bluuebunny/crossref_metadata_2025_split huggingface dataset:
Value of ultrasound in evaluation of cervical lymphadenopathy: correlation with FNAC / histopathology
Authors: Jaiswal Pooja , Sharma Prakash 
Published: June 2019

Introduction: The role of high-resolution ultrasound in evaluation of cervical lymph nodes is well established. The aim of this study was to determine its accuracy in differentiating benign and malignant cervical lymphadenopathy. The objectives were to study various sonographic features applicable in routine clinical practice to identify and differentiate various types of cervical lymphadenopathy.
Methods: The study was done at the Pathology and Radiology department of Manipal teaching hospital (MTH) from Jan 2015 to Dec 2015. Seventy cervical nodes in 70 patients (17-reactive, 23-tuberculous, 9-lymphoma and 21-metastatic) were evaluated by high resolution ultrasound (7.5- 10MHz). Shape (S:L ratio), (maximal short to maximal long axis ratio diameter) nodal margins, hilar echogenicity, vascular pattern, distribution, size, echogenicity, calcification, posterior enhancement, eccentric cortical hypertrophy, matting and soft tissue edema were assessed. Confirmed diagnosis was either made by USG guided FNAC on the largest node or by open biopsy. The first four parameters had the most significant differences between benign and malignant lymph nodes and were evaluated to calculate the accuracy of ultrasound in their differentiation. Individual groups were compared and optimal sonographic features in differential diagnosis were determined.
Results: The common useful sonographic features to identify different types of cervical lymph nodes were S:L ratio, nodal margins, hilar echogenicity, vascular pattern, matting, soft tissue edema, echogeneity, intranodal necrosis, displaced hilar vascularity, eccentric cortical hypertrophy and posterior enhancement. Vascularity was the most accurate parameter (86%) when used in isolation and when combined parameters were used ultrasound had accuracy of 97% in diagnosing benign or malignant cervical lymphadenopathy.
Conclusion: This study showed that high resolution ultrasound has a high degree of accuracy in differentiating benign and malignant cervical lymphadenopathy and assists in differentiating various causes of lymphadenopathy.
Preoperative serum albumin level as a predictor of perioperative outcome in patient undergoing major gastrointestinal surgery
Authors: Bhandari Tika Ram , Shahi Sudha , Bhandari Ramesh Singh , Lakhey Paleswan Joshi 
Published: June 2019

Introduction: Hypoalbuminemia, as a marker of malnutrition and disease, is associated with higher risk of poor postoperative outcomes. However, no study has been reported from our country until now. Our aim was to identify the relationship between preoperative hypoalbuminemia and the development of complications after major gastrointestinal surgery.
Methods: A prospective study of 106 patients who underwent major elective gastrointestinal surgery between July 2012 to June 2013 in Department of Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal were considered for the study. Serum albumin was determined preoperatively in all patients. Hypoalbuminemia was deﬁned as albumin less than 35 mg/dl. Thirty-day postoperative complications were analyzed.
Results: The patients were 70 males (66 %) and 36 females (34%) with a mean age of 50 years (23-81). Thirty-six patients (34%) had hypoalbuminemia. Overall complication rate was 32%. Hypoalbuminemic patients had a significantly higher rate of postoperative complications (26.4 and 5.6%; P<0.05). In multivariate analysis, age (>50 year), BMI (<18 kg/m2), duration of surgery (>3 hours) and hypoalbuminemia (<35 mg/dl) were the significant risk factors for postoperative complications (P<0.05).
Conclusion: Preoperative hypoalbuminemia is an independent predictor of postoperative outcomes in patients with elective major gastrointestinal surgery. Identification and optimization of nutritional status prior to surgery may improve surgical outcomes.
Increasing frequency of iatrogenic fistula- a new challenge
Authors: Tasnim Nasira , Bangash Kauser , Amin Oreekha , Batool Afshan , Javed Nosheela 
Published: June 2019

