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)     

Evaluation of POSSUM and P-POSSUM as a tool for prediction of surgical outcomes in the Indian population

Background

Increased scrutiny and the need to institute a truly patient centered approach to surgical care has motivated the growing interest in measuring the quality of surgical care through comparative surgical audit. This study aimed to assess the validity of the POSSUM (Physiological and Operative Severity Score for enumeration of Mortality and Morbidity) and P-POSSUM (Portsmouth-POSSUM) score in predicting the risk of morbidity and mortality respectively in general surgical patients presenting with conditions of various operative severities at a tertiary care centre in Haryana, a northern state of India.

Method

A prospective study was performed in 100 general surgical patients including an equal number of patients in each of the four groups of operative severity i.e. minor, moderate, major, major plus. The risks of mortality and morbidity were calculated by using the POSSUM equation for morbidity and the P-POSSUM equation for mortality in each patient. The predicted risks were compared with the observed risks of mortality and morbidity and statistically analysed.

Results

The difference in p value of predicted risk of morbidity by POSSUM equation and observed morbidity; calculated by chi square test was 0.756 which was not statistically significant. The difference in p value of predicted mortality by P-POSSUM equation and observed mortality; calculated by chi square test was 0.472 which was also not statistically significant.

Conclusion

POSSUM and P-POSSUM appear to be good and valid indices for use in the risk prediction of morbidity and mortality in the north Indian population.Key Words: POSSUM, P-POSSUM, Surgical outcome     

White Lesions in the Oral Cavity: A Clinicopathological Study from a Tertiary Care Dermatology Centre in Kerala,India

Context:

White lesions in the oral cavity may be benign, pre-malignant or malignant. There are no signs and symptoms which can reliably predict whether a leukoplakia will undergo malignant change or not. Many systemic conditions appear initially in the oral cavity and prompt diagnosis and management can help in minimizing disease progression and organ destruction.

Aim:

The aim of the paper was to study the clinical and histopathological patterns of white lesions in the oral cavity presented at the study setting and to study the factors associated with the histopathological patterns of the lesions.

Settings and Design:

A hospital based cross-sectional study of patients with white lesions in the oral cavity attending the Department of Dermatology and Venereology, Medical College, Thiruvananthapuram was done.

Materials and Methods:

After taking a detailed history, microscopic examination of Potassium hydroxide smear and an oral biopsy with histopathologial examination was done.

Results:

Out of the 50 patients in the study, clinically the diagnoses made were Lichen planus (32 patients; 64%), Frictional Keratosis (4;8%), Dysplasia (2;4%), Oral Hairy Leukoplakia (1;2%), Pemphigus Vulgaris (2;4%), Cutaneous Lupus Erythematosus (1;2%), Oral Submucous fibrosis (3;6%) and Oral Candidiasis alone (5;10%). Out of the 45 patients who had undergone biopsy, 25 (55.6%) had Lichen planus, 9 (20%) had Frictional Keratosis and mild Dysplasia was found in 4 (8.9%) patients.

Conclusion:

The measure of agreement between the clinical and pathological diagnosis was only 32%. Older age, difficulty in opening the mouth, consumption of non-smoked tobacco, site of the lesion (gingival, floor of mouth or lingual vestibule) and presence of tenderness on the lesion were significantly associated with Dysplasia.     

False pulmonary artery aneurysm induced by Swan-Ganz catheter: diagnosis and embolotherapy

A false aneurysm that formed after injury by a Swan-Ganz catheter to the pulmonary artery in a patient on long-term anticoagulant therapy is reported. The lesion was demonstrated both by computed tomography and pulmonary angiography. The case is unique in that the patient was successfully treated with percutaneous transcatheter embolization.     

Helicobacter pylori: ENOUGH TO GIVE ANYONE AN ULCER!

SUMMARY Since the early 1980s, research into gastritis and peptic ulcer disease has been dominated by Helicobacter pylori. This is a small, Gram-negative spiral bacterium which inhabits the mucus layer that coats the gastric mucosa. Colonisation of the human stomach by this bacterium is worldwide and, in certain continents, virtually ubiquitous. While histological gastritis is always the result, H. pylori-positive individuals are characteristically asymptomatic. Transmission is thought to be via the faecal-oral route and infection, usually acquired in childhood, will persist unless treatment supervenes. H. pylori is the main causative agent of peptic ulceration, but its role in non-ulcer dyspepsia is less clearcut. Recently epidemiological, histological and experimental data have been described linking H. pylori to gastric neoplasia — in particular adenocarcinoma and MALT lymphoma. A variety of treatment modalities exists for the eradication of this bacterium, and for adults the recommended drug therapy is a combination course of tetracycline, bismuth and metronidazole. Currently the new combination of omeprazole and amoxycillin is suggested as second-line treatment after failed triple therapy.     

