Breastfeeding practices among mothers attending a tertiary care hospital in Kashmir

Background: According to world health organization (WHO), exclusive breastfeeding (EBF) for the first 6 months of life is vital for optimal growth and development of a child. During this period, other liquids or breastfeeding substitutes should not be given to infants except for medicine or oral rehydration solution. Methods: This cross-sectional study was conducted in the child health clinic of the department of community medicine, SKIMS. The study participants were mothers accompanying their infants coming for immunisation at the child health centre. A semi-structured, questionnaire was used to interview the mothers regarding breast feeding practices of their infants. The data was entered in Microsoft excel 2010 and analysed using SPSS Version 20. Results: The prevalence of EBF was 38.7%. Mixed feeding was received by 54% and 7.3% were formula-fed. Variables that were significantly associated with EBF include residence and mother’s education. Infants from rural area were more likely to be exclusively breastfed compared to those from urban area (OR=0.365; 95% CI=0.166-0.802; p=0.012). Mothers with up to 9 years of formal education were more likely to exclusively breastfed their children than those with more than 9 years of formal education (OR=0.300;95% CI=0.121-0.744, p=0.009). Conclusions: To ensure that the rate of EBF among the mothers is increased, all the stakeholders (spouse, family and government) as well as the people at work place must play their part to the best extent.

Extraction of oligosaccharides and phenolic compounds by roasting pretreatment and enzymatic hydrolysis from spent coffee ground

Spent coffee ground (SCG) is the waste generated during the preparation of instant coffee and is the sourceof industrially valuable organic compounds. In this article, SCG was pretreated by roasting at 150°C for 30minutes and heated with water at 90°C for extracting carbohydrates and phenolic compounds, after which1.0% (w/w) β-mannanase was applied for the hydrolysis of pretreated SCG. SCG is characterized in terms ofits total sugar content by the anthrone–sulfuric assay and phenolic compounds by Folin−Ciocalteu’s procedure.In this study, the total sugar increased by 14.79% (w/w) by the roasting process, and subsequently enzymatichydrolysis increased the total sugar yield up to 17.43% (w/w) compared to the untreated SCG, i.e., 10.24%(w/w). The reducing sugar was estimated by the dinitrosalicylic acid method and the end product increased to106.10 (mg Glucose/g) from the initial content 5.32 (mg Glucose/g raw SCG). The total phenolic compoundincreased to 291.86 (mg Gallic acid/g lyophilized material), which was a 6.39-fold increase compared to thenative SCG (45.68 mg Gallic acid/g). These results point to the valuable compounds present in SCG, can beenhanced by combining the roasting pretreatment and enzymatic hydrolysis, and can be utilized in the foodand biotech industries.

Incidence of endophthalmitis following intravitreal bevacizumab injection at a tertiary care hospital in eastern province of Saudi Arabia

The aim of this communication is to report the incidence of endophthalmitis following the use of intravitreal Bevacizumab [IVB] at a tertiary care hospital in the Eastern province of Saudi Arabia. A total of 2769 intravitreal Bevacizumab injections were carried out between January 2009 and April 2014. During this period, one case of endophthalmitis following IVB injection occurred. The overall incidence of clinical endophthalmitis was 0.036% [1/2769; 95% confidence interval: 0.0001-0.002%]. This compares favorably with studies reported from other parts of the world

Co-existence of thin basement membrane nephropathy with other glomerular pathologies; a single center experience

The co-existence of thin basement membrane nephropathy [TBMN] and another glomerular pathology portends a worse prognosis than TBMN alone. The purpose of our study was to investigate the prevalence of TBMN and associated glomerular pathologies at our institution. We reviewed all renal biopsies performed at Saint Louis University hospital over a 7-year period. We excluded all post transplant biopsies, and biopsies showing diabetic glomerulopathy, membranoproliferative glomerulopathy, membranous glomerulopathy, and biopsies where no electron microscopy or immunofluorescent studies were done. All other biopsies were included. A total of 634 biopsies were included in the study. The prevalence of TBMN was 47 [7.4%], of whom 17 [36.2%] had TBMN alone. In the remaining 30 [63.8%] patients TBMN was associated with other glomerular pathologies: IgAN 9 [19.1%] and FSGS 9 [19.1%]. We found significantly higher prevalence of IgAN in patients with TBMN versus all biopsies [19.1% vs. 7.7%, respectively, P = 0.002]. We found significant similarities in biopsy indications for TBMN and IgAN group. Around two thirds of the cases of TBMN were associated with other glomerular pathologies. The prevalence of IgAN, but not focal segmental glomerulosclerosis, was significantly higher in patients with TBMN as compared to the general renal biopsy specimens