Aims: To determine the frequency of iatrogenic urogenital fistula in patients admitted for the repair of fistula in MCH, Pakistan Institute of Medical Sciences, Islamabad.
Methods: The retrospective analysis was conducted at MCH PIMS, Islamabad. It comprised data related to patients having undergone urogenital fistula repair. Statistical analysis of the record was done using SPSS 21 software.
Results: Total 98 patients were analyzed. Themean age of patients was 31.6. Out of these, 67.3% of fistulas were attributed to iatrogenic causes while 32.7% were due to obstructed labour. The iatrogenic fistula included post instrumental delivery (5.1%), caesarian section (8.2%), caesarean hysterectomy (17.3%), hysterectomy (36.7%). The fistula caused by obstructed labour included post caesarian section (23.5%) and post normal delivery (9.2%).
Conclusions: Our study data showed rising trend of iatrogenic fistula as compared to obstructed labour. This emphasizes the need of optimization of the surgical approach training along with improved obstetric skills, especially in the periphery.
Keywords: iatrogenic fistula, obstetric skills, delivery
Success of Local Fistula Mentorship; Review of Routine Repairs At Referral Hospital in Uganda
Authors: Namala Angela 
Published: June 2019

Aims: To assess surgical capacity building training during fistula camps using FIGO competency manualand skills tracker.
Methods: Between January 2016 to September 2018, six fistula camps were conducted in which the trainee worked with three expert surgeons. The trainee observed, assisted and operated fistula cases with supervision and mentorship from the FIGO accredited expert surgeons. The trainee competence was progressively monitored. Continuous mentorship and coaching was done over two years and the trainee was encouraged to do routine repairs after their skill level improved from standard to advanced level. The routine fistula repairs were done using FIGO competency manual and skills tracker by the trainee.
Results: During the period, 632 patients sought care for treatment of fistula, 31% (199) were diagnosed with fistula, 92 %( 183) treated, 23%(34) through routine while 77 % (149) through camps.Out of the routine repairs, 74% (25) were simple fistulae and 26% (9) were complex 97%. Of the routine repair (33 cases) were continent at discharge with a negative dye test, while 3 %(1) had a failed repair.
Conclusion: The local onsite fistula-training program is a cheaper yet successful way of capacity building for surgeons as individuals and for institutions for routine fistula repairs.
Genital fistula: Successes, challenges and way forward in a facility specialization in fistula management in Bangladesh
Authors: Biswas Nrionmoy , Biswas Animesh 
Published: June 2019

Aims: To explore the success, challenges and way forward on genital fistula in Bangladesh.
Methods: From the October 2017 to September 2018; total numbers of 125 genital fistula cases were identified through a community network system in Cox’s Bazar. Out of them, 101 cases come to hospital for the repair. For each of the patients, details case history was documented, clinical management reports also captured using structured forms. The study performed descriptive analysis using the case history and clinical management data.
Results: Out of 101 cases admitted, 95% of cases were of obstetric, 3% iatrogenic, 1% traumatic and remaining 1% was congenital. Mean age was 31 (18-73) years. Mean duration of disease was 6 (0.1-53) Years. Most of them had urinary incontinence (86.1 %) and 11.9% had faecal incontinence where 2% had both. VVF was performed in most of the cases (78%), another 22% was RVF. Only of them 9.9% had complications, remaining discharged without any complications. Mean duration of hospital stay was 17 (4-29) days. Success rate was 86.1% and in 13.9 % of cases next surgery was advised. For all patients psychiatry counseling was given before and after surgery. However, the hospital doesn’t provide other rehabilitation or reintegration support, therefore, there was challenge to mainstream the women in the society or secure their social positions.
Conclusions: Community surveillance followed by timely referral can improve obstetric fistula burden in Bangladesh. However, as clinical management, its equally important to restore the women’s dignity in the society with rehabilitation and reintegration. Challenges is still persisting in functional of the system and effective collaboration between the different ministry of the government of resolve the condition.
Midwifery tutors training program
Authors: Syed Shershah 
Published: June 2019

