Unknown Poisoning Amongst Serving Personnel

Background

Poisoning is recognized as an important health problem in many countries of the world. There is incomplete information on poisoning accidents, which is a major problem in developing countries.

Methods

A cross-sectional analysis of hospital records of armed forces personnel admitted with a provisional diagnosis of unknown poisoning was carried out.

Result

Unknown poisoning represented 0.25% of hospital admissions and 6584 man-hours were lost. 85% poisonings occurred at railway station and majority were food related. Average length of stay in the hospital was 14.69 days. Ten patients required intensive care and two patients were admitted to the psychiatry ward.

Conclusion

Majority of the incidents occurred in railways, signifying the importance of health education and precaution while proceeding on leave. Since, most of the affected were young soldiers, education should start from recruiting centers. Few patients had alcohol intoxication reflecting their dependence potential and need for reinforcing prohibition on alcohol consumption during travel.Key Words: Unknown poisoning, Serving soldiers     

Exclusive Breast Feeding in Low Birth Weight Babies

Background

Human milk is the ideal source of nutrition for full term neonates, but there is controversy regarding its use as a nutrition source for preterm and low birth weight infants. However current data supports the use of human milk for low birth weight infants. This study was undertaken to evaluate the growth of both preterm and term small for gestational age infants nursed on exclusive breast milk from birth to four months of age.

Methods

This was a prospective, longitudinal study carried out in a recognized baby-friendly hospital where exclusive breast-feeding is practiced in all neonates. All consecutive low birth weight neonates irrespective of gestational age, born during the study period of two years were included in the study. Assessment of growth parameters included recording of weight (daily when in the hospital and later weekly), length (weekly) and head circumference (weekly) till the age of four months.

Result

Low birth weight infants, both the preterm and the term small for gestational age, on being exclusively breastfed by their own mothers, gained weight and had an increase in their head circumference and length to the levels almost comparable to the standard fetal- infant growth norms.

Conclusion

Exclusive breast-feeding results in adequate growth in low birth weight babies including preterms.Key Words: Breast feeding, Preterm, Low birth weight, Neonates     

Primary 360° broad buckling in retinal detachment

Background: Chronic rhegmatogenous retinal detachment behaves like proliferative vitreo-retinopathy (PVR) even without evidence of the same. Surgery could be done either with conventional buckling procedures where the extent of buckling is determined by the number and location of the breaks or by primary vitreous surgery. In this study these cases were managed with primary 360°encircling broad buckle without a vitreous procedure.     

Urinary transglutaminase 2 as a potential biomarker of chronic kidney disease detection and progression

BackgroundThis study aimed to determine whether urinary transglutaminase 2 (TG2) has the potential to act as an early biomarker of chronic kidney disease (CKD) and whether it can predict the rate of progression better than can albuminuria.MethodsUrine samples were collected prospectively from 292 patients with CKD at the Sheffield Kidney Institute and 33 controls and followed for a minimum of 3 years. The cohort consisted of 61·7% men of whom 89% were white. Major causes of CKD were: diabetic nephropathy (29·05%), chronic glomerulonephritis (23·01%), hypertensive nephrosclerosis (16·6%), atherosclerotic renovascular disease (8·3%), chronic interstitial nephritis (6·41%), and autosomal dominant polycystic kidney disease (4·52%). Urinary TG2 was measured by an in-house sandwich ELISA. One-way ANOVA with Bonferroni correction was applied to estimate differences between groups. Area under the curve for receiver operating characteristic (ROC) analysis was used to determine prediction accuracy. A p value of less than 0·05 was considered statistically significant.FindingsUrine TG2 was 41 times higher in CKD patients than in healthy individuals (mean 3381 ng/mL [SD 135·36] vs 81·6 [4·18], p<0·001). Levels were elevated 17 fold by CKD stage 2. The largest increase in urine TG2 was observed in patients with diabetic nephropathy (7005 ng/mL [376]) with a 85-fold rise in CKD compared with healthy individuals, followed by hypertensive nephrosclerosis (3899 ng/mL [277]). TG2:creatinine ratio was 9·72 ng/mmoL [1·29] in controls versus 605·77 ng/mmoL [81·07] in patients with CKD (p<0·001). TG2 excretion was elevated in those patients with progressive (estimated glomerular fitration rate decline 2–5 mL/min/1·73m² per year, 8997·91 ng/mL) or rapidly progressive CKD (>5 mL/min/year, 17650·195 ng/mL) compared with non-progressors (<2 mL/min/1·73m² per year, 2764 ng/mL; p>0·05). There was no correlation between TG2 and total proteinuria (r=0·02808, 95% CI ?0·09814 to 0·1534; p=0·6632). ROC curve analysis determined an 81·1% accurate prediction of progression for the TG2:creatinine ratio compared with just 71·4% for the albumin:creatinine ratio.InterpretationUrinary TG2 was significantly increased in all causes of CKD. ROC curve analysis demonstrated that TG2:creatinine ratio is a better predictor of patients with progressive CKD than albumin:creatinine ratio indicating its potential as a non-invasive biomarker of progressive kidney scarring.FundingUniversity of Sheffield and Pfizer.     

BABY FRIENDLY HOSPITAL INITIATIVE EXPERIENCES FROM A SERVICE HOSPITAL

All pregnant mothers attending antenatal clinic, mothers delivering at Command Hospital (Air Force) and parents of infants attending immunization clinic at Command Hospital (Air Force) from the period June 1998 to July 1999 are included in this retrospective and prospective cross sectional study. A preformatted questionnaire was designed to assess the practices related to breast feeding during antenatal, in labour room and postnatal ward both for the period pre BFHIand post BFH1 Programme initiated at Command Hospital (Air Force). 225 mothers were included in the study with 90 belonging to pre BFHI group (A) and 135 to post BFHI group (B). Significant changes in the breast feeding practices including antenatal advice on breast feeding and breast examination in group A & B were observed (22.3% vs 82.9% and 13.3% vs 74.8%), rooming in with mother and first feed within 1/2 hr (64.4% vs 92.5% and 35.5% vs 96.5%), teaching skill of breast feeding and manual expression (55.5% vs 91.8% vs 24.4% vs 74.0%). Other important changes included total discontinuation of formula feeds, exclusive breast milk in all preterm infants and avoiding all forms of prelacteal feeds. This study strengthens the fact that appropriate education and training of health care givers can result in reversing practices which are ‘inappropriately baby friendly’ to become ‘appropriately baby and mother friendly’. Command Hospital (Air Force) happens to be first service hospital to be recognized as baby friendly. The experience could be applied to achieve the target of all service hospitals becoming baby friendly.KEY WORDS: Baby Friendly Hospital Initiative Program (BFHI)