bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of clinical course of Acute Biliary and Non-Biliary Pancreatitis
Authors: Bhattarai Abhishek , Devkota Pragya , Kandel Bishu Prasad , Ghimire Bikal , Kansakar Prasan Bir Singh , Bhandari Ramesh Singh , Tamrakar Kishor Kumar , Lakhey Palaswan Joshi , Mishra Parshuram , Singh Yogendra Prasad , Vaidya Pradeep , Singh Keshaw Prasad 
Published: June 2019

Introduction: Incidence of acute pancreatitis (AP) varies in different parts of the world. The published data are mainly based on retrospective analysis of hospital admissions, which show that there are considerable geographical differences in the incidence rate. There are also regional divergences with regard to the etiology, and its impact on morbidity and mortality. Therefore, we compare the clinical course of acute biliary and non-biliary pancreatitis at the Tribhuvan University Teaching Hospital (TUTH) as well as we compare the morbidity and mortality and duration of hospital stay in these groups.
Methods: This prospective study included the patients with a diagnosis of AP over a period of one year. Eighty-five patients with the diagnosis of AP were included in the study. Revised Atlanta classification system (2012) was used to diagnose and define the severity of disease. The occurrence of local and systemic complications, median duration of hospital stay and mortality in AP was studied.
Results: Among 85 patients, 34 patients were females and 51 were males. Among them, 46 patients belonged to the biliary group and 39 belonged to the non-biliary group. Alcohol intake was the major etiology in the non-biliary group (n = 26) and all of them were male. The majority of the gallstone induced AP patients were female (n = 29). Twenty-nine patients developed severe acute pancreatitis (SAP: 16 in biliary and 13 patients in non-biliary group). Complications were mostly seen in SAP. The acute fluid collection was the most common local complication (15 patients in biliary and 15 patients in non-biliary group, p > 0.05) and respiratory failure was the most common systemic complication (18 patients in biliary and 16 patients in non-biliary group, p > 0.05) in both groups. Three patients in biliary group and four patients in non-biliary group died due to multi-organ failure (p > 0.05). There was no statistical significant difference in the median duration of hospital stay in these groups.
Conclusion: Though pathogenesis vary for different etiologies, once the disease process has started, local complications, systemic complications, duration of hospital stay and mortality in AP depends on the severity of the disease irrespective of the etiology.
Preliminary analysis of quality of life (QOL) before and after surgery for female genital fistula. A prospective cohort study
Authors: Saha Stacy , Ambauen-Berger Bea , Munira Shirajum 
Published: June 2019

Aims: To describe the characteristics of women who come for repair of FGF, assess their QOL before & after surgery and estimate factors associated with improved quality of life.
Methods: All women who came to LAMB for FGF repairin 2016 and 2017 were interviewed on admission and called for a follow-up visit 6 months after successful surgery. Sociodemographic, obstetric, and fistula-related information was collected on admission. Health related QOLwasmeasured using the 36-item short form (SF-36), and perception of stigma and discrimination were assessed on admission and at follow-up.
Results: A total of 72 women were included.Mean age was 40.1 years, 49% had no education, and 42% were in the poorest wealth quintile.The mean stigma score (out of 7)went from 3.79 to 1.40 post surgery (p<0.001) and the mean discrimination score (out of 5)went from 2.2 to 0.4 (p<0.001). The mean score for all eight of the general health categories increased significantly after surgery (p<0.01 to 0.001). Poor women started lower but showed evidence of greater improvement in health related QOL compared to richer women (p<0.05)) and some evidence of greater improvement in discrimination (p<0.1). Women with no education had a larger decreasein perceived stigma (p= 0.03) compared to the educated.
Conclusions: Surgery for FGF improves quality of life, with poor women showing greater increase in health related QOL and uneducated women reporting a greater decrease in stigma. Further multivariable analysis is needed to determine which factors remain associated with improved QOL.
Rehabilitation and reintegration of Fistula Clients through Micro credit linked services
Authors: Mohiddin Sheikh , Haque Fazlul , Huda Sk Nazmul 
Published: June 2019