PAKISTAN has more than one forty eight (148) school of midwifery in different parts of country. Pakistan National Forum on Women's Health (PNFWH) realized that majority of these school of midwifery has no trained faculty to teach and train future midwives. It is also observed and shown in a study by UNICEF Pakistan that ninety percent midwives get their diploma in midwifery without doing a single delivery in labor room.
To face this challenge PNFWH started a six month midwifery tutors training program at Koohi Goth Women Hospital (KGWH) in Karachi. Twenty five midwifery tutors from midwifery schools in different parts of country came to stay at KGWH for this program.
They were taught to teach in class room with or without modern teaching aids. They were encouraged to use computer and should be able to do power presentation at the end of Theiler training. All tutors were posted in labor ward and train to do clinical teaching at the bed side and laboring women.
The program was a great success. Up till now eleven batches were trained with the help of donors who are working in their midwifery schools.
This paper discusses the issues related to tutors training and problems faced by midwifery schools in recruiting competent tutors.
Profile of Obstetric and Iatrogenic Fistula Surgeries At Kathmandu Model Hospital
Authors: Shrestha R , Karki A , Dangal G , Pradhan H , Bhattachan K , Poudel R , Bajracharya N , Tirwari K 
Published: June 2019

Aims: To find out the pattern of urogenital fistula.
Methods: This was a retrospective study of 222 patients who underwent fistula surgery during the period of January 2012 to March 2018 in Kathmandu Model Hospital. The data were collected from the hospital records. The fistulae were classified according Goh system. Patients’ demography, obstetric characteristics and surgical outcome were reviewed. The primary outcome was in terms of urinary continence.
Results: Among 222 cases, majority of the patients had fistula due to obstetrical cause, contributing 58% (n=127) and 42% (n=95) had fistula after gyanaecological surgery. The age ranged from 15 to 65 years. Most of the patients had fistula of type 1a, contributing 38% (n=84) and only 0.01% (n=3) of type 3c and 4b according to Goh’s classification. Hundred (78.7%) cases of obstetric fistula patients were dry and continent after surgery, whereas 95(89.4%) cases of fistula after gynecological surgery were successfully repaired. Eighteen patients with obstetric fistula and 6 patients with fistula after gynecological surgery had failed repair.
Conclusions: Our study showed obstructed and prolonged labor was the major cause of obstetric fistula, but fistula resulting after gynecological surgery should not be overlooked.
Keywords: fistula, iatrogenic, labour
Translation of Data into Action: Exploring Data Documentation process and further Scope for Improvement in Bangladesh
Authors: Biswas Animesh , Purno Nabila Hossain , Doraiswamy Sathyanarayanan 
Published: June 2019

Aims: This study done to explore the data documentation process of fistula in the facilities and scope to improve.
Methods: In-depth reviews of patents data recoding forms of six selected facilities were performed. Of them, three were government and remaining were private facilities. The study also explored the process of data documentation, reporting in the DHIS-2.
Results: All centers are keeping records of fistula patients; five of them use structured forms. One government facility uses hospital register book to record the data. There was inconsistency in all six different forms. Therefore, uniform data is not captured. Rehabilitation data is missing in the data records. Government facilities report information on number of cases operated in the DHIS-2. While, private facilities are not under this reporting system. Thus, there are gaps identified in the documentation process and reporting system.
Conclusions: Better data helps for better planning and intervene. Bangladesh is documenting gential fistula patient’s data. However, its demands for improvement. A comphesive and uniform database can help to eliminate fistula in Bangladesh as set target in the 2nd national strategy.
Fistula Champions leading local actions for Ending Fistula in Bangladesh
Authors: Karmakar Aysarjo , Karmakar Anirudha , Huda Sk Nazmul 
Published: June 2019

