Background: Surgical site wound infection (SSI) imposes a great challenge worldwide. It is the third most commonly reported nosocomial infection. The objective of the study was to assess the frequency of postoperative wound infections in a newly developed health organization.Material and Methods: This cross-sectional study was conducted from June 2017 to May 2018 in Bakhtawar General Hospital, Jamshoro. A total of 364 cases of surgery, from Obstetrics and Gynecology and General Surgery department were included. Surgical interventions involving an incision were assessed. Infection (SSI) rate was noticed and data was analyzed by SPSS version 18.Results: Healthy discharge rate was 97%. The overall surgical site wound infection rate was 3.1%. These infections were high in genitourinary surgeries (9.09%). Among Obstetrics & Gynecology surgeries, maximum number of SSIs were reported in cases of emergency Lower Segment Cesarean Section (LSCS).Conclusions: The overall rate of SSI for different types of surgeries performed at Bakhtawar General Hospital, Jamshoro was only 3.1%. Frequency of SSI was highest in genitourinary surgeries followed by gastrointestinal and obstetrics and gynecology surgeries, respectively.Key words: General Surgery, Genitourinary surgery, Obstetrics & Gynecology surgery, Post-operative wound contamination
Objective: To find out the prevalence of antibodies against cytomegalovirus and their association with adverse pregnancy outcome in women, at Isra University Hospital Hyderabad. Study Design: Cross-sectional study. Place and Duration of Study: Department of Gynaecology & Obstetrics, Isra University Hospital (IUH) Hyderabad, from Jan to Jun 2018. Methodology: Cytomegalovirus IgM and IgG antibodies in 305 women of reproductive age group were measured using the Enzyme Linked Fluorescent Assaysystem kit. Results: The combined positivity of anti cytomegalovirus IgG and IgM antibodies was 93 (30.40%). About 37 (37.37%) and 28 (34.14%) women were found to be seropositive for cytomegalovirus antibodies who had history of spontaneous miscarriage and recurrent miscarriages respectively. Conclusion: Higher association of seropositivity for cytomegalovirus IgM and IgG with bad obstetrical history and low economy was found.
Objective: To determine the variable clinical presentation of Poly cystic ovarianSyndrome (PCOS) & its association with Hyperinsulinaemia in young adolescent girls. Patients& Methods: A descriptive study was conducted for one year from February 2009-2010 at IsraUniversity Hospital Hyderabad (IUH). 136 adolescent girls who came in OPD with suspectedfeatures of polycystic ovarian syndrome were recruited. Biochemical test, ultrasound of pelvisand test to determine hyperinsulinemia were done .woman having preexisting ovarian pathologywere excluded. All results were analyzed on statistical software SPSS version 16. Frequenciesand percentages were calculated. Result: Insulin resistance significantly increased (43.4 %)in girls who have shown the features of PCOS. Weight gain observed in 69 (50.7 % - Obese)and 40(29.4%- very obese) of girls respectively. Different types of menstrual irregularities suchas oligomenorrhea 50(36.8%), secondary amenorrhea 28 (20.6%) primary amenorrhea 5(3.7%) were observed. 53(39.0%) adolescent girls had normal cycle but evidence of PCO onultrasound. Infertility was found in 32 (23.5%) of participant followed by hirsutism& acne in 59(43.4%) 45 (33.1%) of woman respectively. Conclusions: There is significant association ofPCOS with hyperinsulinemia. Hyperinsulinemia if persist can lead to metabolic syndrome withits serious sequelae .Steps should be taken for early recognition of PCOS in young woman
Objective: To assess, the type of obstetrics and gynaecological cases referred to tertiary care hospitals.Study Design: Descriptive cross-sectional study.Place and Duration of Study: The study was carried out at the Department of Obstetrics and Gynecology Unit 2 of Isra University Hospital Hyderabad, Pakistan from May 2022 to July 2022.Materials and Methods: The patients who were referred to the Department of Obstetrics and GynaecologyUnit 2 at Isra University Hospital during the study duration from various primary, secondary, tertiary, andprivate hospitals for any obstetric or gynaecological emergency were the primary source of data. Theconfidentiality of each patient was carefully respected. This study evaluated the prevalence of various obstetricand