Objectives: To describe the process and performance of reintegration and rehabilitation of women with Fistula through microcredit linked services in north-western region in Bangladesh.
Introduction: Ad-din Social Financing for Community Health Development is a non profit microcredit system established in 1996. The program provides small capital and technical assistance for entrepreneurship development for its members, particularly women from underprivileged communities.
Methods: 56 paramedics linked with Ad-din microcredit system were provided training on fistula case identification, referral, reintegration and rehabilitation. The paramedics identified fistula clients and conducted customized need assessments for their reintegration and rehabilitation services. This included liveihood skills training, financial assistance for fistula clients or their family members and mobilization of local institutions.
Results: Out of 86 fistula clients identified by paramedics, 76 were in need of rehabilitation services and 12 were in need of reintegration support. Only three (4%) were covered by government safety net services. The program provided customized skill training to 43 fistula clients or family members. Three fistula clients were selected for food box drop at their place of residence.
Conclusions: Customized need assessment of reintegration and rehabilitation of fistula clients is effective for sustainable result. The field resources of a micro credit system, which is present in many settings with a fistula burden, can efficiently provide rehabilitation services to fistula clients.
Baseline knowledge of female genital fistula symptoms, causes and treatment among a rural population in Northern Bangladesh
Authors: Saha Stacy , Ambauen-Berger Bea , Munira Shirajum 
Published: June 2019

Aims: To provide baseline information among the general population on knowledge regarding female genital fistula (FGF) prior to media campaigns and diagnostic camps in 30 unions of 8 districts in Northern Bangladesh.
Introduction: The aim of the Bangladesh national strategy is to end fistula by 2030. According to the Maternal Morbidity Validation Study approximately 19,755 women lived with obstetric fistula in 2016. Poor understanding of FGF and how it is treated hinders case finding of those needing treatment.
Methods: The survey was conducted in Kurigram District. Out of a total sample of 500, 380 (76%) were chosen from every 5th household of a randomly selected village on high land and 120 (24%) were all households of two river islands.
Results: The respondents were 83.4% female and 16.6% male. The mean age was 36.2 years of age, ranging from 17 to 85; 58.6% had no formal education and 61% reported a family income of less than Tk 6000/ month. Overall 12% of participants had heard of FGF (‘a condition with leaking of urine and/or feces’), 13% of those living on high land and 7.5% of those living on river islands (p<0.1). 98.2% of respondents could not name any cause of FGF; 90.6% could not name any symptom and only 7 (1.4%) knew that surgery is the only cure.
Conclusions: Knowledge of FGF is low among the public in rural Bangladesh, especially remote areas. Campaigns to disseminate messages on FGF could contribute to case finding of affected women.
Fistula Prevention Awareness
Authors: Siddiqui Sajjad Ahmed 
Published: June 2019

Aim: Genital tract fistula is a known tragedy in Pakistan. We know the causes of this tragedy and we also know the methods to eradicate this curse from the community. Despite the initiative from UNFPA, Islamic Development Bank and other concerned stake holders the government of Pakistan has failed to address the issue and an organized system is not developed to reduced maternal death rate and maternal morbidity in Pakistan. It’s a common practice to exploit the sad situation of victims of fistula and run ghost campaigns to eradicate genital tract fistula from the community.
Methods:In depth analysis on intersections of social inequities in health, polices in Pakistan. The review carried out on the available literature / reports around the theme of women health & rights responsiveness in health systems. This analysis also includes the role and support of the donor agencies working on maternal health in Pakistan.
Results: An overall unfairness prevailing in the healthcare system which is affecting women health resulting a very high maternal mortality ratio (MMR) maternal morbidity like fistula. The health policy is a highly complex phenomenon needs a multi-disciplinary approach to develop public policy that aims to explain the interaction between institutions, interests and ideas in the policy process. Health policies must reflect the specific steps to address the issue of gender based discrimination.
Conclusion: The politics of fistula is serving people to become rich in vested interest group, its providing platform to governments to make their image in front of donor countries. It’s also providing opportunity to people working in donor agencies to get involve in corruption at the cost of poor patients of fistula. Prevention of fistula is ultimate goal to get rid of this morbidity need department of health for provision of basic health facilities specially availability of SBA BUT there is no such policy intervention to produce competent midwives local community level. The existing fistula cases are not treated at district level due to lack of skill of local gynecologists to repair the fistula at district level.
Enhancing primary health care providers’ capacity in screening and referral of women with fistula
Authors: Ndwiga Charity , Sripad Pooja , Odwe George , Warren Charlotte 
Published: June 2019