Aims: To document how fistula champions are contributing to improving maternal health, prevention of female genital fistula in remote villages in Bangladesh and their achievements to date.
Methods: Eight girls grade IX and X from three remote villages of Satkhira district were enrolled in School Girls for Fistula Free Bangladesh. They had four hours orientation workshop on obstetric fistula. They were provided a checklist for community actions for fistula awareness and prevention. The school girls prepared social maps of the villages, identified local resources and institutions for prevention of early marriage and promotion of safe motherhood. Activities included listing all pregnant women in their communities and educating them for pregnancy and labor care.
Results: The school girls identified 54 pregnant women in the villages; these women received 127 ANC visits, 23 deliveries took place in hospitals. There were no incidents of early marriage in the villages. The school girls met the benchmarks to be a fistula champion and were awarded certificates for achievements.
Conclusions: Fistula champions have set up a model for local actions for ending fistula in remote communities.
Management of Genital Fistula in Women with Meyer-Rokitansky-Kuster-Hauser Syndrome
Authors: Jenner Lengmang Sunday 
Published: June 2019

Aims: The study sought to document our experience with management of genital fistula and related symptoms in women with MRKH syndrome.
Methods: This is a retrospective review of women with MRKH syndrome who were treated for genital fistula and related conditions from January 2012 to July 2018. Our Microsoft Access database and operation register were used to locate the folders from which data was extracted. Follow up information was obtained by telephone interview. Data was analysed with SPSS version 17.
Results: The mean age at presentation of the six patients was 21.2 years (SD 4.5). Mean follow-up period was 27.3 months (SD 24.1). One patient presented with infertility; the remaining five presented with genital fistula (two iatrogenic, two gishiri cuts and one sexual trauma). Three fistulae were vesicovaginal and two rectovaginal. All fistulae were successfully repaired. All patients were offered sigmoid neo-vagina as one-stage or two-stage procedure for concerns about penetrative vaginal intercourse. To date, two patients are sexually active during follow-up, and have a pleasing and satisfactory penetrative neo-vaginal sexual experience.
Conclusion: Women and girls with MRKH syndrome present with genital fistula from iatrogenic, harmful cultural practice and sexual trauma. Regardless of presenting complaints of women with MRKH syndrome, they also had concerns regarding penetrative vaginal intercourse. Depending on the mode of presentation, one- stage or two-stage surgical repair was possible and sigmoid neo-vaginal surgery provided a satisfactory penetrative neo-vaginal sexual outcome.
Causes and prevention of Iatrogenic fistula during Gynaecologic Surgery
Authors: Sharma Ashudeep 
Published: June 2019

Pelvic surgery is most common cause of iatrogenic ureteral injury. The incidence of ureteric range from 0.2 to 1% during various gynaecological procedure including laparoscopic surgery. The majority of ureteral injury has no identifiable predisposing factor and occurs more frequently for procedure forbenign lesion. Two third of injury are diagnosed postoperative period. When the injury is recognized intra-operatively, the lesion can be repaired immediately with minimal risk of long term sequelae. Urological injuries to urinary bladder & ureter- uncommon but important. Surgical complications during various obstetric & gynecological open and laparoscopic procedures. One of the important factors is anatomic proximity of ureters & bladder to genital tract. Bladder injuries- most frequent urologic injury. Bladder injuries usually recognized and repaired immediately, and potential complications are typically minor. But ureteral injuries(70%) typically are not recognized immediately & can lead to long term complications. Risk factors are Enlarged uterus, Previous pelvic surgery or radiation, Advanced malignancy Endometriosis, PID ,Pelvic adhesions, distorted pelvic anatomy.
Iatrogenic urologic injuries can be prevented by adequate pre-operative assessment, good surgical technique, and visualization of the bladder & ureters. Anticipation and high index of suspicion, early urological referral, and appropriate investigation of suspected urologic injury is of paramount importance.
Post-operatively they may present with fever, flank pain and tenderness, oligouria, anuria, uremia, ileus, peritonitis, urinary leakage and hematuria depending upon severity of injury. To prevent ureteral injury surgeon must have thorough knowledge of anatomy and location of ureter during various gynaecological procedure and the specific sites where it is most susceptible to injury.
Control of Iatrogenic urogenital fistula in developing country
Authors: Sharma Suman 
Published: June 2019