gynaecological conditions for which patients were usually referred to Isra University Hospital within thestudy duration as well as the management options provided to these patients.Results: The bulk of referrals (71%) were for gynaecological cases, according to the results of our study. Patients under 20 years of age comprised 31% of the total. The majority of patients (20%) were multipara and in their third trimester (18%). Vesicovaginal fistula (VVF) was the most common gynaecological reason for referral(27%) and the least were ectopic pregnancy and UV prolapse 9% each. Placenta previa (13%), was the mostcommon obstetric referral in our study and at least 2% were placental abruption, preterm labour, and preeclampsia. Furthermore, 24% of VVF patients were successfully managed transvaginal while only 4% weremanaged transabdominal. All gynaecological malignancies were treated with total abdominal hysterectomywith bilateral salpingo-oophorectomy and omentectomy. Laparotomies were done for ectopic pregnanciesand 5 patients of UV Prolapse underwent vaginal hysterectomy whereas only 1 had pessary insertion. Amongstobstetric cases 7% cases of placenta previa/accreta had Cesarean section, 4% had Cesarean section along withbladder repair and 2% of cases necessitated myometrial excision. Compression sutures were the mostfrequently used form of treatment (5%) for postpartum hemorrhage patients, followed by hysterectomy (4%)and medical management (2%). Preterm labour was monitored, whereas placental abruption and preeclampsiarequired caesarean procedures.Conclusion: The majority of patients both gynaecological and obstetric referred to Isra Tertiary Care Hospitalthroughout a 3 months period had either an urgent need for treatment or a serious condition that necessitateda specialist's expertise and the availability of the appropriate resources. Therefore, it can be concluded thatthere is a critical need to upgrade our health system infrastructure, particularly in the area of maternal and child health care, in order to make it simple to provide timely and appropriate management to a variety of health conditions and lower the likelihood of any mishaps involving the mother or the fetus. Additionally, this will also benefit patients by avoiding unnecessary travel from distant regions and helps reduce the burden on tertiary care health system.
ABSTRACT… Background: Genitourinary fistula remains a major cause of morbidity worldwide. Approximately 2 million of women suffer from urinary leakage. Since the establishment of Genito urinary Fistula center at Isra University Hospital -Hyderabad Sindh. We are able to share our experience of fistulous women at the time of admission and at follow up visit. Objectives: To determine the different types of urinary incontinence in a woman after genitourinary fistula repair. Study Design: A Follow-up Descriptive study. Study Setting: This Study was done at Fistula center Isra University Hospital Hyderabad GU -11 from January 2011 to December 2013. All the women who were admitted with true incontinence followed by Obstetrical and major gynecological surgeries were included. However women with stress incontinence and urge incontinence and women who are not willing to include in the study were excluded. Result: Out of one hundred and ten (110) women included in this study, 59 (53.6%) were found to have obstetrical fistula, while 43 (39%) were suffering from Iatrogenic fistula. Continence status were explored at follow up visit. Out of 110 women, 108 (98.18%) & 96 (87.27 %) were having no signs of incontinence on examination at first visit and after six week and second visit after three month respectively. Only 7 % women fell into incontinence grade 2 at six week follow up and only one percent had persistent symptoms of stress incontinence at 3 month respectively. Women fall on incontinence grade 3, 4 and 5 were completely cured at 3 month. Conclusion: Success rate of genitor-urinary fistula repair is 98 %. Majority of women (96 %) on short term follow up at 6 weeks showed improved urinary symptoms. Moreover on follow up visit at 3 months, these women reported improved quality of life and social reintegration after fistula closure. Key words:Genito urinary fistula. Vesico vaginal fistula. Follow up. Article Citation: Amna A, Nadeem F, Srichand P. Urinary incontinence; postoperative evaluation in women after successful genitourinary fistula repair. Professional Med J 2017;24(6):824-827.
