WEANING

Objective: To evaluate the awareness & practices regarding weaning in lactating mothers of infants. Design: A crosssectional descriptive study. Setting: At pediatrics OPD in Ghurki Trust Teaching hospital, Lahore. Period: From Octoberto December 2007.Methodology: A non probability convenience sampling was done to collect data from 50 mothers who were attending out patient departmentalong with their infants on a pre-formed questionnaire. After gathering, data was analyzed & presented in the form of tables & graphs.Results: In the present study, 66% mothers were in the age group of 20-29 years, all were house wives, 34 % were matriculate and 72%lived in joint family system, Mean age of weaning was 4-6 months in more than 64 % of the sample. Among the women interviewed, 44%used home-made weaning diets, 30% used mixture of homemade and commercially prepared diets, while 16% used only commerciallyprepared diets. Breast feeding was continued during and after weaning, by 64% of respondents along with weaning diets. Conclusion:Mothers need to be educated about the importance of weaning, the recommended age of weaning and about the types of weaning food.This can be achieved by using lady health workers and lady health visitors and the mass media. Importance of continued breast feedingwith weaning diet should be emphasized upon.

Fetal Size Classified Using Gestational Days rather than Gestational Weeks Improves Correlation with Stillbirth Risk: A Statewide Population Study.

Objective: Many growth charts provide single centile cutoffs for each week of gestation, yet fetuses gain weight throughout the week. We aimed to assess whether using a single centile per week distorts the proportion of infants classified as small and their risk of stillbirth across the week. Design: Retrospective cohort study. Setting: Victoria, Australia. Population: Singleton, non-anomalous infants born from 2005-2015 (529,261). Methods: We applied growth charts to identify small-for-gestational-age (SGA) fetuses on week-based charts (single centile per gestational week) and day-based charts (centile per gestational day). Main outcome measures: Proportions <10th centile by each chart, and stillbirth risk amongst SGA infants. Results: Using week-based charts, 12.1% of infants born on the first day of a gestational week were SGA, but only 7.8% on the final day; ie. an infant born at the end of the week was 44% less likely to be classed as SGA (p<0.0001). The relative risk of stillbirth amongst SGA infants born on the final day of the week compared with the first was 1.47 (95%CI 1.09-2.00, p=0.01). Using day charts, SGA proportions were similar and stillbirth risk equal between the beginning and end of the week (9.5% vs 9.9%). Conclusions: Growth standards using a single cutoff for a gestational week overestimate the proportion of infants that are small at the beginning of the week and underestimate the proportion at the end. This distorts the risk of stillbirth amongst SGA infants based on when in the week an infant is born. Day-based charts should be used

Prevalence and Risk Factors of Subclinical Tuberculosis in a Low-Incidence Setting in China

Objectives: Subclinical tuberculosis (TB) represents a substantial proportion of individuals with TB disease, although limited evidence is available to understand the epidemiological characteristics of these cases. We aimed to explore the prevalence of subclinical patients with TB and identify the underlying association between the subclinical TB cases in the study setting and the Beijing genotype.Methods: A retrospective study was conducted among patients with incident TB at the Fifth People’s Hospital of Suzhou between January and December 2018. A total of 380 patients with TB were included in our analysis.Results: Of the 380 patients, 81.8% were active TB cases, whereas the other 18.2% were subclinical TB cases. Compared with patients aged 65 years and older, the risk of having subclinical TB is higher among younger patients. The use of smear, culture, and Xpert identified 3, 16, and 13 subclinical TB cases, respectively. When using a combination of positive culture and Xpert results, the sensitivity improved to 33.3%. In addition, the neutrophil-to-lymphocyte ratio was significantly elevated in the active TB group compared with that in the subclinical TB group. We also observed that the proportion of the Beijing genotype in the subclinical TB group was significantly lower than that in the active TB group.Conclusion: To conclude, our data demonstrate that approximately one-fifth of patients with TB were subclinical in Suzhou. Mycobacterium tuberculosis could be detected by the existing microbiologic diagnostics in one-third of patients with subclinical TB. The patients with subclinical TB are more prone to having low neutrophil-to-lymphocyte ratio values than those with active TB. Additionally, non-Beijing genotype strains are associated with subclinical TB.