Humoral immune response following extracorporeal immunoadsorption therapy of patients with hypercholesterolemia

Low-density lipoprotein apheresis (LDL-apheresis) is an extracorporeal procedure that preferentially removes LDL cholesterol from the blood. One of the primary techniques for performing this procedure uses immunoadsorption columns containing monospecific polyclonal sheep antibodies to human LDL covalently coupled to a gel filtration medium. LDL-apheresis has generally been well-tolerated, with chills, fever, or flushing occurring rarely. The possibility of an immune reaction was investigated as a basis for these reactions observed in 12 of the 1312 procedures performed. Antibodies to sheep IgG developed in 12 of the 15 patients treated with LDL-apheresis as a result of the shedding of small quantities of the sheep immunoglobulin from the columns. A column acid-washing procedure minimized the quantity of shed antibody but did not prevent immunization of the patient. The clinical reactions were probably unrelated to shedding and immunization, as the reactions occurred even in patients who were not immunized to the sheep IgG. Immunization to ethylene oxide was not the cause, as determined by a radioallergosorbent test. The reactions were more likely related to the activation of complement, as indicated by the generation of C3a des Arg by the columns and an increase in C3a des Arg levels systemically.     

Studies on the pathophysiology of posttransfusion purpura

Posttransfusion purpura typically occurs in PLA1 negative blood recipients who have been previously immunized to the PLA1 antigen. Following transfusion, severe thrombocytopenia develops with the formation of anti-PLA1. Since the patients' platelets lack the PLA1 antigen, one would not expect this antibody to destroy autologous platelets. In this study we show that PLA1 antigen exists in stored blood and can absorb to PLA1 negative platelets making them PLA1 reactive. Incubating PLA1 (-) platelets with ultracentrifuged plasma from PLA1 (+) blood donors allowed anti-PLA1 to bind to PLA1 (-) platelets. Control plasma from PLA1 (-) blood donors did not lead to anti-PLA1 binding. Using an inhibition assay, we showed that stored blood contains PLA1 material that was not removed by ultracentrifugation. The material absorbing to PLA1 (-) platelets represented the PLA1 antigen, which was confirmed by Western blotting. After incubating plasma containing PLA1 antigen with PLA1 (-) platelets, reactivity at 95,000 D was observed. Native PLA1 (+) platelets showed a similar band. When PLA1 (-) platelets were incubated with plasma from a PLA1 (-) donor, this band was not present. These studies show that a soluble form of PLA1 antigen exists in stored blood that can absorb to PLA1 (-) platelets. Consequently, anti-PLA1 can bind to these platelets leading to thrombocytopenia. These observations may explain the autologous destruction of platelets in posttransfusion purpura.     

Biodistribution of radiolabeled lymphocytes

Factors that might affect the biodistribution and clinical utility of radiolabeled lymphocytes were evaluated in experimental animals. Indium-111 (In-111) labeled lymphocytes (10(7)-10(9) syngeneic or allogeneic cells; 1-10 microCi [.037-.37 MBq]/10(8) cells) obtained from peripheral blood, lymph node, or spleen were found in significant amounts in the lymphoid tissues of Lewis rats as early as 3 hours after infusion. A progressive increase in nodal activity with concomitant fall of activity in other organs followed, indicating active recirculation of the lymphocytes. However, In-111 labeled thymocytes or xenogeneic lymphocytes failed to accumulate in lymphoid tissue. In vitro irradiation of the In-111 labeled lymphocytes (100-400 rads [1-4 Gy]) before in vivo administration and increase of the In-111 to 40 microCi [1.48 MBq]/10(8) lymphocytes resulted in no detectable lymphocyte recirculation and/or reduced localization in lymphoid tissue. Splenectomized animals and those sensitized to an organ allograft before cell infusion showed increased activity in their bone marrow. These results suggest that the source of the injected cells, cell irradiation dose level, and host sensitization should be considered when radiolabeled lymphocytes are being prepared for use in clinical diagnosis and therapy.