Background: Genitourinary fistula remains a major cause of morbidity worldwide.Approximately 2 million of women suffer from urinary leakage. Since the establishment ofGenito urinary Fistula center at Isra University Hospital –Hyderabad Sindh. We are able to shareour experience of fistulous women at the time of admission and at follow up visit. Objectives:To determine the different types of urinary incontinence in a woman after genitourinary fistularepair. Study Design: A Follow-up Descriptive study. Study Setting: This Study was done atFistula center Isra University Hospital Hyderabad GU – 11 from January 2011 to December2013. All the women who were admitted with true incontinence followed by Obstetrical andmajor gynecological surgeries were included. However women with stress incontinence andurge incontinence and women who are not willing to include in the study were excluded.Result: Out of one hundred and ten (110) women included in this study, 59 (53.6%) were foundto have obstetrical fistula, while 43 (39%) were suffering from Iatrogenic fistula. Continencestatus were explored at follow up visit. Out of 110 women, 108 (98.18%) & 96 (87.27 %) werehaving no signs of incontinence on examination at first visit and after six week and secondvisit after three month respectively. Only 7 % women fell into incontinence grade 2 at six weekfollow up and only one percent had persistent symptoms of stress incontinence at 3 monthrespectively. Women fall on incontinence grade 3, 4 and 5 were completely cured at 3 month.Conclusion: Success rate of genitor- urinary fistula repair is 98 %. Majority of women (96 %)on short term follow up at 6 weeks showed improved urinary symptoms. Moreover on follow upvisit at 3 months, these women reported improved quality of life and social reintegration afterfistula closure.
Hypertension has been recognized as a global health concern. In developing countries, it is not addressed and described to the extent that the actual prevalence of the disease makes it necessary. In these countries, control of blood pressure (BP) remains suboptimal. Worldwide BP reduction is a serious issue, and the situation is more alarming situation in our country. Pakistan is one of them, more than 46% of the Pakistani population are hypertensive. In 2010, hypertension was the leading cause of death and disability worldwide, and a greater contributor to events in women. South Asia contributes 24% of world population and is undergoing a rapid epidemiological transition with significant rates of hypertension in different countries. The prevalence of hypertension in low socioeconomic population in Pakistan is 39% in women vs. 37% in men. There is no proper data regarding hypertension in women in Pakistan, except for a few populations based surveys conducted which showed the prevalence of hypertension. The pooled prevalence in Pakistani women is 24.76% vs. 24.9% for men for an age bracket of above 40 years. The occurrence is higher in urban compared to rural areas. General practitioners (GP) in Pakistan underdiagnose and undertreat high BP, especially in the elderly women. Only in 37% of patients, the treatment was initiated by a GP. 23% of this group received only sedatives alone or combination of sedatives and hypertension control medication. We lack published guidelines regarding hypertension. Hypertension still remains the major preventable cause of cardiovascular disease. Hypertension is a leading cause of mortality globally, and especially in our continent. The purpose of these guidelines is to highlight the neglected population (i.e., Women) of Pakistan, who are physically and hormonally different from men. They have more complications as a result of hypertension. Early diagnosis and proper treatment and adherence to the treatment is therefore important. The task of developing guideline on hypertension is by Go Red Chairperson and Scientific Council Pakistan in collaboration with Pakistan cardiac society. This is first clinical practice guidelines for management of hypertension which is a need of our time with the objective to control the epidemic of hypertension in women. This scientific document on hypertension in women with local recommendation which are made local studies and randomized trials and south Asian studies. These educational tool help the health care providers GP and doctors because all see the women in theirs practice and using this guideline facilitate them for treatment because specially in elderly women usually received only sedative alone or in combination with antihypertensive medicines by GPS. Our efforts will encourage GPs and medical practitioners to practice these guidelines in their clinical judgment about risk and complications, as well as in the determination and implementation of preventive, diagnostic or therapeutic medical strategies for control of hypertension. What is new in this guideline is that we focused on treatment of hypertension according to our circumstance as women have limited access to health care and are undertreated. That is the reasons why more women develop complications of hypertension as delay in diagnosis, initiation of recommended treatment and the control is only in 50% in women. These guidelines focused on risk factors and complication throughout the life cycle of women. Lifestyle management should be started in adolescent and more focus should be given to adherence to treatment. This is crucial for control of hypertension. New topics like management of hypertension in chronic kidney diseases is added. Recommendation-based treatment should be started in such cases. The initiation of widespread and intensive continuing medical education for all physicians involved in the management of women patients with hypertension will be the main benefit from this guideline.
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