Aims: To describe PHC providers’ perspectives on the intervention and differences between intervention and comparison districts in PHC providers’ fistula-related capacity.
Methods: At intervention endline, structured interviews were conducted across 50 PHCs in intervention (n=22) and comparison (n=28) districts with 100 providers on their knowledge of fistula screening, counseling and referral, perceived access barriers and experience implementing the intervention.
Results: More than a third of trained providers used the job aid to screen for OF, while 25% used the hotline at least once. Half thought the transportation voucher was the most important intervention component, while 70% selected community agents. Awareness of emergency obstetric care as a prevention strategy was significantly higher in intervention than comparison district (56% v. 16%; p <0.001). A higher proportion of providers in intervention sites recognize and refer women with fistula symptoms (38% v. 26%).
Conclusions: Strengthening PHC provider capacity can improve screening and referral of fistula patients in marginalized areas, reducing barriers to repair.
Human Resource Development for Prevention and Care of Fistula:Experience of University Fistula Center, BSMMU
Authors: Chowdhury Saleha Begum , Huda SkNazmul , Mahmud Sharmeen 
Published: June 2019

Aims: The purpose of this presentation is to share the experience of doctors and nurses training on prevention and care of fistula at University Fistula Center (UFC), BSMMU.
Methods: From June 2016 to June 2018, UFC implemented training for doctors using a FIGO curriculum and for nurses using an EngenderHealth curriculum. The training and performance data have been captured using an aggregated DHIS2 database developed by the Fistula Care Plus (FC+) Project at EngenderHealth, FC+ Safe Surgery Toolkit, and regular narrative reports.
Results: In this period, 11 surgeons were provided with basic and refresher training through four structured courses. Additionally, 16 nurses were provided training and refresher training on fistula nursing.
Conclusions: The multicenter approach for fistula training was found to be helpful in creating more opportunities for hands-on experience and developing partnerships for inter-institutional capacity sharing for fistula services.
Experience of Managing Ureterovaginal Fistulas following Obstetric and Gynecological Surgeries
Authors: Upadhyay Amit Mani , Kunwar Ashok , Shrestha Sanjesh , Pradhan Hema Kumari , Karki Aruna , Dangal Ganesh 
Published: June 2019

Aims: Iatrogenic ureteric injuries leading to fistula are rare but devastating complications of obstetric and gynecological surgeries.The aim of the study is to review the demography of ureterovaginal fistula (UVF) and its surgical outcome in the starting phase of fistula surgery.
Methods: This is a retrospective review of 15 patients of ureterovaginal fistula who were referred to department of Obstetrics and Gynaecology of Kathmandu Model Hospital from Feb 2014 to Sept 2017. The study reviewed the demography, causes and surgical outcome of ureterovaginal fistula (UVF). Ten patients who had complete blind end at the distal ureter undergone Lich-Gregoir extravesicalur enteroneocystostomy. In other 5 patients, guide wire was successfully negotiated beyond the fistula site, however retrograde double J stenting could be done in only 4 patients.
Results: All the patients had distal ureteric injury close to vesicoureteric junction leading to ureterovaginal fistula. Among them, majority were due to post hysterectomy 60% (n=9) followed by obstetrics procedures (caesarean section) 40% (n=6). Fourteen patients (93%) had successful closure of the fistula with complete preservation of renal function till date. Retrograde double J stenting was possible in patients who were referred earlier within two weeks of the onset of injury.
Conclusions: In our short review, iatrogenic injury to the distal ureter during Obstetrics/Gynaecologic surgery was found to be the leading cause for the formation of ureterovaginal fistula. Endoscopic management with ureteric stents is still possible if the patients are referred earlier following primary surgery.
Iatrogenic Genitourinary Fistula: Changing Trends
Authors: Pradhan T , Agrawal A , Regmi MC 
Published: June 2019

