Objective: To know the factors governing the onset of lactogenesis II and to find out the clinical markers of establishment of lactogenesis II. Design : Cross section observational study,200 mother infant pairs who were selected by systematic sampling procedure (every 10^th case) in two hospitals attached to the medical college. Results: A total of 200 mother-infant pairs were studied during their hospital stay. Among them 139(69.5%) cases had normal lactation and 61(30.5%) cases had delayed onset of lactation .37.7% of primiparous mothers had delayed lactation in contrast to 19.3% of multiparous mothers (p<0.01). Among cesarean deliveries, 48.7% had delayed lactogenesis as compared to 28.3% of vaginal deliveries (p<0.01). There was a direct relation between time of initiation of feeding and subsequent delay in lactation (p<0.001) .Mean percentage of weight loss was 9.3% in delayed lactogenesis group as against 5.4% in early group. On day 4 mean no. of voids was 5.4 in early group, whereas it was 2.6 in delayed lactation group. Similarly mean no. of stools passed on day 4 was 4.4 in early lactation group and 2.6 in delayed lactation group. Various factors associated with delayed onset of lactation were: wrong techniques of feeding, cesarean deliveries, use of pacifiers and inverted nipple. Conclusions : Appearance of yellow tinge in the stool can be used as a field marker in the peripheries by health workers for assessment of establishment of adequate breastfeeding.

Introduction: Rabies is a vaccine preventable disease. Still it poses a significant public health problem in developing countries like India particularly in children. Nearly half of those bitten by suspect rabid animals are children less than 15 years of age. Objectives: To study the epidemiological determinants of children with animal bite. Methods: A hospital based cross-sectional study was conducted in 50 children. Detailed sociodemographic profile, type of bites including site, duration, category of exposure, wound toilet, home treatment, clinical treatment including active and passive immunization etc. was inquired. Results : Out of 50 patients 74% were male and 26% were female. Majority of patients i.e. 94% were from urban areas and only 6% were from rural areas.74% animal bites were of category III with 69% being unprovoked.72% injuries were of abrasion type and 24% were deep wounds and only 4% were licking type of wound. Maximum number i. e. 70% bites were on lower limb, 20% were on upper limb and only 6% on trunk and 4% were on head. Wound toileting was done by 58% of patients and 26% patients had given history of local application of turmeric. Out of total patients, 80% were of dog bites, 12% were pig bites followed by 6% monkey bites and 2% cat bites. Active immunization (Anti rabies vaccine) was administered to 56% of cases whereas passive immunization (Immunoglobulin - equirab) was given to 20% cases. Conclusion : Our study findings suggest that, majority of the patients were bitten by dogs (80%) and most of them did not follow the proper wound care in the form of immediate washing of wound with soap and water. All these call for concerted effort for a mass awareness campaign.

Introduction : Hyperbilirubinemia develops in 13% of breast fed infants in the 1^st wk of life because of decreased milk intake with dehydration or reduced caloric intake. Clinical examination to detect hyperbilirubinemia is done by visual assessment, a method whose diagnostic accuracy remains unclear. Aim : To study the diagnostic accuracy of clinical examination to detect hyperbilirubinemia. Material and Methods: This study was performed in the Neonatology unit at Mahatma Gandhi Institute of Medical Sciences, Sevagram, from May 2009 and July 2009. Study Design: A diagnostic study of the index test (clinical assessment of jaundice) as compared to a reference standard (laboratory confirmed hyperbilirubinemia) in a blind and independent manner. Inclusion criteria: All the healthy full-term newborns who will be admitted in postnatal ward. Exclusion criteria: Neonates who would have received exchange transfusion or phototherapy prior to inclusion (day 3) would be excluded. Performance of the index test: Medical student, Nurse and Doctor had examined the entire neonate on 3^rd day of life for jaundice in the manner suggested by the American Academy of Pediatrics, which is by (a) blanching the skin and (b) determine the cephalocaudal progression of jaundice as well as (c) predict the total serum bilirubin. The total serum bilirubin estimation will be done by calorimetrically using green filter with 540 nm wavelength (KLETTE) method. Statistical analysis: The diagnostic accuracy of each clinical sign was measured by computation of sensitivity, specificity, positive likelihood ratios (LR+), negative likelihood ratios (LR–), and positive and negative predictive values. We used ĸ_ statistic to assessed reliability of physical findings between the pair of physicians. STATA 13 software was used for statistical analysis. Result : Of 99 eligible neonates, 54 were male and 45 were female. The mean gestational age was 39 weeks; mean birth weight was 2.6±0.7kg; and the mean age at the time of data collection was 3.2±0.4days The infants were examined by student, nurse and doctor . The bilirubin levels ranged from 1.8 to 27.3 mg/dL with mean of 12.03±5.69. The diagnostic accuracy was better for prediction of higher levels of hyperbilirubinemia. At lower levels clinical assessment had modest sensitivity but poor specificity. The Area under curve(AUC) by ROC was 0.870 ( CI: 0.80-0.95) for predicting the s.bilirubin >15mg/dL by the doctor , as well as the AUC of the nurse and student were 0.80(CI: 0.70-0.90) and 0.72 ( CI: 0.60-0.83). Similarly, the Area under curve by ROC was 0.81 (CI: 0.72-0.89) for predicting the s.bilirubin >12mg/dL by the doctor , as well as the AUC of the nurse and student were 0.78 (CI: 0.69-0.88) and 0.75 (CI:0.65-0.85). Similarly, the AUC by ROC was 0.86 (CI: 0.78-0.94) for predicting the s.bilirubin >10mg/dL by the doctor , as well as the AUC of the nurse and student were 0.81 (CI:0.71- 0.90) and 0.76(CI:0.65-0.86). Conclusion: Clinical examination for neonatal jaundice was reliable, and prediction of serum bilirubin concentration using clinical examination alone had good accuracy in our study.