Risk factors for surgical site infection in clean surgeries in Abbasi Shaheed Hospital

To assess the risk of surgical site infection in clean surgeries associated with age, sex and duration of surgery in Abbasi Shaheed Hospital. This study is a Case control study and was conducted in surgical Unit-1, Abbasi Shaheed Hospital, Karachi from January 2006 to December 2008. Its sample size is Non-probability, convenience and 150 patients were taken for this study in which 100 patients with healthy surgical site were taken as control while 50 patients with infected surgical site were taken as the cases. All male and female patients of age between 18 to 55 years were included in this study. For ail diabetic and non-diabetic patients who were admitted in ward for elective clean surgery, same method of skin preparation was under taken with povidone iodine and spirit. Control were patients without surgical site infection while cases were patients with surgical site infection. All patients received three doses of prophylactic antibiotic first generation cephalosporin 500 mg i/v Shourly preoperatively. SPSS version 10 was used to analyze the data. The ages of the patients were between 18-55 years with increased risk of surgical site infection with increasing age. Out of 50 patients with surgical site infection, 28 [56%] were diabetic and 22 [44%] were non-diabetic. It was seen that 24 patients [16%] had surgery of duration 46-60 minutes and 12 of them [50%] had surgical site infection as compared to 36% in surgery of less than 30 min. Odd ratio of infection for diabetes, duration of surgery, age and gender were 10.3, 6.5, 3.1 and 1.3 respectively. Significant association was found between type, duration of surgery and ASA score. Adjusted analysis revealed a significant relation between age, ASA class, diabetes mellitus, uncontrolled postoperative blood glucose level, duration of surgery and surgical site infection. Mastectomy was significantly associated with surgical site infections along with longer duration and ASA class III

Effects of diuretic and vasodilator therapy in meniere's disease

Meniere's disease is recognised by frequent periods of remissions. The available wisdom about the disease and treatment reflects the openion of experienced clinicians, rather than scientific facts. To determine the efficacy of vasodilator and diuretic therapies in the prophylaxis of Meniere's disease. A randomized controlled trial. The study was carried in the ENT Department, Combined Military Hospital, March 2007 to Dec 2009. Subjects and Methods: All new patients [N=120] of clinically diagnosed Meniere's disease were included by consecutive non-probability sampling. Demographic characteristics of the patients were noted and the patients were divided into three groups irrespective of age and sex. Group A was placed on amiloride 5 mg and hydrochlorthiazide 50 mg combination, one tablet daily, the Group B on tablet betahistine hydrochloride 48 milligram in three divided doses and Group C patients on tab multivitamin once daily respectively. The patients were reviewed after 06 weeks. Improvement in vertigo was seen in 77% in group A, in 68% patients in group B and in 45% in group C [p=0.021]. Hearing thresholds improved in 54% in group A, 63% in group B and in 36% in group C [p=0.067]. There was subjective improvement in tinnitus in 54% in group A, 80% in group B and in 37% in group C. Diuretic and vasodilator had a definitive and significant effect in Meniere's disease, in controlling vertigo and tinnitus, when compared with placebo [p<0.05]. Diuretics and vasodilators do have a significant role in the prophylaxis of Meniere's disease

PEG tube insertion: enhanced need for greater selectivity in patient referral

Percutaneous endoscopic gastrostomy [PEG] refers to insertion of a tube into the stomach percutaneously, aided by endoscope and was first described in 1980 by Gauderer. This was devised for feeding the patients who have swallowing problems due to any reason especially neurodisability. There is an enhanced need for greater selectivity in patient referral. Retrospective, single-institution case series. The study was performed in Waterford Regional Hospital, Waterford, Ireland. Jan 2003 to Dec 2007. A total of 203 consecutive patients referred for nutritional support underwent PEG tube insertion during this period. Written informed consent was taken from all the participants or their attendants and the procedure was performed with prophylactic antibiotic and under intravenous sedation. Standard PEG set was used for the procedure. Feeding was started 12 hours after tube placement and care instructions were given. The parameters of study included indications, annual frequency, and overall outcome. A total of 203 patients having a male to female ratio 1:0.7 underwent PEG tube insertion. The age ranged from 26 to 96 years [mean 79+5.17. The mean duration of PEG feeding was 93 [3-785] days. The annual frequency of insertion increased from 19 [9.3%] patients in 2003 to 64 patients [31.5%] in 2007. The length of stay ranged from 1 to 350 days [median 93]. In this cohort, 32 [15.7%] patients died during the same admission. A total of 79 [38.9%] were discharged for home, 92 [45.3%] were discharged back to nursing home care. This study underscores the need for enhanced awareness and protocol-driven selectivity in patient referral for PEG tube insertion

