Feeding of low birth weight newborns in tertiary care hospitals in Pakistan: do they follow the world health organization latest guidelines?

To determine the extent the World Health Organization [WHO] guidelines on the care of Low Birth Weight [LBW] newborns are followed in Pakistani hospitals and analyze any difference in policy compliance between different hospitals. Descriptive analytical study. Data was collected from five tertiary care hospitals, one each from Peshawar, Lahore, Quetta, Karachi and Islamabad, from January to June 2012. LBW newborns data derived from medical records was used. It was collected using a questionnaire, which encompassed the recent WHO recommendations for feeding of LBW. Twenty questionnaires were collected from each hospital. STATA 11.0 was used to analyze the data. Fifty seven LBW newborns [57%] were fed with mother's own milk, and 9 [9%] were fed on donor human milk. Forty four newborns [44%] were initiated breastfeeding within the first hour after birth. Most of the babies not able to be breastfed were fed with intra gastric tube. Feeding practices varied markedly across hospitals, ranging from one hospital where all newborns were fed formula milk to one where all were fed breast milk. The WHO guidelines were only partially implemented, with significant differences between hospitals in level of implementation of recommended practices. Given the benefits expected from the application of the guidelines, efforts should be made for the establishment and promotion of a single national policy for LBW feeding that follows the WHO new guidelines and streamlines the LBW feeding practices across the country

Dehiscence of laparatomy wounds in children

To assess the various causes or factors leading to dehiscence of incised surgical wounds of the abdomen in children. The record and charts of all patients who developed dehiscence of the abdominal wounds after operation for various diseases were reviewed and data was collected. The age, sex, timing of surgery, reason for surgery, place of primary surgery, operating experience of surgeon, type of suture material, surgical technique, associated medical conditions, nutritional status and the use of per operative antibiotics were the variables which were analyzed. Different causes of wound dehiscence were assessed and analyzed. During the period of 12 months 22 patients developed wound dehiscence. Age ranged from 3 days to 10 years. There were 13 male and 9 female patients. The reason for primary surgery was: intussusceptions in 2 patients; worm obstruction: 2; colostomy for recto vaginal fistula: 3; colostomy closure: 3; posterior saggital anorectoplasty combined with abdominal approach: 1; abdominal injuries [blunt and penetrating]: 5; enteric perforation: 3; mass abdomen: 2 ; band obstruction and subsequent anastomotic leak: 1. Two patients died during the treatment. 17 patients developed complete burst which was repaired while 5 patients were treated conservatively and developed incisional hernia. Wound dehiscence was commonly seen in patients with abdominal wound infection, peritonitis and malnutrition. Control of infection, correction of anemia and malnutrition along with strict adherence to surgical principles plays a vital role in preventing the dreaded complication of abdominal wound dehiscence

Which age, sex and season brings more chances of intussusception for children-an analysis

To know as to which age, sex and season has more cases of intussusception, in children up to the age of 12 years. This prospective study spread over a period of 18 months. A total of 71 patients with surgically diagnosed intussusception were studied. The relevant data, both pre-operative and post-operative, of children who were operated for intestinal obstruction and finally turned out to be suffering from intussusception, was entered in a pre-designed proforma and the information so obtained was analyzed according to objectives of the study. Out of 71 children 55 [77.45%] were male and 16 [22.55%] were female patients. Male to female ratio was 3.4:1. 16[22.53%] were 3 to 7 months old, 55 [77.46%] below 1 year, 16 [22.53%] between 1 to 2 years and 13 [18.30%] above 2 years. 9 [12.67%] were recorded in January, 6 [8.45%] in February, 8 [11.26%] in March, 2 [2.81%] in April, 11 [15.49%] in May, 4 [5.63%] in June, 4 [5.63%] in July, 2 [2.81%] in August, 9 [12.67%] in September, 6 [8.45%] in October, 7 [9.85%] in November, 3 [4.22%] in December., Intussusception is more common in male than female children and again is more common below the age of 2 years and occurs mostly in January-March, May and September to November months of the year, the first 3 months and month of May coinciding with the period when gastroenteritis is endemic and September - November when respiratory tract infections predominate in children

