Background. Pelvic organ prolapse (POP) is a condition in which one or more pelvic organs (consisting of the uterus, vaginal cuff, bladder, intestines, and rectum) or more are still in or out of the vagina. Risk factors that influence the incidence of POP consist of obstetric risk factors (number of parity and birth method) and non-obstetric risk factors (age, menopause, BMI, comorbid disease, and hypertension). The purpose of this study was to analyze the risk factors associated with the degree of POP.
Methods. This study is an observational study with a cross-sectional approach to 111 patients examined at the Department of Obstetrics and Gynecology, Dr. Mohammad Hoesin general hospital Palembang on January 2017 to December 2019, who was diagnosed with pelvic organ prolapse.
Results. The results showed the effect of variables with the degree of POP using the chi-square test, consisting of parity (p=0.007), birth method (p=<0.001), age (p=0.016), menopause (p=0.001), BMI (p =0.005), indicates that there is a significant effect on the degree of POP. Meanwhile, comorbid factors (p=0.481) and hypertension (p=0.415) did not show a significant relationship with the degree of POP. The results of the binary logistic regression analysis of all risk factors, the number of parity >4, overweight, and age 40 years, will have a 99.85% chance of experiencing grade 3 or 4 prolapse.
Conclusion. Age is the most dominant risk factor affecting the degree of pelvic organ prolapse, with 19 times the chance of developing POP 3 or 4 degrees.
The retinal blood vessels in humans are major components with different shapes and sizes. The extraction of the blood vessels from the retina is an important step to identify the type or nature of the pattern of the diseases in the retina. Furthermore, the retinal blood vessel was also used for diagnosis, detection, and classification. The most recent solution in this topic is to enable retinal image improvement or enhancement by a convolution filter and Sauvola threshold. In image enhancement, gamma correction is applied before filtering the retinal fundus. After that, the image should be transformed to a gray channel to enhance pictorial clarity using contrast-limited histogram equalization. For filter, this paper combines two convolution filters, namely sharpen and smooth filters. The Sauvola threshold, the morphology, and the medium filter are applied to extract blood vessels from the retinal image. This paper uses DRIVE and STARE datasets. The accuracies of the proposed method are 95.37% for DRIVE with a runtime of 1.77[Formula: see text]s and 95.17% for STARE with 2.05[Formula: see text]s runtime. Based on the result, it concludes that the proposed method is good enough to achieve average calculation parameters of a low time quality, quick, and significant.
Background. Vesicouterine fistula (VUF) is a rare pathological communication between the uterus or cervix and the bladder. Youssef's syndrome is an atypical presentation of a patient with a vesicouterine fistula, characterized by a triad of cyclic hematuria, amenorrhea, and absence of urinary incontinence. Because of this atypical presentation, the patient may go undiagnosed and patient management will be delayed.
Case presentation. A 39-year-old woman complained of hematuria. The patient underwent a second caesarean section in 2008 and a few weeks after the procedure the patient complained of leakage of urine from her vagina. Six months later the patient complained hematuria on her menstrual cycle and amenorrhea, with absence of urinary incontinence. Ultrasound examination found adhesions between the uterus and vagina, and irregular bladder mucosa. Patient underwent cystoscopy with endometriosis were suspected on vesicovaginal repair scars and a bladder biopsy was also performed with the results of no endometrial stroma and glands then followed by hysteroscopy. Hysteroscopy result showed a 20 mm diameter hole with irregular margins. Subsequently, the patient was treated with hysterorrhaphy laparotomy and fistula repair.
Conclusion. One type of vesicouterine fistula is Youssef's syndrome, which is a complication following a lower segment caesarean section with undiagnosed bladder injury. The diagnosis can be confirmed by cystoscopy, intravenous pyelography, hysterosalpingogram, sonography, and other types of imaging tests. Management of patients with VUF can be conservative, medical, or surgical.
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