bluuebunny/crossref_metadata_2025_split huggingface dataset:
Factors affecting conversion of laparoscopic to open cholecystectomy
Authors: Chhetri Raj Kumar , Shrestha Muza , Shrestha Ram Prasad 
Published: June 2019

Introduction: Laparoscopic cholecystectomy is the gold-standard operation for the treatment of cholelithiasis. Various factors affect the conversion of laparoscopic to open cholecystectomy.
Methods: In this prospective analytical study one hundred and sixty consecutive patients who underwent laparoscopic cholecystectomy were studied to see the factors that affect the conversion to open cholecystectomy. Factors contributing to conversion of laparoscopic to open cholecystectomy were analyzed.
Result: In this study the conversion rate of laparoscopic to open cholecystectomy was 6.25%. The most common cause for conversion was unclear anatomy and adhesion at the Calot’s triangle and abnormal course of the cystic artery.
Conclusion: Proper knowledge about the anatomical variations of cystic duct and artery and timely conversion in cases of confusion can help prevent bile duct injuries during cholecystectomy.
Safety of laparoscopic cholecystectomy in children using conventional instruments in a general teaching hospital by general surgeons: 14 years review
Authors: Maharjan Shantabir , Shah Jay Narayan , Gurung Rajan , Shah Shailedra , Mandal Rajesh , Baral Reetu 
Published: June 2019

Introduction: There is limited specialist facility and lack of data on gallstone and laparoscopic cholecystectomy (LC) in children locally and in the region. With one government children hospital in Nepal, specialist service is far from adequate. Utilizing existing facilities to provide service is the need. We analyzed 14 years data to look in to the safety of LC in children provided by general surgeons in a general teaching hospital with conventional LC instruments used for adults.
Methods: This descriptive review included children up to 14 y of age who had cholecystectomy during 14 y period from 2002 to 2015. Data on sex, age; clinical and ultrasonography findings; risk factors for gallstone; types of surgeries; bile duct injury, would infection and in-hospital mortality were analyzed.
Results: There were 61 children, 0.8% of total 7469 cholecystectomy during 14 years study period. Average age was 9 years and females were 56 (84%). Out of 58-attempted LC, 56 were completed successfully. All children had history of right upper quadrant pain. Two presented with acute calculous cholecystitis. We did not find associated risk factors for stones. There was no bile duct injury. One wound infection occurred in LC converted to open. In-hospital mortality was nil.
Conclusion: Cholelithiasis and cholecystectomy in children was low at 0.8% of total. With 3.4% conversion, no bile duct injury, no hospital mortality LC was safely provided by general surgeon in a general hospital using conventional facility.
Prevalence, aetiology and management of ureteric injuries in Mulago National Referral Hospital, Kampala, Uganda
Authors: Obore Susan , Barageine Justus 
Published: June 2019

Aims: To determine the prevalence, aetiology and management of ureteric injuries in the Urogynecology unit of Mulago National Referral Hospital.
Methods: Records of patients operated for ureteric injuries from January 2005 to December 2017 were reviewed. The type of operations associated with the injury, duration of injury and mode of management of the injuries was reviewed.
Results: There were 140 patients operated for ureteric injuries during the study period and this constituted 9.1% of all operations for urinary incontinence. Records of 125 patients were reviewed. The mean age of the patients at admission was 30.9 years and the mean duration of leakage was 19.8 months. In 100 (80%) of patients the leakage followed delivery and 25(20%) followed gynecological operations. Most of the patients 80 (64%) presented with vaginal leakage of urine/fistula while 7(5.6%) presented with transection of the ureter. The commonest site of injury was the left ureter (73.7%) and 17(13.6%) had bilateral injury. All the patients were managed by surgical repair with a success rate of 90.6%.
Conclusions: Iatrogenic ureteric injuries following c/section and c/section hysterectomy are a cause of morbidity and effort should be made to improve on surgical skills and ensure early recognition of injury.
Keywords: fistula,iatrogenic, ureter injury
Iatrogenic Fistula: Types, Causes and Post-repair outcome – 70 cases
Authors: Begum Bilkis 
Published: June 2019