Intravitreal bevacizumab as a primary treatment for idiopathic choroidal neovascularization

To report long-term outcomes of the use of intravitreal bevacizumab in subjects with idiopathic choroidal neovascularization [ICNV]. Six consecutive subjects with ICNV were included in this prospective study. All subjects received 1.25 mg intravitreal bevacizumab at diagnosis. A decrease in best corrected visual acuity [BCVA], presence of increased retinal edema or hemorrhage, increased retinal thickness on optical coherence tomography [OCT] or increased leakage documented by fluorescein angiography prompted further injections of bevacizumab. The study cohort was comprised of 3 males and 3 females with a mean age of 31.17 years. Mean follow-up was 13.8 months [range, 8 months to 20 months]. Following intravitreal bevacizumab injection, vision improved in 3 subjects, remained stable in 3 subjects and no patient lost visual acuity. The mean BCVA improved to logMAR 0.20 at final follow-up from baseline at 0.950 logMAR [P=0.031]. The mean central macular thickness and central foveal thickness at the last postoperative visits were reduced from pre-treatment levels of 374.33 +/- 146.52 and 347.16 +/- 213.97 to 251.20 +/- 35.36 and 215.33 +/- 43.94 ?m, respectively. [P=0.99 and P=0.16, respectively]. Four subjects required repeat treatments. The total number of repeat treatments was 4. Two subjects required no repeat injections, 3 subjects had 1 retreatment and one subject required 2 additional treatments. The injections were well tolerated by all the subjects, with no ocular or systemic adverse events. Intravitreal injection of 1.25 mg bevacizumab in patients with ICNV is effective in improving and stabilizing vision. Additional studies, particularly determination of optimal protocol for timing of re-injection are required to assess long-term effects

Complications of colostomy in Abbasi Shaheed hospital

To describe the different complications of colostomy that developed after its construction either in emergency or elective surgery in Abbasi Shaheed Hospital Karachi. Descriptive study from January 2006 to Dec. 2007 during which fifty patients who were above 12 years of age were admitted in Surgical Unit-I, of Abbasi Shaheed Hospital, Karachi, through emergency and out patient department. Information of patients including history, clinical examination, investigations, and indication of surgery, operative procedure and operative findings were collected. Gut preparation was done in elective cases only. Detail about stoma, its type, complications and treatment were observed carefully. Emergency colostomies were performed in emergency theatre while elective cases were done in main theatre. Patients were followed up from the construction of colostomy to the fourth post operative week to analyze the complications associated with stoma formation. Reversal of colostomy was done after 8th to 12th post operative period. Among them 40 patients 80% were males and 20% were females. Students, labors and old age were mostly affected class. Most of them were victims of terrorism. Intestinal trauma due to gun shots and stab were the leading cause while the intestinal pathology like tuberculosis, carcinoma, volvulus, intestinal obstruction were found to be the less common causes of stoma formation. 40 patients [80%] were operated in emergency theatre while 10 patients [20%] under went elective faecal diversion. Majority of Colostomies were temporary loop colostomies, formed only for diversion and decompression of distal segment. Out of fifty patients, none of the patients had any major post operative complications like necrosis, prolapsed, parastomal hernia and fistula formations. Only twelve patients [24%] developed complications. Abdominal wall infection in two patients [4%] and skin excoriation in 3 patients [6%] around the stoma were found the commonest local complications. Retraction in 2 patients [4%], stenosis in two patients [4%] with stoma obstruction in 1 [2%] and detachment in 1 [2%] were found. All these cases required refashioning of Colostomy. Stoma bleeding and pain was also observed and treated in 2 patients [4%]. The psychological trauma of having colostomy with a bag on the belly was a considerable problem which patient had during the period, which was reduced and post operative counseling and training was given. Stoma surgery has a wide range of clinical implication. It is relatively a save procedure either to reduce leakage of distal colonic repair or to provide sufficient time for the healing of intraperitonial trauma. The complications occurred in only 24% patients among which skin excoriation and skin infection occured in a few patients. Having an artificial anus was a mental torture for patients

