Early Breast-Feeding Initiation Using Point of Care Quality Improvement Model at Tertiary Care Hospital in AJK

ABSTRACT: Urgency and solely utility of breast feeding for six months is better for the provision of a healthy start to newborn and reduces infant mortality and morbidity. The prevalence of late lactation and other ways to formula or animal milk feeding the neonate in Pakistan is often observed other than the WHO recommendations. Early initiation of breast feeding is one of the indicators to express quality of Care in Maternal, and newborn Health. Among many approaches, point of care Quality improvement initiative (POCQI) is a simplified tool for learning the basics of quality improvement in the health care facilities. This study aimed to assess the prevalence and associated factors of early initiation of breastfeeding among mothers in a tertiary care hospital in AJK, where POCQI has been piloted.  Methods: A quality improvement, cross sectional study before and after the implementation of POCQI model on two independent samples was carried out from August to November 2019. A total of 100 women (50 before intervention and 50 after intervention) who delivered neonates of 0-7 day’s age were included in study by using non-probability convenience sampling technique. The relevant information was gathered by using questionnaire. Mothers who did not start breast feeding within first hour did not receive any health education during antenatal visits. such women lack knowledge about benefits of colostrum. Hence an intervention was introduced by Researcher jointly in collaboration with POCQI team of the hospital by using Plan-Do-Study-Act (PDSA) cycle. Slogans and health education messages for promotion of early initiation of breast feeding were developed and message was spread to pregnant mothers who visited hospital for antenatal care or came for delivery in labor room.  Results: A total of 100 women (50 before intervention and 50 after intervention) who delivered newborn babies of 0-7 day’s age were selected purposively. Before POCQI intervention out of fifty only eleven (22 %) women breastfed their new born within one hour after birth. After POCQI intervention, out of fifty, thirty-seven women (74%) exclusive breastfed their new born within one hour. Thus, total increase in term of percentage was 54%.  CONCLUSION: The study gives evidence for more needs to enhance breastfeeding uptake in AJK. The prevalence of EIBS was low before implementation of POCQI model but it improved significantly after its applicatio

Comprehensive Account of Inoculation and Coinoculation in Soybean

This chapter elaborates dependency of leguminous plants on rhizobia to carry out dynamic process of nitrogen fixation. Soybean, an extensively grown leguminous crop with 30% share in world’s vegetable oil, is taken into account to understand its symbiotic relationship with plant growth-promoting rhizobacteria (PGPRs). This chapter narrates colonization of PGPRs on soybean roots and single and mixed inoculation and coinoculation of certain strains of specialized bacteria with rhizobia. PGPRs’ coinoculation seemed more effective than mono-inoculation and is discussed in Ref. to nodulation rate. Moreover, dynamic linear models for quantification of leguminous biological nitrogen fixation (BNF) are reviewed. This chapter further uncoils the relevance of foliar application to the release of phytohormones by PGPRs, resulting in situ biosynthesis of active metabolites in phyllosphere. Inoculation of phytohormones is compared to their exogenous application for nodule organogenesis. Finally, the influence of coinoculation on enhanced micronutrient bioavailability is relayed. The chapter is concluded with technical and economic aspects of coinoculation in soybean

Common Organisms causing surgical site infection(SSI) in Postoperative patients in a tertiary care Hospital

Objective: To investigate the types and frequency of organisms causing surgical site infections in postoperative patients and their association with other factors. Study Design: Cross-sectional Duration and Place of Study: Surgical Unit-II of –removed for blind review---and from 1st March 2021 – 31st July 2021. Patients and Methods: There were 391 surgeries in this study, but only 27 patients met the inclusion criteria. A diagnosis of SSI was based on specific parameters, including the detection of two or three cardinal signs of inflammation and the surgeon's confirmation of the diagnosis. This data was analyzed using IBM SPSS 23. Results: Among 391 patients, 242 had elective surgeries (male:female, 1.6:1), and 149 had emergency surgeries (male:female, 1:3.4). The mean length of stay for elective surgeries was 2.19 ± 1.8 days and 4.2 ± 3.7 days for emergency procedures. There were 98 abdominal procedures (65.77%) performed in emergency settings. Only 9 (3.71 %) elective procedures and 18 (12.08 %) emergency procedures reported surgical site infections. Escherichia coli was the most commonly isolated organism from SSI during the study. The rate of SSI in postoperative patients was 6.9%. There was a statistically significant association between SSI and type of surgery (p=0.002). The mean length of stay (LOS) was longer for patients with SSI (mean=12.5, p=.000).  Emergency cases had a longer LOS compared with elective cases (mean= 4.21 days vs 2.19 days, p=.000). Conclusion: According to our study, our unit's SSI were comparable to other developing countries. SSI are more frequent in emergency cases, men, and diabetics, and are the primary cause of longer hospital stays.  Keywords: Surgical Site Infection; E.Coli; Length of stay

Diverse trends witnessed in assessing laryngeal lesions while comparing transcutaneous laryngeal ultrasound & videolaryngoscopy