Aims: In Bangladesh since iatrogenic fistula is gradually increasing so aim of this study is to find out the types, causes and post-repair outcome of iatrogenic fistula.
Methods: 70 cases in Bangladesh were reviewed between periodof January 2012 to April 2018. Detailed history, clinical examination and investigations were done to find out the causes. Proper evaluation was done for diagnosis of type of fistula and treatment plan.
Results: Among 70 cases, 48 were vault fistulae, 10 intracervical, 7 juxta-cervical, 2 mid-vaginal and 2 at neck region, 1 uretero-vaginal and 1 extensive from neck to cervix. Regarding causes, among 70 cases, 47 fistulae developed after hysterectomy of which 38 following TAH, 6 following caesarean hysterectomy and 3 after vaginal hysterectomy. Rest 16 cases were due to caesarean section, 1 case was following coitus and 6 were due to other than gynecological-obstetric causes. 65 patients were repaired vaginally, 1 abdominally and 4 through combined route. Among 70 cases, 68 patients were successfully repaired at 1st attempt without any significant complication. 2 cases failed at 1st attempt and were dropped out.
Conclusions: Almost all of these causes are preventable. So emphasis should be given to identify the causes of iatrogenic fistula to prevent the event. At the same time, our aim is to make these patients free of urinary smell by applying appropriate surgical technique.
Experience of Partnership with Fistula Program in Bangladesh: University Fistula Center, Bangabandhu Sheikh Mujib Medical University
Authors: Alam Farhana , Chowdhury Saleha Begum , Mahmud Sharmeen 
Published: June 2019

Aims: The aim of this paper is to share the performance data of University Fistula Center (UFC), BSMMU as well as the partnership experience of UFC with national fistula program at different levels and various activities.
Methods: UFC uses an aggregated DHIS2 database and Safe Surgery Toolkit, two dedicated systems for record keeping of fistula activities introduced by the Fistula Care Plus (FC+) project at EngenderHealth. UFC fistula service data have been compiled using DHIS2 and SPSS.
Results: From 2015 to 2018, UFC has provided surgical care to 98 cases fistula and 72 cases of complete perineal tear. UFC has provided technical assistance in field testing of the 4Q checklist- a novel tool for fistula case identification at the field level developed and refined by the FC+ project. UFC has contributed developing and testing a model for Community Based Fistula Diagnosis events (CFDEs) and to drafting the 2nd national fistula strategy of Bangladesh.
Conclusions: The UFC is now recognized as a key contributor to national fistula programming in Bangladesh and in defining standards of care.
Experience of using Community Radio for Fistula Communication in Bangladesh
Authors: Biswas Nitta , Huda Sk Nazmul 
Published: June 2019

Aims: To share the experience of using community radio networks for female genital fistula communication in Bangladesh.
Methods: We selected 11 community radio stations from remote areas in Bangladesh. Four hours orientation training was provided to manager and fistula focal person per radio station. We provided pre-recorded education and advocacy materials for fistula prevention and communication. Station staffs were provided with a manual for fistula communication.
Results: 32 key staff members of community radios were trained. At least 33 episodes were broad casted focusing on prevention of early marriage, care of obstructed labor, treatment and rehabilitation of fistula. Information about fistula prevention, case identification, repair center and rehabilitation were provided to an estimated number 660,000 people living in hard to reach places through community radio stations. They incorporated fistula messages song, dramas and talk shows on fistula throughout the year.
Conclusions: Community radio is a low cost, effective media for fistula communication in hard to reach areas. It is capable of linking a range of stakeholders and can be a strong force for facilitation of social movement for fistula free communities.
Building a Countrywide Treatment Network: Lessons from Kenya and Zambia
Authors: Pollaczek Lindsay , Mohamed Habiba , Chomba Bwalya 
Published: June 2019