Pediatric retinal detachment in the Eastern Province of Saudi Arabia: experience of a tertiary care hospital

Because no previous studies have addressed the issue, we describe clinical characteristics and surgical outcome of patients with rhegmatogenous retinal detachment [RRD] in a pediatric population of the Eastern province of Saudi Arabia. We conducted a retrospective review of all consecutive cases of pediatric RRD [0-18 years] patients presenting at Dharhran Eye Specialist Hospital, a tertiary care hospital, in the Eastern Province of Saudi Arabia over a period of 3 years. Twenty patients were included in the study, accounting for 9.4% of all retinal detachment surgery cases performed over a period of 3 years [January 2006 to December 2008]. The median age was 11.0 years, [range, birth to 18 years]. Trauma, [45%] myopia/vitreoretinal degeneration [10%] and prior ocular surgery [25%] were significant risk factors for RRD. Proliferative vitreoretinopathy [PVR] more than grade C was present in 14/20 [70%] of cases. Most patients [15/20, 75%] were treated with pars plana vitrectomy and placement of an encircling buckle, while silicone oil or gas was used as tamponade in 13/20 [65%] patients. Surgery was successful in 17/20 [85%] cases in achieving retinal re-attachment. Visual acuity improved significantly following surgery [Mean preop 2.146 LogMAR, Mean postop 1.497 LogMAR] [P=.014]. Longer duration of RRD [P=.007] and macular involvement [P=.05] were associated with worse anatomical outcomes following surgery. Pediatric RRD in the Eastern province is often associated with predisposing pathology. Surgery is successful in achieving anatomical reattachment of the retina in a majority of cases with improvement of visual acuity

Crianças com linfadenopatia cervical significativa: análise clínico-patológica e papel da aspiração por agulha fina no contexto indiano / Children with significant cervical lymphadenopathy: clinicopathological analysis and role of fine-needle aspiration in Indian setup

OBJETIVO: Estudar o perfil clínico-patológico de crianças indianas com linfadenopatia cervical e o papel da citologia aspirativa por agulha fina com ênfase especial na tuberculose como causa. MÉTODOS: Foram incluídas 89 crianças com faixa etária de 10 meses a 12 anos, admitidas em nosso hospital de abril de 2004 a março de 2005. Todos os pacientes foram submetidos a completa avaliação clínica e investigativa em relação à linfadenopatia cervical. Medidas de desfecho incluíram estado clínico e a capacidade de testes convencionais em categorizar tipos diferentes de linfadenopatia e sua utilidade no diagnóstico de linfadenite tuberculosa. A variabilidade interobservador foi analisada através do teste de kappa, tendo boa concordância. RESULTADOS: A hiperplasia reativa foi o tipo mais comum de linfadenite, seguida da granulomatosa. Os linfonodos do triângulo posterior unilateral foram o grupo afetado com maior freqüência no grupo de linfadenopatia cervical tuberculosa. A aspiração por agulha fina, seguida da coloração de Ziehl-Neelsen, histopatologia e cultura em associação, obteve sucesso em realizar o diagnóstico em 85,7 por cento dos casos de etiologia tuberculosa. CONCLUSÕES: A aspiração por agulha fina é uma ferramenta diagnóstica valiosa no tratamento de crianças com apresentação clínica de linfonodos cervicais aumentados. A técnica reduz a necessidade de procedimentos mais invasivos e dispendiosos, principalmente em países em desenvolvimento.Cultura e histopatologia, entretanto, devem ser consideradas em casos nos quais a citologia aspirativa por agulha fina não é diagnóstica.

