Background: Despite its known advantages, breastfeeding rates are low world over. Large number of factors affect breastfeeding. This study was designed to detect maternal and neonatal factors that adversely affect breastfeeding in the perinatal period. Methods: A prospective, single-blinded study was conducted on randomly chosen mother-infant pairs in the maternity ward of a tertiary care service hospital. Only full term singletons born by normal vaginal delivery were studied. The B.R.E.A.S.T observation score and time spent by the infant at the mother's breast were primary outcome variables. Maternal age, gravida, para status and education level were recorded. Birth weight, sex, gestation age of the infant and time interval from birth to observation were also recorded. Initial univariate analysis followed by multivariate analysis was performed using SPSS ver 7.5 software. Results: A total of 54 mother-infant pairs formed the study group; 19(35.2%) were primigravidas. Primigravidas status of the mother led to significantly lower scores (p<0.04; 95% CI 0.10 to 3.62) as did maternal age < 26 years (p<0.04; 95% CI 0.2. to 3.46) on univariate analysis. Low birth weight (<2500 g) was the only neonatal factor that significantly lowered breastfeeding scores (p<0.02;95%Cl 0.56 to 6.31). On multivariate analysis only primigravida status was significantly associated with lower scores (p<0.02). The alpha value of the study was 5% and the power was 74%. Time spent by infant on breast was not significantly different between primigravida and non-primigravida mothers. Conclusion: Primigravida status adversely affects breastfeeding scores; therefore counseling and support should be focused on this group. Extra care should also be taken to ensure adequate breastfeeding by younger mothers and in those with low birth weight infants. Larger studies with long-term follow up will be able to identify other factors and dertermine the effects of focused counseling and support in the perinatal period upon long-term breastfeeding rates. MJAFI 2005; 61 : 216-219
Background: There was an epidemic of enteric fever in Mumbai garrison during Nov-Dec 2000 with more than 150 cases admitted to a tertiary care service hospital. Methods: All the cases presented with fever and some had splenomegaly, bradycardia, abdominal pain and diarrhoea. The epidemic was investigated by the station health organization (SHO) and the case and bacteriological study was carried out in pathology laboratory of the service hospital. The serological study was carried out at Armed Forces Medical College (AFMC), Pune and the Phage typing was carried out at Lady Harding Medical College, New Delhi. Results: Blood cultures were positive in 92(63%) for Salmonella typhi and Widal test was positive in 83(55%). All strains were resistant to four primary drugs i.e. ampicillin, chloramphenicol, co-trimoxazole and tetracycline. All but two were treated successfully with ceftriaxone. The Salmonella typhi belonged to phage group E1 and biotype I. Conclusion : Extensive epidemiological investigation of cases and water sources of cantonment area pointed to a common source of the epidemic i.e. the well near 'Gurudwara'.
We evaluated the effectiveness of teaching at a neonatal resuscitation programme (NRP) workshop held for 35 medical personnel (including postgraduate trainee doctors, general duty medical officers, nursing officers and probationer nurses) using a onegroup pretest-posttest design. None of the participants had any formal exposure to the NRP guidelines. A pre-workshop test of 20 multiple-choice questions was administered to all the participants. At the end of the workshop, the same 20 questions were administered and the two scores compared using t-test for paired data on SPSS statistical software. The mean pre-workshop score was 9.03 (SD 2.66) which improved to a mean of 15.53 (SD 1.93) post-workshop. This improvement was highly significant with p < 0.0001 (two-tailed) and the 95% confidence interval being -7.41 to -5.59. Subgroup analysis revealed that nursing officers and probationer nurses showed highly significant improvement in the post-workshop scores while trainee doctors doing Medicine, Pediatrics and the general duty medical officers showed statistically significant improvement in the post-workshop scores. This study shows that a medical workshop is an effective means of imparting knowledge to a mixed group of medical personnel. ResultsOut of a total of 35 participants, 34 completed both the pre-workshop and post-workshop test and thus qualified for entry into the study. One trainee in Obstetrics could not complete the post-test due to an emergency call from the ward. The participants' groups according to their qualification were as follows: pediatric trainees -4 (11.4%); medicine trainees -4 (11.4%); anaesthesiology trainees' -3 (8.6%); obstetrics and gynecology trainees -3 (8.6%); general duty medical officers -5 (14.3%); nursing officers -7 (20.0%) and probationer nurses -9 (25.7%).Out of a maximum possible score of 20 for each test, the lowest pre-workshop score was 3 out of 20 (15.0%) and the highest was 16 (80.0%). The lowest post-workshop score was 11 out of 20 (55.0%) while the highest was 20 (100.0%). The mean pre-workshop score was 9.03 (SD 2.66) which had risen post workshop to a mean of 15.53 (SD 1.93). Based on the t-test for paired samples the two-tailed p value of this difference was < 0.0001, suggesting that the improvement in the post-workshop score was highly significant; 95% confidence interval for the same being -7.44 to -5.99.Subgroup analysis of scores was done and the results are depicted in Table 1. This analysis was not done for the trainees of Obstetrics as only two of them completed the study and the resulting scores had a skewed distribution. Sub-group analysis revealed highly significant improvement (two-tailed
A spurt of cases of Neurocysticercosis (NCC) at our department reopened the debate on whether to treat or not and spurred us on to review the available literature for a viable solution. Despite the disease having been around for centuries a cogent treatment plan eludes us even as other ancient scources have been successfully engaged. Neurocysticercosis presents a peculiar problem as it is an end-stage infection, accidental in man, with a benign natural course and would have merited considerably less attention, had it not chosen to infest the brain. These unique and characteristic features are the fundamental reasons why so many different treatment strategies are continuously proffered; many or none seem to work, depending on the viewpoint. And the target organs of this otherwise unglamorous tapeworm cyst--the brain, eye and spinal cord-ensure that there is always pressure, and temptation to treat rather than let it be, even if the weight of evidence is to the contrary. An overview of the history of the disease and the most recent happenings is presented here, in which these issues are reviewed with special attention to the debate on treatment. From the facts that emerge, an attempt has been made to present a workable plan that would help practicing pediatricians in treating most encountered cases till such time we hear the last word on the issue.
Background: To study the promotility effects of low dose erythromycin on gastric emptying time in a population of normal low birth weight (LBW) neonates on breast feeds with or without nutritional supplements and human milk fortifier (HMF). Method: A randomised control trial involving 50 neonates was undertaken and they were given 6mg/kg/day of oral erythromycin or placebo in three divided doses for four consecutive days in the first two weeks of life. The gastric emptying time (GET) was assessed ultrasonographically by measuring the decrease in the antral cross sectional area (ACSA). The time taken for the ACSA to become half the prefeed value, was taken as t/2 or half GET. The babies were also assessed for pre and post intervention side effects of the drug. The results were analysed using SPSS ver 11.5. Results: The test group showed a significant decrease in GET after the intervention. This effect was mainly seen in the preterm babies as compared to term Small for Gestational Age (SGA) babies. The decrease in GET was more in babies born after 34 weeks of gestation as compared to smaller babies. The reduction in GET was seen in babies on breast milk alone and nutritional supplements with breast milk but not when HMF was added. No side effects of the drug were noted. Conclusion: Low dose erythromycin is a safe way of decreasing gastric emptying in preterm babies born after 34 weeks of gestation in the first two weeks of life. MJAFI 2007; 63 : 226-228
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