In 2014, Fistula Foundation and partners launched Action on Fistula in Kenya, a comprehensive initiative focused on expanding access to fistula care and building the national capacity for fistula treatment, training, and community mobilization. Between May 2014 - September 2018, over 4,000 fistula repair surgeries have been performed at six partner hospitals throughout the country, far surpassing the original targets and nearly doubling the treatment capacity in the country. This was accomplished through partnerships with the Ministry of Health, public and private hospitals, Federation of International Gynecology and Obstetrics for accreditation of the first FIGO obstetric fistula training center in the country, and community-based organizations responsible for patient identification, referral, and reintegration programs. This integrated and holistic model of delivering fistula care has resulted in over 4,100 fistula surgeries performed by 10 Kenyan surgeons, 8 new surgeons trained to the FIGO standard or intermediate competency level, 309 community health volunteers trained and deployed, over 12,000 community events conducted to improve knowledge and awareness of fistula, and over 300 women enrolled in support groups post repair to enhance social and psychological health and boost livelihood development opportunities.
The success of the Kenya program prompted the launch of a new countrywide treatment network in Zambia in January 2017. In the first 20 months, the program supported over 375 additional surgeries at six hospitals (from a baseline of approximately 200 surgeries annually done across the country), trained three surgeons to FIGO standard competency level, trained 217 CHVs and Safe Motherhood Action Group Members, and conducted over 2,000 outreach activities for fistula awareness.
Improving fistula data reporting through collaboration, learning and adaptation of fistula tools and indicators in Uganda
Authors: Kanakulya Hassan , Kaduyu Paul , Arnoff Elly , Mukisa Rose , Tripathi Vandana 
Published: June 2019

Aims: To report on efforts to improve fistula service statistics reporting in Uganda.
Methods: A process review assessed the adoption of fistula tools and indicators nationally and in four districts. In addition to HMIS/DHIS2 data review, nine key informant interviews were conducted, at two district hospitals, two specialized hospitals and with the national senior biostatistician.
Results: Two of four were included in the revised HMIS/DHIS2 and three of four hospitals were using standardized fistula tools. From July 2017- June 2018, 595 repairs and 310 fistula cases were reported into DHIS2 and evidence of data use at the district level. However, there was low reporting rate for fistula data, due to low awareness of the new HMIS indicators.
Conclusions: Integration of the fistula and obstetrics/gynecology registers, refinement of the fistula register, and development of discharge and follow-up registers were considered by partners thus leading to availability of routine data to support planning.
Female Urinary Incontinence: Prevalence and Impact on the Quality of Life of Gynaecological Clinic Attendees in Lagos, Nigeria
Authors: Akinlusi FM , Ottun TA , Oshodi YA 
Published: June 2019

Aims: To determine the prevalence of urinary incontinence (UI); risk factors; impact on quality of life and symptom specific health seeking behaviour.
Methods: A cross-sectional study of 395 women attending gynaecological clinic of the Lagos State University Teaching Hospital. UI was defined as the complaint of any involuntary leakage of urine in the previous six months. Socio-demographic characteristics, obstetrics, gynaecological, medical and surgical risk factors, impact on daily activities and treatment history were assessed. Univariate, bivariate and multivariable analyses were performed.
Results: Participants age ranged from 25-67 years with a mean of 38.81 ± 10.1. Prevalence of UI was 32.9%. Urge UI occurred in 18.0% of all respondents while the prevalence of stress and mixed incontinence was 7.3% and 7.6% respectively. Independent risk factors for urinary incontinence were age (OR= 0.49, 95%;CI = 0.26-0.92), higher body mass index (OR = 1.92; 95% CI =1.53-3.00) and history of constipation(OR = 2.11; 95% CI =1.30 - 3.43). About47%of those with UI admitted to having negative feelings such as despair, anxiety and depression while 45% had a cumulative moderate to severe affectation of their quality of life in all domains. Despite these, only 27.7% sought help.
Conclusions: Despite thesubstantial impact of UI on the quality of life, majority do not seek help. Addressing modifiable risks factors, improving treatment seeking behaviour by correction of misconceptions and elimination of stigma will go a long way in reducing the prevalence of UI.
Abandonment and isolation of Fistula Clients by spouses / partner and society
Authors: Malungo Jacob , Kasanda Goshon , Mijere Jenipher 
Published: June 2019