Antimicrobial Resistance Following Prolonged Use of Hand Hygiene Products: A Systematic Review

Background: This systematic review aimed to establish whether antimicrobial resistance (AMR) occurs following prolonged use of antimicrobial hand hygiene (HH) products, and, if so, in what magnitude. Methods: Key bibliographic databases were searched to locate items on HH use and AMR development from database inception to December 2020. Records were screened and full texts of all potentially eligible articles were retrieved and checked for inclusion. The following data from the included studies were abstracted: type of HH product used, including the name of antimicrobial agent, study setting, country, study year, duration of use and development of AMR including the organisms involved. Quality assessment was done using the Newcastle-Ottawa Scale (NOS). Results: Of 339 full-text articles assessed for eligibility, only four heterogeneous United States (US) studies conducted in the period between 1986 and 2015 were found eligible, and included. One hospital-based study showed evidence of AMR following long term use of HH products, two studies conducted in household settings showed no evidence of AMR, and another experimental study showed partial evidence of AMR. The overall certainty of the evidence was moderate. Conclusion: Prolonged use of HH products may cause AMR in health care settings, but perhaps not in other settings.

Treatment outcomes and its associated factors among breast cancer patients at Kitui Referral Hospital

Objectives: Despite breast cancer treatment outcomes being relatively poor or heterogeneous among breast cancer patients, there was a paucity of data in the African settings, especially in Kenya. Hence, this study aimed to determine treatment outcomes among breast cancer patients at Kitui Referral Hospital. Methods: A hospital-based retrospective cohort study design was conducted among adult patients with breast cancer. All eligible breast cancer patients undergoing treatment from January 2015 to June 2020 in the study setting were included. Hence, a total of 116 breast cancer patients’ medical records were involved in the study. Patients’ medical records were retrospectively reviewed using a predesigned data abstraction tool. The data were entered, cleaned, and analyzed using SPSS (Statistical Package for Social Sciences) version 26 software. Descriptive analysis—such as percentage, frequency, mean, and figures—was used to present the data. Kaplan–Meier survival analysis was used to estimate the mean survival estimate across different variables. A Cox regression analysis was employed to determine factors associated with mortality. Results: The study showed that the overall survival and mortality rate was 62.9% (73) and 37.1% (43), respectively. The regression analysis showed that patients who had an advanced stage of disease had a 3.82 times risk of dying (crude hazard ratio= 3.82, 95% confidence interval = 1.5–9.8) than an early stage of the disease. Besides, patients with distant metastasis had 4.4 times more hazards of dying than (crude hazard ratio = 4.4, 95% confidence interval = 2.1–9.4) their counterparts. Conclusion: The treatment outcome of breast cancer patients was poor, and its overall mortality among breast cancer patients was higher in the study setting. In the multivariate Cox regression analysis, the tumor size was the only statistically significant predictor of mortality among breast cancer patients. Stakeholders at each stage should, therefore, prepare a relevant strategy to improve treatment outcomes.

Experience of the surgical team in COVID-19 in a tertiary care hospital in Pakistan.

Objective: To analyse experience of the surgical team in COVID-19 in a tertiary care hospital in Pakistan. Study Design: Analytical Observational study. Setting: Department of Surgery, Tertiary Care Hospital Sialkot, Pakistan. Period: March to September 2020. Material & Methods: After the permission of ethical review committee (ERC/12/2020), data was collected by all four groups surgeons, Resident and internees, paramedical staff and other staff of surgical teams. A simple, 6 question-questionnaire, manually typed, was distributed to all members willing to complete and return the questionnaire. Data was analyzed by using SPSS-23. Results: Majority (91.27%) of the surgical team members got satisfactory training to handle with Covid-19 Cases. The 80 % was in fear to contract the disease while working in isolation and COVID-19 wards and about (76%) were well adjusted to their newly assigned duties. About 85% of surgical team members experienced prolong duty hours (12 hours a day) related stress and similar percentage participated in the management of surgeries done during this period. Conclusion: Surgical Team participated and adapted to meet the newly assigned duties to lookafter the isolation and COVID-19 wards. Team members experienced stress and fear of contracting disease was a matter of concern. However, it has taken care of all trauma, life-threatening emergencies and oncological cases adhering to use of principles of use of PPEs.

Etiology, presentation and treatment of ocular trauma in paediatric population.

Objective: To determine the etiology, presentation and treatment of ocular trauma in paediatric population. Study Design: Cross Sectional Study. Setting: Institute of Ophthalmology, Liaquat University Hospital Jamshoro. Period: January, 2020 to December 2020. Material & Methods: Data was collected using a questionnaire having age, sex, cause of injury and time at presentation to the emergency. It also focused on which structures were damaged due to injury, investigations being used, and treatment performed. Results: In our study we found 80 cases of ocular trauma in pediatric population visiting the ophthalmology department. Gender distribution of the study group which includes 72.5% (n=58) males and 27.5% (n=22) females. It was found during playing 86.3% of children had ocular trauma followed by injury due to domestic stuff like glass, bleach cleaners in 7.5% of the study group. The most frequently occurring ocular trauma was found to be corneal tear occurring in 25% of the study group. Conclusion: Ocular trauma in children can be prevented by simple measures like supervising children and educating parents and teachers for potential hazard substances. It is important to address like healthcare issue as ocular trauma can lead to lifelong blindness along with psychological and financial burden for the caretaker and children themselves.

