Evaluating the impact of baby-friendly Hospitals on mother’s knowledge and practices regarding breastfeeding in Karachi, Pakistan

Introduction: Breastfeeding is a natural way of feeding to a new born baby. World Health Organization launched a Baby Friendly Hospital initiative in 1992, to strengthen maternity practices to support breast-feedings. Currently, about 19250 hospitals world wide have achieved Baby Friendly Status. To evaluate the role of Baby Friendly Hospital Initiative on feeding and weaning practices of mothers in improving health status of children under five years of age Methodology: Cross sectional comparative study was done at baby friendly hospital (BFHI) and non-baby friendly hospital (Non BFHI) Karachi. A total of 784 mothers were selected through convenient sampling and grouped according to place of birth. Results: Feeding practices in BFHI group was better in some respects. Among them 81% mothers did not give any pre-lacteal feeds, 79% mothers reported that their babies were exclusively breast fed up to four months of age and 31% reported that they initiated breast feeding within one hour after the delivery. Conclusions: Baby Friendly Hospital initiative has a beneficial effect on feeding practices of mothers and duration of exclusive breastfeeding. But some areas of optimal breastfeeding practices are not taken care well. Initiation of breastfeeding within ½ to 1 hour needs attention.   Key words: Breast feeding, Baby Friendly Hospital Initiative, weaning, exclusive breast feedin

Correlation of Atrial Fibrillation with Left Atrial Volume in Patients with Mitral Stenosis. a Single Centre Study From Pakistan

Background: Rheumatic heart disease has a strong association with mitral valve stenosis. Atrial fibrillation is one of the most common complications of this condition and is a poor prognostic factor. Early detection and prompt management of atrial fibrillation can help to improve the quality of life and increase the life expectancy of the patients. We carried out this study to investigate the significance of left atrial volumetric changes in mitral stenosis and its correlation with atrial fibrillation. Methodology: We audited the data of 60 patients of rheumatic heart disease who had mitral valve stenosis. The patients were randomized into atrial fibrillation (Group A) and normal sinus rhythm (Group B). We conducted this cross-sectional analytical study at Cardiology Department, Mayo Hospital, Lahore, from 1st February 2017 to 31st January 2018. We only included those patients who consented to be a part of this study and fulfilled our predefined inclusion criteria. Left atrial volume was measured by prolate ellipse method and biplane methods on echocardiography. The Data was analyzed on SPSS v20. Results: Sixty patients were included in the study. Among the subjects, thirty-six (60%) were males, and twenty-four (40%) were females. Atrial fibrillation was noted in 43.33% of the patients of mitral valve stenosis. There was a marked difference in the mean volume of the left atrium among the two groups. We observed that the mean area of the mitral valve for Group A patients was larger than that of patients in Group B. Our study showed an inverse correlation between left atrial volume and mitral valve area among Group A patients. Conclusion: Patients of mitral stenosis are at an increased risk of developing atrial fibrillation if the left atrial volume is increasing. All patients with mitral stenosis should have routine echocardiography & measurement of left atrial volumes, so that proper treatment can be started if the left atrial volume is increasing, to prevent atrial fibrillation

Radiological locations of mental foramen in local population

Objective: To evaluate the accurate radiographic location of the mental foramen and its prevalence by gender and different age groups.Methodology: This Cross-sectional study was conducted at dental department at ISRA University Hospital Hyderabad, from September 2014 to Feb 2015. We studied 70 patients. All patients > 18 years age and both sex and presence of the canine, first premolar, second premolar and first molar in the images were included. Detailed patients’ history was taken and detailed clinical examination was done. Patients were subject to relevant investigation panoramic digital images. All the data was recorded in the proforma.Results: Out of total 70 patients included in this study 30 were male (42.85%) and 40 females (57.14%); with male to female ratio of 1:1.3. The mean age was 22+3.20 years. Mental foramen on radiographic were visible below first premolar in 35(50%) cases followed by mental foramen at below 2nd premolar in 30(42.85 %) cases and below first premolar in 5(7.14%) cases. Variation in the inferior alveolar canal observed. Variation in the inferior alveolar canal was Bifid canal only in two patients.Conclusion: Mental foramen on radiographic were visible below first premolar 50%, below 2nd premolar 42.85% and below first premolar in 7.14%. While no significant relationship was found with gender and age