Surgical management of hepatic hydatid cyst in children

To know the effectiveness of removal of hydatid cyst of liver along with pericyst [pericystectomy] as operative treatment, in terms of intra-operative and post-operative complications in the pediatric age group. This study was conducted on paediatric patients with liver hydatid cysts at Department of Paediatric Surgery, Lady Reading Hospital, Peshawar from January 2000 to December 2006. All patients with ultrasound findings for hydatid cyst disease of the liver were included in the study. They were evaluated according to age, clinical presentation, ultrasound and CT scan findings for operative management. After Laparatomy through right transverse incision, half of the contents of the cyst were aspirated, refilled with hypertonic saline solution of the aspirated volume and after waiting for five minutes Pericystectomy was carried out, followed by careful examination and stoppage of any leakage of blood or bile from the residual cavity. In infected cases the cavity was drained. Out of 21 paediatric patients operated for liver hydatid cysts during the study period, 11[52.4%] were girls and 10 [47.6%] were boys, with age ranging from 4 to 15 years. Cystectomy with tube drainage was performed in 20 patients while in one patient de-roofing was performed because of rupture. Hypertonic saline was used as a scoliocidal agent. There was no operative mortality. The mean hospital stay was 6.5+3.8 days. Recurrence after operation was seen in one [4.8%] patient. Hepatic hydatid cysts in children can be treated successfully by peri-cystectomy

Frequency of renal stone disease in patients with urinary tract infection

To determine incidence of renal stone disease in patients with urinary tract infection, this cross sectional study was conducted at Surgical Unit of District Head Quarters Hospital, Charsadda over a period of one year from January to December 2005. One hundred consecutive patients were enrolled in this study. All those patients who presented with urinary symptoms were included. While patients with lower urinary tract stones, upper urinary tract stones with renal failure, renal tumours and previous history of renal stones disease were excluded. The data was obtained and analyzed by filling a specially designed proforma for each patient. All 100 patients were between age ranges of 15-60 years [Mean age 37.5 years]. Infection was present in 79% of cases. The commonest organisms isolated according to culture report were E. Coli [30%], Proteus [19%], Klebsiella [11%], Pseudomonas [7%], Staphylococcus aureus [3%] etc. The frequency of renal stone disease in patients with urinary tract infection was 18.98%. [12.6% in male and 6.3% in female]. Mean age of patients with renal stones was 31.26 years and male to female ratio was 1.5:1. Renal stone disease makes an important group among urinary stone diseases. Urinary tract infection with certain bacteria plays an important role in the synthesis of renal stones. A high incidence can be prevented by adopting a variety of simple conservative measures

Evaluation of modified Alvarado score in the diagnosis of acute appendicitis

To evaluate Modified Alvarado Score in patients with right iliac fossa pain. Prospective cross-sectional study from March 2006 to May 2007. District Headquarter [DHQ] Hospital, Charsadda. One hundred consecutive patients with right right iliac fossa pain. Both male and female patients with ages >14 years were included. Basic data of all the patients was collected. They were divided into two groups on the basis of modified Alvarado score. Group-I: Alvarado score >/= 7. Group-II: Alvarado score /= 7

Retrospective analysis of clinical presentation of children with diagnosed intussusception

To know the presenting clinical features of intussusception in children up-to the age of twelve years. The study was conducted at the Department of Paediatric Surgery, Post-Graduate Medical Institute, Lady Reading Hospital, Peshawar, over a period of 18 months. A total of 71 patients with diagnosed intussusception were included. The relevant data, both pre-operative and postoperative, of children who were operated for intestinal obstruction and finally turned out to be suffering from intussusception, was fed into a pre-designed proforma and the information so obtained was analyzed according to objectives of the study. The common presenting features were colicky abdominal pain in 70 [98:59%] cases, vomiting in 67 [94.36%] cases, abdominal distension in 67 [94.36%] cases, constipation in 63 [88.73%] cases, bleeding per rectum in 61 [85.91%] cases, palpable mass per abdomen in 56 [78.87%] cases and fever in 18 [25.35%] cases. In 11 [15.49%] cases there was a mass palpable per digital rectal examination and 05 [07.04%] patients had diarrhoea on presentation. Colicky abdominal pain, vomiting, abdominal distention, constipation, bleeding per rectum, palpable mass per abdomen are the commonest presenting clinical features of intussusception in children

Frequency of hypertension in stroke patients presenting at Ayub teaching hospital

Stroke is a frequent medical problem occurring in patients with hypertension and other risk factors. The objective of this study was to find the frequency of hypertension as important risk factor in stroke patients presenting at Medical 'B' unit of Ayub Teaching Hospital, Abbottabad from November 2003 to January 2005. Patients who clinically presented with features of stroke and then confirmed on C.T scan were included in this study. Other underlying risk factors were diabetes mellitus, smoking, cardiovascular disease and dyslipidemia. Hypertension was found to be the most common risk factor in current study. Out of 91 cases, 51 [56.04%] were suffering from hypertension. Thirty five patients were male and sixteen patients were female. Peak stroke prone age was 61-70 years in males and 51-60 years in females. Hypertension is the leading risk factor of stroke. It is therefore essential to detect and treat hypertension at its outset