Aims: The study investigated the extent to which women who had experienced fistula had been Ostracized or abandoned by spouses or partners.
Methods: Descriptive study
Results: Thirty-eighty per cent ((38) of the fistula victims were abandoned by their husbands or partners while sixty-two percent (62%) were not. Fifty percent of those abandoned had no living children. This percent decreased with increasing number of children. The breakup in the marriage was more reported among spouses who did not have any living children. There were utterances to the effect that where divorce had not occurred, the men had married additional women or co-wives for them to enhance sexual intercourse and bear children. Spouses who did not abandon their wives fully took responsibility in taking care of them, including giving them medical and economic support.
Conclusions: There is marital break-up more on those who have not children. The family members took responsibility of those who had been abandoned by their spouses.
Profile of Obstetrics Fistula Clients; is the trend changing?
Authors: Morhason-Bello IO , Bello OO , Abduls-Salam RA , Babawarun TO , Lawal OO , Ojengbede AO 
Published: June 2019

Aims: To assess the changes in the profiles of obstetric fistula clients.
Methods: This was a retrospective review of the medical records of all obstetric fistula clients managed by the Oyo state fistula team at University College Hospital and Adeoyo Maternity Hospital Ibadan, Nigeria. A proforma was used to extract information on socio-demographic and obstetric characteristics of clients and was analyzed using SPSS 25.0. Level of significance was set at P <0.05.
Results: The median age and number of pregnancy with occurrence of fistula were 34 years and 2 respectively. Above a quarter (32.2%) had at least secondary level of education, three quarter (75.2%) were currently married and about half were traders. Only 20 (22%) booked the pregnancy that resulted in fistula with 44 (44.9%) delivering through cesarean section. Majority 70 (72.9%) of the fetuses were stillbirth.
Conclusions: The widely held believe of a typical obstetric patient still holds but substantial cases of fistula occurred in multiparous women and at older age.
Eradication of Neglected Surgical Diseases in Kenya: A Study Protocol
Authors: Jaymie Henry , Mwai Patrick , Waiguru Estella , Jani Pankaj 
Published: June 2019

Aims: We aim to conduct a county-wide door to door identification, referral, and treatment of Neglected Surgical Diseases (NSDs) as a health systems strengthening activity.
Methods: To establish the true prevalence of NSDs and to pilot test an eradication strategy, a single-county door to door census will be conducted in a county in Kenya by community health workers (CHWs) utilizing a mobile app that categorizes six NSDs: obstetric fistula, cleft lip and palate, cataracts, clubfoot, hernia, and neglected injuries. A two-day training workshop on NSD identification was conducted. Prevalence data will be calculated. Identified cases will immediately be referred for treatment to established NGOs who will also train existing health workers in appropriate level district hospitals.
Results: Meru County was identified as a pilot study area with a population of 1,517,077 people, 11 administrative sub-counties, and 45 wards. A total of 1,552 CHWs were identified. Demographic data on the number of patients with NSDs, the type of NSD, their contact details, geographical location as well as the contacts of the parent/guardian will be collected by trained research assistants. The data will be fed onto a dashboard that dynamically updates with each NSD identified to aid in tracking cases.
Differential Effects of Low-Dose Erythropoietin in Rat Model of Diabetic Nephropathy
Authors: Fouda Abdel-Motaal , Ashour Rehab H. , El-Banna Farida , Saad Mohamed A. , Mostafa Fatma A. , Fouda Manal I. 
Published: June 2019