Radiological locations of mental foramen in local population

Objective: To evaluate the accurate radiographic location of the mental foramen and its prevalence by gender and different age groups.Methodology: This Cross-sectional study was conducted at dental department at ISRA University Hospital Hyderabad, from September 2014 to Feb 2015. We studied 70 patients. All patients > 18 years age and both sex and presence of the canine, first premolar, second premolar and first molar in the images were included. Detailed patients’ history was taken and detailed clinical examination was done. Patients were subject to relevant investigation panoramic digital images. All the data was recorded in the proforma.Results: Out of total 70 patients included in this study 30 were male (42.85%) and 40 females (57.14%); with male to female ratio of 1:1.3. The mean age was 22+3.20 years. Mental foramen on radiographic were visible below first premolar in 35(50%) cases followed by mental foramen at below 2nd premolar in 30(42.85 %) cases and below first premolar in 5(7.14%) cases. Variation in the inferior alveolar canal observed. Variation in the inferior alveolar canal was Bifid canal only in two patients.Conclusion: Mental foramen on radiographic were visible below first premolar 50%, below 2nd premolar 42.85% and below first premolar in 7.14%. While no significant relationship was found with gender and age

Impacts of the Free Trade Agreement on Pakistan Export to China and Economic Growth

The Free Trade Agreements between Pakistan and China increased the trade prospects between Pakistan China, resulting in an increased trade deficit in Pakistan with China. The study is based onhow the FTAs impact exports in Pakistan. This paper's results suggest a positive contribution of FTAs to Pakistan's exports in China's economy and the imports from China. However, the increase in imports is much higher than the increase in exports after Pakistan entered into subsequent FTAs with China. As a result, there is an increase in the Pakistan trade deficit, and the growth prospects of Pakistan suffered. The constant marketsuggests that,by focusing on products that enhance Pakistan's comparative advantage,improving infrastructure, efficient tariff line utilization, and deep understanding of China's market, all are necessary for Pakistan to benefit from FTAs; otherwise, their provision becomes counterproductive. It is concluded that Pakistan needs to reduce the trade deficit with China as it negatively impacts its macroeconomic situation. Exports enhanced by investing in innovative technologies andreduced importsthrough production inland

Awareness regarding causes of infertility among out-patients at a tertiary care hospital in Karachi, Pakistan

Introduction: Infertility is the inability of a couple to achieve pregnancy within 12 months of sexual intercourse without the use of contraceptives. The Pakistani population, belonging to a low-middle income country, has a high prevalence of infertility due to a low knowledge and awareness regarding its causes, and lack of healthcare-seeking behavior for this medical issue. The prevalence of infertility in Pakistan is reported as 22%, with primary infertility accounting for 4% of the total cases. This leads to psychological trauma among women as societal norms equate infertility with failure on a personal, emotional, and social level. In this study, we aimed to assess among this population the general awareness regarding infertility and its causes; and identify any key knowledge gaps pertaining to the subject.Methods: A cross-sectional study was carried out between June 2019 and November 2019, at a public hospital (Civil Hospital Karachi) in Karachi, Pakistan. Convenience sampling technique was used to collect data from adult participants (older than 18 years) via an interview-administered questionnaire. The questionnaire was based on the Cardiff Fertility Knowledge Scale (CFKS) and assessed the knowledge regarding causes of infertility such as smoking, healthy lifestyle, contraceptives, genital tract infections among others. We also determined the association between socio-demographic variables with mean knowledge scores. Data were analyzed using Statistical Package for Social Sciences (SPSS), version 20.0.Results: The majority of the participants were married (n=342, 68.8%) and more than half were unemployed (n=259, 52.1%). Approximately, two-quarters (n=250, 50.3%) did not believe that equal proportions of males and females contribute to infertility. The mean knowledge score of our study population was 12.95 ± 2.48 points. An overwhelming proportion of the participants (n=326, 65.6%) falsely believed that the usage of the intra-uterine device contributes to infertility. Additionally, more than half of the responders (n=278, 55.9%) incorrectly believed that a male achieving erection is an indication of fertility. Education (p=0.019), vehicle ownership (p=0.018), and marital status (p=0.031) were the only demographic factors that showed significant differences with mean knowledge scores.Conclusion: Awareness regarding the causes of infertility among the general population was found to be inadequate. Emphasis on targeted fertility education, in association with general public awareness programs regarding its causes and risk factors may help mitigate this problem by potentially reducing the prevalence of this condition, and increasing the number of affected individuals who seek medical care in a timely fashion

Standardising Marine Renewable Energy Testing: Gap Analysis and Recommendations for Development of Standards

Marine renewable energy (MRE) is still an emerging technology. As such, there is still a lack of mature standards and guidance for the development and testing of these devices. The sector covers a wide range of disciplines, so there is a need for more comprehensive guidance to cover these. This paper builds on a study undertaken in the MaRINET2 project to summarise recommendations and guidance for testing MRE devices and components, by reviewing the recently published guidance. Perceived gaps in the guidance are then discussed, expanding on the previous study. Results from an industry survey are also used to help quantify and validate these gaps. The main themes identified can be summarised as: the development progression from concept to commercialisation, including more complex environmental conditions in testing, accurately modelling and quantifying the power generated, including grid integration, plus modelling and testing of novel moorings and foundation solutions. A pathway to a standardised approach to MRE testing is presented, building on recommendations learnt from the MaRINET2 round-robin testing, showing how these recommendations are being incorporated into the guidance and ultimately feeding into the development of international standards for the marine renewable energy sector