Urogenital fistula is one major health problem of developing countries. It is an abnormal communication between genital tract (Vagina, Cervix and Uterus) and urinary tract (Bladder, Urethra and Ureter) secondary to obstetrical trauma or iatrogenic insult, causing continuous urinary leakage.
The previous studies shows obstructed labor as main cause of urogenital fistula but recently received an increase number of patients after gynaecological and obstetrical surgeries mainly hysterectomies and C -section. Iatrogenic urogenital fistula is not yet recorded as frequently as in some region such as southern Asia, but is becoming an issue with significant concern for treatment and prevention.Iatrogenic urogenital fistula is an indicator of the health system failing to provide good and quality health care system.
Iatrogenic fistula which is induced inadvertently by a surgeons or diagnostic procedure. There are several regions for iatrogenic urogenital fistula like unsafe surgeries, rising in C-section and hysterectomy surgeries. Iatrogenic urogenital fistula commonly occurs in emergency procedures conducted by the resident/junior registrars or lack of proper surgical training of surgeons performing these surgeries . Sometime it may be due to abnormal surgical anatomy .
Few things we can do to reduce or minimize Iatrogenic urogenital fistula . Firstly safe surgical practices for C-section, hysterectomy and ruptured uterus repair. We must improve training, establish standardized surgical ,anesthesia and obstetric criteria. At least few months rotational training in urology should be mandatory for resident in obstetrics and gynaecology to deal with common complication of bladder, urethra and ureter encounter during gynaecological and obstetrical surgeries. Secondly we must reduce unnecessary surgeries such as C-section and hysterectomy. Finally we must expand access to basic maternal health care. All women have the rights to family planning to space desired birth and quality midwifery services to reduce unnecessary C-section and promote optimal birth outcome.
Contribution of Ad-din Micro-credit program in Fistula Prevention, Case identification and Referral
Authors: Haque Fazlul , Mohiuddin Sheikh , Huda Sk Nazmul 
Published: June 2019

Aims: The objective of this presentation is to describe the practice of fistula case identification, referral and rehabilitation of patients under the Ad-din microcredit program and to share performance data and program experience in this field.
Methods: Using a 4 question checklists developed through the Fistula Care Plus project, Ad-din field workers identify fistula clients from community. Ad-din does a customized rehabilitation need assessment of individual fistula cases then and supports them accordingly.
Results: During this period, 358 cases have been identified with probable fistula symptoms. Diagnosis was confirmed among 169 cases through community fistula diagnosis events. Ad-din facilitated treatment of 153 cases. The program has provided rehabilitation training to 46 cases and livelihood support to 59 cases.
Conclusion: Microcredit networks can be used for community-based fistula case identification, treatment facilitation, case referral and case rehabilitation. If the networks of microcredit systems in many settings are utilized in fistula prevention and care, they could be useful partners to address fistula in any community.
Community Radio Supporting Maternal and Child Health and Preventing obstetric Fistula in an area impacted by climate change
Authors: Shahriar Selim , Al Mahmood Abdullah , Biswas Nitta , Huda Sk Nazmul , Nalta Radio , Satkhira - 
Published: June 2019

Aims: To describe how a community radio station and its allied resources have supported maternal and child health promotion and prevention of fistula in hard to reach and climate change-affected areas in Bangladesh.
Methods: The volunteers and operators of Radio Nalta were provided training on maternal health and fistula communication by a development partner. Information packs were made available through different institutions.
Results: We produced and broadcast public service announcements on maternal health and fistula, integrated maternal health and fistula related messages radio plays and prioritized maternal health and fistula coverage in community radio news. We aired 11 talk shows on fistula, eight in observation to International day to end obstetric fistula. We reached 600,000 people with fistula information.
Conclusions: Community radio can help in reaching out populations in hard to reach areas with information and education for promoting maternal health and prevention of fistula. Coastal areas are impacted by climate change and the community radio can effectively communicate with communities there.