induced hypertension in the Sultanate of Oman

In Oman, many hypertensive patients with a family history of the disease respond to treatment with spironolactone, a mineralocorticoid receptor [MC-R] blocking agent thus suggesting a high prevalence of mineralocorticoid [MC] induced disease. The aim of this study was to document the prevalence of MC induced disease in patients with a positive family history of hypertension [HTN]. Serum calcium, potassium, creatinine, aldosterone and renin levels were measured under standard conditions in all patients together with an abdominal ultrasound scan and an adrenal computed tomography [CT] scan in four patients. In this small study, we show that 18 of the 27 patients [66%] had undetectable [suppressed] renin levels with usually normal aldosterone values [14 patients] and respond to treatment with spironoactone. We suggest that MC induced hypertension is likely to be common in the Middle East. In evolutionary terms, this makes sense as the ability to conserve salt in hot climates might be expected to confer a definite survival advantage

Serum leptin and its relationship with metabolic variables in Arabs with type 2 diabetes mellitus

Most studies on serum leptin in type 2 diabetes mellitus have focused on white populations. We studied serum leptin concentrations and parameters related to glycemic control and the association between leptin levels and anthropometric and metabolic factors in Arab patients with type 2 diabettes and in Arab control subjects. Ninety-two patients [65 females and 27 males] with type 2 diabetes and 69 matched normal control subjects [48 females and 21 males] were included. Anthropometric measures [including body mass index [BMI] and waist:hip ratio] were assessed in all subjects. After an overnight fast, blood was collected for serum leptin assay. Other metabolic parameters including glucose, insulin, C-peptide, intact proinsulin, insulin resistance index [HOMA-IR], insulin-like growth factor 1 [IGF-1], lipids and hemoglobin A1c [HbA[1C][C]] were determined. Fasting serum leptin levels, IGF-1 and high-density lipoprotein [HDL] cholesterol were similar in pattients with type 2 diabetes and control subjects. When obese subjects [BMI >/= 30 kg/m[2]] were analyzed separately, serum levels of leptin were significantly lower in patients compared to controls. In contrast, patients had higher fasting glucose, insulin, C-peptide, intact proinsulin, insulin resistance, total cholesterol, triglycerides, HbA[1C], and a larger waist circumference and waist-to-hip ratio than controls. Serum leptin correlated positively with BMI, negatively with waist-to-hip ratio, and demonstrated no relationship to other parameters. Patients with type 2 diabetes in an Arab ethnic population showed evidence of an unfavorable metabolic profile despite having leptin levels similar to controls. Obesity influences serum leptin levels more significantly in type 2 diabetes, in which leptin levels tends to be low

Glucocorticoid replacement in panhypopituitarism complicated by myelinolysis. A case report

To report a case of glucocorticoid substitution in panhypopituitarism that can lead to uncontrolled rise in serum sodium and myelinolysis. Clinical Presentation and Intervention: A 42-year-old man presented with disturbed conscious level and hyponatremia. Initial data suggested glucocorticoid deficiency. Later, hormonal levels indicated panhypopituitarism. MRI of the brain led to the diagnosis of a pituitary macroadenoma. Glucocorticoid substitution was initiated immediately after admission, and possible myelinolysis subsequently became a complication. We report this case to illustrate the fact that glucocorticoid substitution can lead to rapid rise in serum sodium and myelinolysis in panhypopituitarism. This case illustrated the need to use minimum doses of glucocortcoids with close monitoring of serum sodium, in order to avoid this complication

Behaviour of bicyclists in Al-Ain city, Unted Arab Emirats: an observational study

We aimed to study the behaviour of bicyclists in Al-Ain city so as to define the level of safety of cycling. 415 bicyclists were observed on the main roads of Al-Ain city over a period of 6 weeks.57% [236] of these observations were at day light hours and 43% [179] were during night. 99.5% [413] of bicycle riders were males. 97% [403] were adults, and 98% [407] were non-local, mainly from the Indian continent. In 91% [377] there was only one rideer while in 9% [38] there were two riders. 70% [289] were on the main road in contact with high speed vehicles while 30% [126] were on a side path or pavement. 54% [223] rode with the direction of traffic and 46% [192] against it. Only 0.5% [2] used helmets and 1% [2/179] used lights at night. Safety standards for bicycle riders in Al-Ain city are alarmingly low. These standards should be raised both by public education and law