Low Rate of Bacterial Coinfections and Antibiotic Overprescribing During COVID-19 Pandemic: A Retrospective Study from Oman

Objectives: The recommended treatment for COVID-19 includes antiviral drugs, corticosteroids, immunomodulatory drugs, low molecular weight heparin, as well as antibiotics. Although COVID-19 is a viral disease, many studies indicate that antibiotics are prescribed frequently, mainly to treat suspected bacterial coinfection. At the same time, the prevalence of bacterial coinfections during COVID-19 is rather low indicating the significant antibiotic overuse in these patients. It is well known that this can trigger antibiotic bacterial resistance, and once it emerges the reversal of resistance is a complex and long-lasting process. The aims of this study were to estimate the prevalence of bacterial coinfections during the COVID-19 and to analyze the antibiotic treatment justification during this pandemic in Oman. Methods: This retrospective analysis was conducted using the Royal Hospital COVID-19 Registry Database. The study analyzed demographic and clinical characteristics, as well as laboratory parameters and antibiotic treatment of hospitalized patients. Results: During the study period, 584 patients were enrolled in the analysis. Coinfection was rare as it was confirmed in 0.9% of patients. Superinfections were present in 15.2% of patients. Gram-negative bacteria were isolated in 95 (69.9%) samples, gram-positive bacteria in 25 (18.4%) samples, while Candida spp. was found in 16 (11.8%) samples. On admission, empirical antibiotic treatment was started in 543 (93.0%) patients. Conclusions: During COVID-19, coinfections are rarely seen and the overuse of antibiotics is not justified. The incidence of superinfections is the same as in other patients in healthcare settings caused by the same resistant microorganisms, which implies the use of even more

Offshore aquaculture of finfish: Big expectations at sea

Offshore aquaculture has gained momentum in recent years, and the production of an increasing number of marine fish species is being relocated offshore. Initially, predictions of the advantages that offshore aquaculture would present over nearshore farming were made without enough science-based evidence. Now, with more scientific knowledge, this review revisits past predictions and expectations of offshore aquaculture. We analysed and explained the oceanographic features that define offshore and nearshore sites. Using Atlantic salmon (Salmo salar) as a case study, we focussed on sea lice, amoebic gill disease, and the risk of harmful algal blooms, as well as the direct effects of the oceanography on the health and physiology of fish. The operational and licencing challenges and advantages of offshore aquaculture are also considered. The lack of space in increasingly saturated sheltered areas will push new farms out to offshore locations and, if appropriate steps are followed, offshore aquaculture can be successful. Firstly, the physical capabilities of the farmed fish species and infrastructure must be fully understood. Secondly, the oceanography of potential sites must be carefully studied to confirm that they are compatible with the species-specific capabilities. And, thirdly, an economic plan considering the operational costs and licencing limitations of the site must be developed. This review will serve as a guide and a compilation of information for researchers and stakeholders

Global prevalence and genotype distribution of hepatitis C virus infection in 2015 : A modelling study

Publisher Copyright: © 2017 Elsevier LtdBackground The 69th World Health Assembly approved the Global Health Sector Strategy to eliminate hepatitis C virus (HCV) infection by 2030, which can become a reality with the recent launch of direct acting antiviral therapies. Reliable disease burden estimates are required for national strategies. This analysis estimates the global prevalence of viraemic HCV at the end of 2015, an update of—and expansion on—the 2014 analysis, which reported 80 million (95% CI 64–103) viraemic infections in 2013. Methods We developed country-level disease burden models following a systematic review of HCV prevalence (number of studies, n=6754) and genotype (n=11 342) studies published after 2013. A Delphi process was used to gain country expert consensus and validate inputs. Published estimates alone were used for countries where expert panel meetings could not be scheduled. Global prevalence was estimated using regional averages for countries without data. Findings Models were built for 100 countries, 59 of which were approved by country experts, with the remaining 41 estimated using published data alone. The remaining countries had insufficient data to create a model. The global prevalence of viraemic HCV is estimated to be 1·0% (95% uncertainty interval 0·8–1·1) in 2015, corresponding to 71·1 million (62·5–79·4) viraemic infections. Genotypes 1 and 3 were the most common cause of infections (44% and 25%, respectively). Interpretation The global estimate of viraemic infections is lower than previous estimates, largely due to more recent (lower) prevalence estimates in Africa. Additionally, increased mortality due to liver-related causes and an ageing population may have contributed to a reduction in infections. Funding John C Martin Foundation.publishersversionPeer reviewe