Objective: To determine the accuracy of Transcutaneous Laryngeal Ultrasound (TLUS) and Video Laryngoscopy (VL) taking Direct Laryngoscopy (DL) as Gold Standard for assessment of  laryngeal pathologies.Methodology: This Cross Sectional Comparative clinical study recruited a sample of 24 cases of either gender, requiring laryngeal examination prospectively using convenience sampling from otolaryngology outpatients of Capital Hospital, Islamabad, Pakistan over a period of six months from 1st March, 2018 to 31st August, 2018. Patients fulfilling the selection criteria were subjected to Video Laryngoscopy under local anesthesia, Transcutaneous Laryngeal Ultrasound followed by Direct Laryngoscopy under general anesthesia and findings recorded.  Data was analyzed using SPSS 23. Variables specially studied included Diagnostic values of both VDL and TLUS versus DL and presented with frequency, percentage, sensitivity, specificity, PPV and NPV and Accuracy Rate.Results: Study sample revealed 54.2% males and 45.8% females with mean age of 46.79 + 25.34 years. Hoarseness was commonest presentation (58.3%) and Laryngeal Polypi was the more frequent pathology noted (25%). VL had a sensitivity of 87.50%, specificity of 37.50%, PPV of 73.7%, NPV of 60% and Accuracy rate of 70.83%. While TLUS revealed a sensitivity of 43.80%, specificity of 70.80%, PPV of 100%, NPV of 47.15% and Accuracy rate of 62.50%.Conclusion: Video Laryngoscopy with a higher Accuracy and sensitivity compared to Transcutaneous Laryngeal Ultrasound, is more accurate examination for assessment of Laryngeal lesions

Outcome of Surgical Treatment for Lumber Disc Herniation Causing Painful Incomplete Foot-Drop

Objective:  To determine the outcome of surgical treatment for lumder disc herniation causing the painful incomplete foot drop. Material and Methods:  This retrospective observational study was conducted at the Department of Neurosurgery Lady Reading Hospital, Peshawar. Both Male and female patients with lumbar disc disease causing unilateral incomplete painful foot drop were included in our study. Patients with complete or painless foot drop, bilateral foot-drop, Multiple level disc prolapse, cauda equina syndrome or sciatic neuropathy due to injection injury were excluded. Patients were followed was post-operatively in terms of power in foot dorsiflexion, medical research council (MRC) grade and pain relief  on a Visual Analogue Scale (VAS) after 1 month and then after 6 months. Results: Total number of patients included were 43. Age was ranging from 18 years to 54 years and mean age was 33 years. Before surgery,  power of MRC grade 3 or less, but greater than 1 in dorsiflexion was noted in all patients. The pain was scaled using VAS. Post peratively, at 1 month follow up, the foot-drop improved to MRC grade 4 or 5 along with pain relief of ≥ 2 points on VAS in 81. 4% (n = 35) patients and at 6 month follow-up, the figure rose to 93% (n = 40). Conclusion:  Lumbar disc disease can cause a debilitating foot-drop and pain. Improving or restoring a neurology early surgical intervention has proven benefits

Quality of Life in Patients with Stoma

Objective: To determine the quality of life of patients with stoma at tertiary care Hospital. Methodology: This prospective study has been conducted at the general surgery department, Pakistan Institute of Medical Sciences hospital Islamabad (PIMS). The study was conducted from September 2019 to February 2020. All the patients having age more than 12 years, underwent intestinal stoma formation and either gender were included for study. Patients were interviewed regarding their routine activities after stoma and the impact of it on their social life including working status, sexual activities and life satisfaction. All the information of patients including demographic data was documented via self-derived proforma. Analysis of data was done by SPSS version 20. Results: Total 46 patients were studied having a stoma and were interviewed regarding their quality of life. The patient's mean age was 44.93+6.78 years. Out of all 34.8% were working currently and rest of the patients were still on bed rest.  34.8% were satisfied with sexual life. 71.7% were depressed after stoma surgery and 52.2% were hopeful about their future. 63% were socialised with peoples as before, 58.7% replied that stoma has affected their recreational activities and 52.2% answered that they can’t travel in any way. However according to overall satisfaction, 32.6% of patients were disagreeing, 34.8% were agreeing and 30.4% were undecided. Conclusion: It was concluded that almost half of the patients were satisfied and they are performing social and daily life activities however almost half of the patients needed psychological, financial, and relative support. Key words: Stoma, Quality of lif

Ameloblastoma : Management and outcome

Introduction Ameloblastoma is a locally destructive tumor with a propensity for recurrence if not entirely excised. Management of ameloblastoma poses a challenge for all involved in the field of head and neck surgery because successful treatment requires not only adequate resection but also a functional and aesthetically acceptable reconstruction of the residual defect. Methods Patients who had histologically proven ameloblastoma between 1991 and 2009 were identified from the database of Aga Khan University Hospital. A review of all medical records, radiological images, operative reports and pathology reports was undertaken. Results A total of 15 patients with histologically confirmed ameloblastoma were identified. Out of 15 patients nine were males and six were females with age range from 20 to 60 years (mean age 43 years). The most common symptom found in our patient group was painless facial swelling. In 13 patients the origin of tumor was mandible and in the remaining two the tumor originated from maxilla. Eleven out of 15 patients underwent segmental mandibulectomy, two had maxillectomy and two had enucleation. All patients who underwent segmental mandibulectomy required reconstruction. Reconstruction was done with microsurgical free tissue transfer in eight patients, non-vascularized iliac crest bone graft was used in one patient and two had plating only. All free flaps survived with no evidence of flap loss. The mean follow-up was eight years. There was no evidence of graft failure which was used in one patient. Complication was seen in only one of our patients in the form of plate exposure. Recurrence was seen in two of our cases who primarily underwent enucleation. All patients had satisfactory speech, cosmesis and mastication. Conclusion The management of ameloblastoma still poses a big challenge in spite of being the most common odontogenic tumor. In our study we have found that segmental mandibulectomy with disease-free margin of around 1 cm and immediate reconstruction with free tissue transfer have shown good results