OBJECTIVE: To study the clinicopathological profile of children from India with cervical lymphadenopathy and the role of fine-needle aspiration cytology with special emphasis on tuberculosis as a cause. METHODS: A total of 89 children in the age group of 10 months to 12 years, presenting to our hospital from April 2004 to March 2005, were included. All the patients underwent thorough clinical and investigational assessment vis-à-vis cervical lymphadenopathy. Outcome measurements included clinical status and ability of conventional tests to categorize different types of lymphadenopathy and their utility in diagnosing tubercular lymphadenitis. Interobserver variability was analyzed measuring kappa test and was found to be in agreement. RESULTS: Reactive hyperplasia was the most common type of lymphadenitis, followed by granulomatous involvement. Unilateral posterior triangle lymph nodes were the most commonly affected in the tubercular cervical lymphadenopathy group. Fine-needle aspiration followed by Ziehl-Neelsen staining, histopathology and culture in combination were able to perform the diagnosis in 85.7 percent of cases affected with tubercular etiology. CONCLUSIONS: Fine-needle aspiration is a valuable diagnostic tool in the management of children with the clinical presentation of enlarged cervical lymph nodes. The technique reduces the need for more invasive and costly procedures, especially in a Third World country. Culture and histopathology, however, should be considered in cases where repeated fine-needle aspiration cytology is non-diagnostic.

Blood transfusion is associated with increase resource utilization and bacterial infection

To observe the association of blood transfusion and clinical outcome in cardiac surgery patients. Forty patients underwent cardiac surgery during a period of two months in a single institution. Coronary artery bypass surgery [CABG] was performed in 21 [52.5%] patients, Mitral valve replacement [MVR] in 15 [37.5%] patients, aortic valve replacement [AVR] in 2 [5%] patients and Atrial septal defect [ASD] was closed in 2 [5%] patients. The mean age of the patients were 41.7 +/- 18 years, 80% were male. Twenty five [62.5%] patients required blood transfusion. Transfusion group showed chest wound infection [7.5%], pulmonary oedema [12.5%] and shortness of breath [10%]. Total leukocyte count and platelets count were significantly lower in transfusion group. We conclude that blood transfusion is associated with increased rate of infection and pulmonary oedema, with high cost and resource utilization. Blood transfusion should be used with appropriate caution

Barrier laser photocoagulation for recurrent retinal detachment

To describe results of barrier laser photocoagulation in preventing progression of recurrent retinal detachment. Prospective review of five patients with recurrent retinal detachment confined to the peripheral inferior retina. Three rows of barrier argon laser photocoagulation of moderate intensity white burns were performed. Patients were observed carefully after laser photocoagulation for signs of progression of retinal detachment beyond the barrier laser confines. Barrier laser photocoagulation was successful in limiting the progression of retinal detachment in all cases during follow-up period [average 34.4 months], and maintaining good central visual acuity. Barrier laser photocoagulation can be useful in preventing progression of recurrent retinal detachment in selected patients

Phacoemulsification using iris-hooks for capsular support in high myopic patient with subluxated lens and secondary angle closure glaucoma.

We report an unusual case of angle closure glaucoma in a 78-year-old highly myopic female patient. The patient did not show any preoperative signs of subluxation of lens. However, the capsular bag was noted to be unstable during surgery. The patient was managed with phacoemulsification of lens using a novel method of iris hooks for stabilization of capsular bag during surgery.

Sleep Deprivation and its associated factors among general ward patients at a Tertiary Care Hospital in Pakistan

To estimate the occurrence rate of sleep deprivation and to identify the environmental, staff-related and patient-related factors associated with SD among general ward patients of a tertiary care hospital in Pakistan. In a cross-sectional study, a pre-tested questionnaire was administered to 108 patients admitted into the general medical and general surgical wards of Aga Khan University Hospital, Karachi. In all, 50 [46.3%] respondents felt deprived of adequate sleep in the hospital. Worry about illness disturbed the night-time sleep of 47 [43.5%] patients; most of these had SD [70%] [p<0.001]. Other patients' noise disturbed 31.5% of study subjects and a significant majority [68%] of these had SD [p=0.003]. Over 17% of study subjects reported cell phone's ringing as a disturbing factor; more by those with SD [68%] compared to those with no SD [32%]; again the difference was significant [p=0.003]. Physical discomfort and presence of cannula were reported as disturbing factors by 41.7% and 28.7% of the study subjects respectively but these were not significantly associated with SD. Our study revealed that sleep deprivation occurs commonly among general ward patients in tertiary care setting. Factors found to be associated with SD were amenable to modification to a greater extent

Computerized tomography in diagnosis of idiopathic inflammatory pseudotumor of the orbit

A 30-year-old woman presented with pain, proptosis and external ophthalmoplegia of the left eye. Although routine investigations were normal, computerized tomographic scanning suggested a diagnosis of non-specific and idiopathic inflammatory pseudotumor of the orbit. The patient was successfully treated with oral corticosteroids