Background. Previous reports on the renoprotective effect of erythropoietin (EPO) in the setting of chronic kidney disease (CKD) have yielded conflicting results. The aim of this study is to clarify the effect of low, non-hematopoietic dose of EPO on the evolution of diabetic nephropathy (DN) in rat model. Methods. Low dose of recombinant human EPO (150 U/kg, s.c. three times/week) was given to streptozotocin (STZ)-induced diabetic rats in two schedules; in the first one, EPO was given from day 2 after STZ injection till the end of the study (28 weeks) as prophylactic treatment; and in the other schedule EPO was given after development of DN (last 8 weeks) as therapeutic treatment. Albuminuria, blood pressure, creatinine clearance, renal venous oxygen tension (vPO2), plasma EPO, hematocrit and renal histopathology were assessed. Results. Unexpectedly, 28 weeks administration of EPO to diabetic rats led to aggravation of albuminuria and worsening of histopathological damage in spite of partial correction of renal hypoxia. Contrary to this, terminal 8 weeks EPO therapy of DN reduced albuminuria and demonstrated some favorable effects on biochemical changes and histologic picture. Conclusion. Low dose EPO exerted differential effects in rat model of DN according to treatment duration. In addition, findings of the present study warrants further investigations of the exact renoprotective role of EPO in diabetic patients with CKD who receive EPO therapy for long periods.
HUMAN RESOURCES AS A FACTOR OF PROVIDING UKRAINE SOCIAL SECURITY SYSTEM IN MODERN CONDITIONS
Authors: Stavnycha N. I. 
Published: June 2019

The purpose of the article is to research and analyze indicators that directly effect on the level of country’s human resources development, and assessment of Ukraine’s rating place among other countries. The following methods of scientific research, such as generalization, comparison and analysis were used to achieve the goal.
The attention is focused on the fact that in conditions of post-industrial economy, the role of human and its knowledge increase, resulting in implementing the human development concept. This concept is aimed at forming measures to prevent the population impoverishment, unemployment, loss of health by stimulating human development, increasing its role in society, and, at the same time, increasing responsibility to society. The main task of the concept is to ensure the welfare of the person.
The article shows the comparative assessment of Ukraine’s ranking among other countries according to the human development index and its components. The following indicators such as gross national income per capita, average and expected duration of training, average life expectancy at birth were analyzed.
It was agreed that economic ability to create and use human resources to a greater extent determines human well-being and is the main criteria for assessing the social security level. Since the background for well-being is income, education, and human health, social security becomes an integrating link between the modern concept of human development and the state social policy. In this manner, everything that reduces welfare, harms a particular person and society as a whole are factors that threaten social security. In this context human resources emerged as a key resource to the state development.
FINANCIAL CONTROL KEY ELEMENT TO PROVIDE ECONOMIC SECURITY OF THE ENTERPRISE
Authors: Demchuk N. I. , Tkachenko H. A. 
Published: June 2019

The article considers the essence of financial control and its importance in ensuring the economic security of the enterprise. It has been established that financial control is an effective coordinating system for ensuring the interconnection between the formation of an information base, financial analysis, financial planning and internal financial control, which ensures concentration of control activities. In the most priority areas of financial activity of the enterprise, timely detection of deviations of its actual results from the foreseen and the adoption of operational management decisions that ensure its normalization.
The views of leading scientists concerning the definition of the concept of financial controlling and its key elements are researched. Also, the key financial control functions are analyzed and analyzed in the article.
Six main concepts of financial controlling used for realization of functions of financial control in crisis conditions of management. The concept of generation of integrated planning and control tools; concept of production, sale or service; the concept of taking into account the specifics of the enterprise; the concept of the orientation of the movement of funds; use of the tools of the concept of financial control as the basis for making managerial decisions; management concept and management decision making.
The effectiveness of the company in difficult conditions, and especially in the long run, means not just survival in the market, but also ensuring high rates of development and competitiveness, is determined by the level of financial potential and quality of financial management in the enterprise. Which is provided by a certain extent with the effective organization and implementation of the financial system controlling. The application of the financial controlling system at the enterprise will enable to prevent emergence of crises, to identify the causes of financial problems and to effectively search for solutions to them. the primary task of financial control is the maintenance of liquidity and solvency of an enterprise, which can be achieved under the condition of financial planning with the current analysis of financial sustainability.