Background:Although gracilis muscle transposition for faecal incontinence has been well-described method, its literature for use in obstetric perineal tear without colostomy is sparse. In this study, we have tried to analyse its use in fourth-degree obstetric perineal tears.Patients and Methods:A total of 30 patients with recto-vaginal fistula with faecal incontinence secondary to obstetric perineal tear were retrospectively studied between February 2003 and May 2014. The recto-vaginal fistula was explored, dissected and identification of sphincters was done using muscle stimulator. Fistula closure was done followed by sphincter repair, vaginal tightening procedure and single gracilis transposition. None of the patients had covering colostomy. Faecal incontinence was assessed pre- and post-operatively by digital rectal examination (single examiner), Park's score and Corman's score in all cases and using barium hold and transperineal ultrasonography, manometric studies in a few cases. The outcome was measured at an average follow-up of 8.8 months (7–24 months).Results:As per Park's score 26 patients had Grade I continence, two had Grade II and two patients had Grade III continence. Corman's score improved from fair to excellent in 26 patients. The patients in whom manometry was performed showed a remarkable rise in both resting and squeeze pressures. Two patients developed post-operative infections in upper 1/3 thigh incision site and three patients at gluteal region scar site.Conclusion:Satisfactory continence following gracilis muscle could be achieved.
BackgroundSurvival in patients of SLE has improved considerably over the last five decades. However in India, survival rate in SLE patients was reported to be poor. Infections remain a major cause of mortality in patients of SLE. Prospective studies analyzing the risk of infection in SLE patients are scarce.ObjectivesTo study the incidence, type and severity of infection in SLE and their relation to clinical severity of disease and treatment profile.MethodsThis is a prospective controlled study carried out in a single centre at a tertiary care hospital during September 2008 to September 2014. We included 108 patients of SLE fulfilling at least 4 criteria of 1997 revised ACR Criteria and 100 RA patients as non SLE controls.Clinical variables included age, sex, SLE mean disease duration, complement level, anti dsDNA level, presence of nephritis and other features of disease activity.The patients reported any symptoms of infection in outpatient clinic, wherein diagnostic protocols were followed to confirm or rule out infection events. Patients were also followed up at three weekly intervals, during which laboratory and clinical evaluation to detect infections were done. The clinical and lab tests as well as treatment received were recorded.Infections were confirmed by positive cultures and/or supportive clinical and radiological features. Where cultures were not available, infections were confirmed by response to antibiotic therapy.Infections in SLE patients were compared with the control group of population that is RA. Risk factors such as disease activity (using mean SLEDAI score), presence of lupus nephritis, presence or absence of leucopenia, complement levels, average daily dose of prednisolone, mean duration of disease, use of cyclophosphomide, mycophenolate moefetil and azathioprine were noted for all the patients.ResultsSLE Group comprised of 108 patients (102 females, 6 males). RA cohort patients consisted of 100 patients (92 females, 8 males). Mean follow up duration of SLE pateints was 22±10 months and 20±12 months in control. 55 patients of SLE suffered at least one infection (50.92%) (p<0.001) (RR- 4.38) versus 12 (12.0%) in controls. 91 infections were recorded in these 55 patients. Urinary tract infection (37%), skin and mucous membrane (31.8%). E.coli was the most common organism isolated (30.7%), followed by Candida Albicans (18.7%), Herpes Zoster (14.28%). Tuberculosis was diagnosed in 10.98%. Mean SLEDAI score during infections was 7.3. Renal activity (p<0.001), low complement level, leucopenia (<4000), prednisolone dose >10 mg and immunosuppressive therapy was associated in 55 episodes of infections. Total numbers of deaths were 8, out of which four were due to infection and 4 were due to SLE.ConclusionsThe patients of SLE had an overall increased risk of infections. The numbers of infection episodes in SLE were significantly higher than in controls. The infection rate was higher in patients with high dose of steroids and immunosuppressant therapy. The infections were associated with higher diseas...
Background SLE is a chronic autoimmune disease. Although NP events are well recognized in SLE, there is uncertainty regarding true prevalence of events, their attribution to SLE, their etiology and clinical significance. There are several NP manifestations of SLE other than seizures and psychosis. NP involvement is the indicator of disease severity and important determinant of quality of life in these patients. Objectives (1) To study pattern of NP involvement in patients of SLE and its relation with disease activity; (2) To study the cognitive dysfunction in SLE and its relation to disease activity. Methods This is an observational single center prospective study carried out at a tertiary care hospital from September 2010 to August 2013 in Mumbai. Inclusion criteria – 60 Patients satisfying 4 or more ACR classification criteria for SLE were included. Patients involved in the study were subjected to detailed clinical history and drug history. All patients of SLE who had clinical neurological or psychiatric features were included in this study. The patients' demographic data, findings on general examination, neuro-psychiatric manifestations, results of laboratory investigations and imaging study were recorded. Blood, CSF and urine culture were done in relevant clinical set up. MRI and CT were used for brain imaging for NP event. ANA, dsDNA and anti Cardiolipin antibody were obtained for each patient. Cognitive assessment was done using Addenbroke's Cognitive Examination Scale 2005 (ACER). Patients were assessed under 6 cognitive domains i.e. attention, orientation, memory, verbal fluency, language and visuo-spatial processing. Screening was done for psychiatric symptoms using Brief Psychiatric Rating Scale. Symptom severity score for each symptom was done ranging from 1 (absence) to 7 (extremely severe). The mean Systemic Lupus Activity Measure (SLAM) score and mean SLICC damage index were determined in these patients. Exclusion criteria – Patients with SLE who had NP manifestations secondary to infections, electrolyte imbalance, metabolic abnormalities or drugs were excluded from study. Results Mean duration of disease in these patients was 20±(6-72) months and that of neurological illness was 15.86 months. Mean SLAM score and SLICC damage index revealed mild disease activity (SLAM 8.33) and minimal cumulative organ damage (SLICC DI 1.83), respectively. Out of 60 patients 30 patients (50%) had at least one NPS and 10 patients (16.67%) had more than one NP event. NP manifestations noted were anxiety, headache, seizures, depression, major psychosis, CVA, demyelination and neuropathy. In patients with Cognitive dysfunction (56.6%), cognitive domains affected were memory (100%), verbal fluency (88%), visuospatial functions (86%), attention and orientation (82%). Conclusions NP syndromes in SLE have varied manifestations ranging from mild headache and anxiety to life threatening cerebrovascular accidents. Cognitive dysfunction is the most common neurological manifestation in patients with SLE, and is also r...
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