RESUMO
Background: Exclusive breast feeding is essential for baby's health
Objective: To determine the factors associated with failure of exclusive breast feeding
Methodology: Study design: Cross - sectional study. Place and duration of study: The study was carried out in Pediatric department of Sheikh Zayed Hospital, Rahim Yar Khan, from 1 July 2015 to 30 June 2016. This study was conducted on five hundred women having infants up to 6 month of age and not on exclusive breastfeeding. A questionnaire was designed and data was collected through interviewing infant's mothers about various risk factors including maternal education, socioeconomic status, maternal employment status, family type, maternal separation, social myths, number of children, mode and place of delivery, maternal systemic illness, maternal breast condition, birth spacing, and counseling for breast feeding. The data was entered and analyzed by SPSS version 16
Results: Our study showed that among mothers having lack of exclusive breast feeding practice, following factors were found including lower socioeconomic status in 51.2%, joint family system 75.8%, male sex of infant in 62.8%, use of water up to 4 months is good in 64%, mother thinking that milk is not good in 29.2% and to familiarize baby to top feeding in 78.4%. Study showed that place of delivery was private clinics in 55.4%, caesarean section in 37.6% of and 73.4% of caesarean sections as mode of delivery took place at private clinics. Pathological maternal breast conditions [engorgement, sore or cracked nipples, abscess] were found in 36.6% and maternal systemic illness in 19.2%. It was found that proper counseling of mothers for exclusive breast feeding was done among 20.8%, at antenatal visits and 37.2% after delivery
Conclusion: Our study showed that among mothers not practicing exclusive breast feeding, most of these belonged to lower socioeconomic status, not employed, living in joint family system, and having social myths like use of water up to 4 months and to familiarize baby to bottle feeding. It was also found that pathological maternal breast conditions and lack of counseling, antenatally and postnatally were also important risk factors
RESUMO
Background: Kala pathar is a chemical used as hair dye in the developing countries. Cases of trans dermal absorption are reported, but the main concerns are regarding its suicidal intake, as there is no specific antidote for this
Objective: To determine the frequency of acute renal failure in patients with kala pathar [paraphenylene diamine] poisoning
Methodology: This cross sectional study was carried out at Department of Medicine, Sheikh Zayed Hospital, Rahim Yar khan from the period of 1[st] January to 31[st] December 2016. The patients with age 15-50 years with history of kala pathar poisoning either by transdermal or oral ingestion [assessed by history] of any amount were included. The frequency of acute renal failure was labeled where the blood urea level was found more than 30 mg/dl and serum creatinine more than 2 mg/dl.The data was entered and analyzed by SPSS by version 21
Results: In this study there were 65 cases, out of which 47 [72.31%] were females and 18 [27.69%] males. The mean age was 24.35+/-9.8years. The mean duration of kala pathar taken before presenting to the hospital was 5.35+/-0.48 hours. Out of 65 cases 58 [89.23%] had oral intake as compared to 7 [10.77%], trans-dermal absorption. All 7 trans-dermal absorption suffered accidental exposure while out of 58 oral intakes, 54 [93%] took it for suicidal attempt. Acute renal failure was seen in 12 [18.46%] out of 65 cases. Renal failure was common in females affecting 9 [19%] out of 47 cases with p= 0.17. It was significantly higher [19%] in age group less than 30 years [ p= 0.04]. Renal failure was also significantly associated with cases that took it orally, with suicidal intent and their time to presentation to hospital was more than 4 hours with p values of 0.001, 0.02 and 0.03 respectively. There was no significant difference in terms of marital status, however, it was common in un-married with p= 0.08
Conclusion: Kala pathar poisoning is common in our population and acute renal failure is seen almost in every 5[th] cases. Young age, oral intake, suicidal intent and late reporting to hospitals were significantly associated with acute renal failure
RESUMO
To determine the frequency of clinical features of Celiac disease [CD] and Celiac crisis in children. Case series. Paediatrics Unit, Sheikh Zayed Medical College and Hospital, Rahim Yar Khan, from September 2009 to September 2010. Forty children aged between 4 to 13 years of either gender, presenting with complaints of recurrent diarrhea, abdominal distention, severe emaciation and dehydration were included. The information about breast feeding, weaning diets, age of introduction of wheat diets, onset of diarrhea, characteristics and frequency of stools, growth, vaccination status, symptoms in 1st degree relatives, restriction of Gluten diet in the past and anthropometric measures were recorded. Serological tests against anti-Tissue Transglultaminase [anti-tTG] antibodies were obtained in all cases. Upper gastrointestinal endoscopies were performed and multiple biopsies were taken from distal parts of duodenum. Among the forty children, twenty four [60%] were females and 16 were males [40%]. The mean age was 6.35 +/- 2.83 years. Thirty five [87.5%] parents were cousins. Breast feeding was not exclusively given and the Gluten containing weaning diets were given as early as 3.5 months of age. Thirty [75%] children presented with typical sign and symptoms of CD. Celiac crisis presented with profuse diarrhea, severe dehydration; abdominal distention; pedal edema, carpopedal spasm due to tetany; wasted muscles; head drop and inability to stand. The serum TtG antibodies in thirty-eight cases [95%] were above the cut off level of 7u/ml ranging from 35-99 u/ml. The histopathology of specimens from distal duodenum revealed lesions of M3 type in thirteen [32.5%] and M2 type in eighteen cases [45%]. All cases recovered and improved on follow-up after strict adherence to gluten-free diet [GFD]. Majority of children with Celiac disease presented with typical symptom, while Celiac crisis was characterized by severe dehydration, weakness and calcium deficiency signs. Most were the product of consanguineous marriages and were given Gluten - containing weaning foods as early as the 4th month of life