BACKGROUND & OBJECTIVE: Vesicovaginal fistula is one of the common gynecological problems faced by ladies in developing countries on account of certain significant lacunas in the healthcare delivery system and lack of awareness. The purpose of this study is to highlight our experience of primary vesicovaginal fistula repair. METHODOLOGY: It is a cross-sectional experimental study from February 2019 to February 2020. Nineteen consecutive patients having vesicovaginal fistulas up to 3 cm in size, single in number were included in the study while those having fistulas more than 3 cm, involving urethra, bladder neck, and ureteric orifice were excluded. After a detailed history, physical examination, laboratory workup, and cystoscopic examination under anesthesia, the fistulas were repaired. All information was noted on the pre-planned questionnaire for this purpose. RESULTS: There are around 63% of patients having fistula infratrigonal and the rest percentage on the supratrigonal area of the urinary bladder. The risk factor found hysterectomy in 32% of patients, unsupervised home delivery in 16% of patients, C-Section in 12% of patients, delivery by an untrained person in 26% of patients, induced miscarriages in 5% of patients, and other risk factors found in 12% patients. The 68% of patients managed through transabdominal and the rest 32% patients operated through the transvaginal approach. The surgery, either transabdominal or transvaginal, was successfully done in 84% of patients and failed in the rest of 16% of patients. CONCLUSION: Fistulas due to obstetric trauma were mostly preventable. The success of surgical repair was due to health professionals' expertise, the suitable decision about approach, method of repair, proper preoperative evaluation, and careful postoperative management.
The renovation of agro-industrial waste to valuable form such as protein containing food is dire need of world to decrease the agricultural and industrial waste material. Pleurotus pulmonariusis a type of oyster mushroom used generally as protein rich food. Oyster mushroom is commonly used as commercial level for the protein consumption. Peanut (Arachis hypogaea) shells are not easily degradable in the natural environment so mushroom cultivation can easily convert the cellulosic material into protein with less effort and time. Research was conducted on the Pleurotus pulmonaris cultivation by utilizing chiefly peanut shell along with other agricultural wastes such as wheat straw, cotton straw and Paper waste. Cultivation of oyster mushroom was observed on peanut shell substrate by mixing it with cotton waste, wheat straw and paper waste. It was found that the best yield 337.68 g of mushroom was observed when peanut shell was mixed with cotton waste with maximum biological efficiency 33.38%. While the minimum yield 156.58 g was observed when peanut shell alone was used as substrate with minimum biological efficiency 18.21%.
The renovation of agro-industrial waste to valuable form such as protein containing food is dire need of world to decrease the agricultural and industrial waste material. Pleurotus pulmonariusis a type of oyster mushroom used generally as protein rich food. Oyster mushroom is commonly used as commercial level for the protein consumption. Peanut (Arachis hypogaea) shells are not easily degradable in the natural environment so mushroom cultivation can easily convert the cellulosic material into protein with less effort and time. Research was conducted on the Pleurotus pulmonaris cultivation by utilizing chiefly peanut shell along with other agricultural wastes such as wheat straw, cotton straw and Paper waste. Cultivation of oyster mushroom was observed on peanut shell substrate by mixing it with cotton waste, wheat straw and paper waste. It was found that the best yield 337.68 g of mushroom was observed when peanut shell was mixed with cotton waste with maximum biological efficiency 33.38%. While the minimum yield 156.58 g was observed when peanut shell alone was used as substrate with minimum biological efficiency 18.21%.
Objective: To compare two different techniques for ureteric reimplantation for management of Vesicoureteric reflux in children. Study Design: Comparative study. Setting: Department of Pediatric surgery at D. G Khan Medical College Dera Ghazi Khan. Period: January 2010 to April 2021. Material & Methods: Seventy four patients with vesicoureteric reflux were included. Extravesical reimplantation technique was performed in 35 children labeled as Group A , while intravesical reimplantation was performed in 39 children labeled as Group B. Parameters compared between two groups were length of the surgical procedure, average duration of hospital stay, postoperative bladder spasms, significant hematuria >72 h, and long-term complications. Results: The mean age at operation was 6.5 years in Group A and 6.35years in Group B. The mean duration of surgery was significantly less in Group A .i.e 104 min with SD 18 min compared to Group B where mean duration was 128 min; SD 15 min. The mean postoperative stay was significantly lower (P value =0.032) at 4.5 (1.5) days in Group A compared to 6.5 (0.5) days in Group B. Postoperative bladder spasms were significantly lower (P = 0.003) at 1/35 in Group A compared to 35/39 in Group B. Postoperative hematuria was significantly lower (P =0.001) in Group A compared to Group B. Conclusion: Extravesical reimplantation technique has lower operative time, less postoperative discomfort and shorter hospital stay compared to intravesical reimplantation. Both techniques are equally effective in treating reflux.
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