Aims: To study the frequency of iatrogenic cause amongst the surgery done for genitourinary fistula and to study the type and cause of iatrogenic genitourinary fistula.
Methods: This is a 5 year retrospective study analyses 73 iatrogenic fistulas from 217 women undergoing surgery for genitourinary fistula repair from year 2013 to 2018 on going. The analysis considers frequency and characteristics of type of fistula.
Results: Out of 217 genitourinary fistula 73(33.6%) were iatrogenic. Vaginal vault fistulas were 54.7% followed by ureteric fistula 32.8%, vesicovaginal fistula 10.9% and there were 2 iatrogenic RVF. The frequency of surgeries for iatrogenic fistula were found to be in increasing trend towards current years and 83.5% of the iatrogenic fistula were found with history of hysterectomy followed by emergency caesarean section 16.4%.
Conclusions: Women undergoing hysterectomy were under risk for iatrogenic fistula. Optimum work environment is important to reduce surgical error during procedures. Operating training should be emphasized on optimal surgical skills, decision making.
Assessment of the aetiology and outcome of fistulae cases (VVF RVF) operated at Shaikh Zaid woman hospital Larkana
Authors: Baloch Rafia , Shaik Shazia , Chandio Fouzia , Qazi Marvi Nisar 
Published: June 2019

Aims: To study etiology of fistula in patient at Shaikh Zaid Women hospital Larkana.
Methods: A cross-sectional Survey was conducted at Gynecology and obstetrics wards of Shaikh Zaid Women hospital Larkana. All patients were admitted in outpatient departments along with emergency department were the part of the study. Sample was collected by universal sample technique. Total sample size was of 49 patients. Detailed history regarding fistula formation and its etiology and duration, examination and related investigation carried out in each and every patient. Young and elderly patients both were included.
Results: 49 patients were selected, who were admitted and registered at the gynecological and obstetrics wards of Shaikh Zaid Women hospital, out of which 38 patients were found having urinary fistula from which 28 patients were having fistula due to obstetric causes while 10 pts were having fistula due to iatrogenic causes. Moreover, 11 patients were having fecal fistula from them 7 were again due to obstetric causes, 1 patient was having congenital fistula and remaining 3 patients were found having fistulas due to malignancy.
Conclusions: Obstetrics fistula is still most common cause of fistula followed by iatrogenic cause. Urinary fistula is more common than fecal fistula.
The medical and psychological morbidity of patients with urogenital fistulae
Authors: Srichand Pushpa 
Published: June 2019

Aims: To analyze the frequency of medical and psychological morbidity of patients with urogenital fistulae. There are many complications related to childbirth and gynaecological surgeries. Urogenital fistula is one of the worst complications. The women suffer from significant medical and psychological morbidity. These issues need to be addressed at every forum.
Methods: A descriptive study was carried out at Liaquat University Hospital and Isra University Hospital Hyderabad Pakistan from 01/06/2007 to 30/06/2018. 520 patients with urogenital fistulae were managed. A pre-designed performa was used to record the details about medical and psycho-social consequences. Data was analyzed, results were described as frequency and percentage.
Results: During the study period 520 confirmed cases of urinary fistulae were managed. Regarding psychological health all (100%) patients had major degree depression. 511 (98%) patients were found socially isolated. 458 (88%) patients were malnourished. 338 (65%) had severe excoriation of vulva, bladder and vaginal calculi were present 25 (4.8%) patients. Majority of the patients were suffered social, verbal and physical abuse.
Conclusions: Patients with urogenital fistulae are not only having the surgical morbidity but they do suffer significant medical and social morbidity. There is a definite need to address these under looked miseries by a devoted fistulae team work in collaboration with social workers, religious leaders and healthcare providers to bring life back to these patients.
Vesico-vaginal fistula post Right radical nephroureterectomy with bladder cuff excision
Authors: Poudel R , Dangal G , Karki A , Pradhan H , Shrestha R , Bhattachan K , Bajracharya N , Tiwari K 
Published: June 2019