Frequency of wound infection in children undergoing appendectomy for acute versus perforated appendicitis.

Objective: To find out the frequency of wound infection in children undergoing appendectomy for acute vs perforated appendicitis. Study Design: Observational and Cross-sectional study. Setting: Department of Surgery at Children’s Hospital and the Institute of Child Health Lahore. Period: January 2018 to July 2018. Material & Methods: Data was collected by using Random sampling technique. Patients of both genders were included. Diabetic children were excluded. Questionnaire was developed with the help of experts, literature review and data collection. Results: A sum of 120 patients were included with mean age of 9 + 1.94 SD minimum was 7 and maximum was 13. Some patients have acute appendicitis 20(16.67%) and 100 (80.33) perforated appendix undergone appendectomy. Conclusion: The findings of the study indicated that there is less wound infection in acute appendix but more wound infection observed in perforated appendix after appendectomy.

Comparison of aprepitant and dexamethasone versus metoclorpramide and dexamethasone for prevention of post-operative nausea and vomiting in patients undergoing laparoscopic cholecystectomy.

Objective: To compare the efficacy of aprepitant and dexamethasone versus metoclopramide and dexamethasone combination in prevention of post-operative nausea and vomiting in females undergoing laparoscopic cholecystectomy. Study Design: Prospective Comparative study. Setting: Department of Anesthesia, CMH Lahore. Period: October 2019 to April 2020. Material & Methods: A total of 140 female patients planned for laparoscopic cholecystectomy under general anesthesia, of age ranges from 35-65 years and ASA classification I and II were recruited for the study and were divided into two equal groups. In group A (n=70), patients were given oral aprepitant 80 mg with once sip of water one hour prior to induction and dexamethasone 8 mg upon induction. In group M (n=70), patients were given a placebo one hour prior to induction and intravenous metoclopramide 10 mg and dexamethasone 8 mg upon induction. Results: Age range in this study was from 37 to 65 years with mean age of 46.82 ± 7.29 years. The mean age of patients in group A was 45.73 ± 6.77 years and in group M was 47.91 ± 7.66 years with p-value of 0.076. In our study, significant difference was found between the efficacy of two groups of drugs. The efficacy of aprepitant and dexamethasone was found in 62 (88.57%) patients, while with metoclopramide and dexamethasone, it was found in 51 (72.86%) patients with p-value of 0.031. Conclusion: it is concluded that aprepitant and dexamethasone combination has higher efficacy as compared to metoclorpromide and dexamethasone in prevention of post-operative nausea and vomiting in elective laparoscopic cholecystectomy.

Effect of salicylidene salicylhydrazide on testes of albino mice: A histomorphological study.

Objectives: To evaluate salicylidene salicylhydrazide (SCS) for any possible toxicological effects on male reproductive system in Albino male BALB/c mice. Study Design: Experimental study. Study Setting: Department of Histopathology, Khyber Medical College Peshawar and Department of Pharmacy, University of Peshawar, Peshawar were utilized for conducting this study. Period: July, 2020 to December, 2020. Material & Methods: Male BALB/c mice were daily administered with SCS at 5, 25, and 50 mg/kg for 7 and 14 days. The body and testes weights were measured and the testes were subjected to histological tissue processing techniques. Results: The extent of testicular toxicity was evaluated by using modified Johnsen scoring system for assessing the level of spermatogenesis, and morphometric analysis by measuring the diameter of the seminiferous tubules, thickness of germinal epithelium, and area of interstitial cells of Leydig. The body and testes weights showed that the various doses of SCS have no substantial effects after 7 and 14 days. The tested doses of SCS did not produce any distinguishable change in the normal histological features of seminiferous tubules and interstitium after 7 days. However, after 14 days, the 50 mg/kg dose of SCS was associated with vacuolization and loosening of germinal epithelium. These mild-to-moderate histopathological aberrations was confirmed from morphometric analysis in this dose group in which a decrease in the seminiferous tubules’ diameter and reduction in the thickness of germinal epithelium along with an increase in the interstitial area were observed. Conclusion: These findings concluded that SCS is considered to be relatively safe.