Case: 61 years, female presented at KMH OPD with involuntary urinary leakage per vaginum for seven months following Right radical nephreureterectomy with bladder cuff excision for urinary bladder carcinoma at other centre. Dye test was positive. Cystoscopy revealed VVF defect around 2 cm (Goh’s stage 3biii) at right posterior wall of urinary bladder. Ureteric catheter was placed in left ureter and VVF repair was done. Dye test following 14 days of Foley’s catheterization was negative and patient went home dry. We present here a case of successful repair of VVF following Right radical nephreureterectomy with bladder cuff excision.
Key words: dye test, Goh’s stage, pelvic surgeries, urinary tract injuries, vesico-vaginal fistula
Primary menouria due to a congenital Urethrovaginal fistulawith vaginal agenesis
Authors: Razzak Lubna , Rizvi Raheela Mohsin 
Published: June 2019

Case: A female aged 22 years, suffering from cyclical menouria since age of 12 years presented to our clinic with concerns for future sexuality and fertility. Clinical examination revealed the absence of a vagina, although labia minora and majora were adequately developed. Secondary sexual growth such as axillary and pubic hair, breast development was normal. Micturating cystogram shows abnormal fistulous communication between the posterior urethra and upper vagina with contrast outlining the uterine cavity. Magnetic resonance imaging revealed functioning left kidney along with vaginal agenesis and an abnormal communication between uterus and urethra. The surgical treatment included urethrovaginal fistula repair and pull through vaginoplasty. The patient was asymptomatic till her last visit
Conclusions: In this case, the diagnosis of congenital urethrovaginal fistula was delayed until adulthood despite menouria. This is a rare case report and to our best of literature search .we could not find any such case report.
Predictors of Successful Urogenital Fistula Repair and Incidence of Urinary Problems Post Successful Fistula Repair
Authors: Tasnim Nasira , Bangash Kauser , Amin Oreekha , Batool Afshan , Javed Nosheela 
Published: June 2019

Objective: Despite the successful fistula repair many patients may continue to complaint of persistence of symptoms in terms of frequency, urgency, urge incontinence and stress incontinence. To evaluate the association of various predictive factors with the outcome of surgical repair of urogenital fistula and todetermine the incidence and association of urinary problems post successful fistula repair.
Methods: The retrospective analysis was conducted at Maternal Child Health, PIMS, Islamabad. It comprised data related to vesicovaginal fistula repair of patients from January 2008-June 2018. Various modalities were used to determine the underlying cause of these symptoms including patient’s history, examination, ultrasound, urine examination and urodynamic studies.
Results: A total of 364 patients of urogenital fistula repair were reviewed, with an overall success in 318 (87.4%) cases.Primary surgical repair of vesicovaginal (90.0%), vesicouterine (86%), ureteric (100%) & ureterovaginal (98%) were more successful. Success rate was further decreased with the history of >1repair attempt of vesicovaginal (71.4%) & vesicouterine (66.5%) fistula.
Among 318 successful fistulas repair patients, 78 (24.5%) had urinary problems post operatively. Out of these 78, 56.4% had stress incontinence, 41% infection and 2.6% urge incontinence.
Conclusions: Urinary incontinence after fistula repair requires careful evaluation as the successful repair of a urogenital fistula can correct the fistula defect, but it might not make the patient dry.
Implementing physiotherapy services into fistula care at Panzi Hospital, Bukavu, DRC
Authors: Keyser LE , McKinney JL , Mukwege CH , Mukwege D , Kinja Rachel 
Published: June 2019

Aims: To describe implementation of physiotherapy services in the context of fistula care and report early program observations.
Methods: Process evaluation of treatment pathway/protocol implementation and presentation of provider observations of treatment results since January 2016.
Results: Dedicated physician, nursing, social work and physiotherapy staff provide various aspects of rehabilitative care to women with fistula, pre- and post-operatively. Following variations in hospital census, 5-50 women participate in group exercise sessions 2-3x/week. Targeted individual physiotherapy is selectively provided to 1-15 women 1-5x/week. Staffing priorities reflect perceived importance and impact of physiotherapy services. Providers offer clinical observations of program successes, including improved post-surgical functional outcomes, and express interest in further training to cultivate advanced clinical skills.
Conclusions: Early results indicate value of physiotherapy-informed care in a comprehensive approach to fistula care services. Improving and expanding upon these skills may prove equally useful in addressing the physical impairments associated with other reproductive morbidities, such as POP. In the future, systematic use of standardized tools, such as WHODAS 2.0 is recommended, both to quantify the burden of disability in this population, as well as to measure change with therapeutic interventions, including surgery and rehabilitation.