Background: Primary objective of this work was to study the prevalence of voiding and defecatory dysfunction in women with pelvic organ prolapse and correlate the stage and compartment of prolapse with voiding and defecatory dysfunction. The secondary objective was to correlate stage of prolapse with flow rate and post void residue and to study the voiding dysfunction in pelvic organ prolapse.Methods: A prospective observational cohort study in 120 post-menopausal women scheduled for vaginal hysterectomy pelvic floor repair. Short form of pelvic floor distress inventory (PFDI-20) and International prostate symptom questionnaire I-PSS score for Lower urinary tract symptoms (LUTS)was employed.Results: The prevalence of voiding dysfunction in this study was 78% and defecatory dysfunction was 77%. Higher stage of prolapse had significant correlation with voiding dysfunction. (P value was 0.028). Women with posterior compartment defect had more voiding dysfunction with the significant P value (p value was 0.04). Pre-operative voiding dysfunction resolved post operatively in 86%, the p<0.000 which was highly significant.Conclusions: Women with pelvic organ prolapse had high prevalence of voiding and defecatory dysfunction. Stages of prolapse have positive correlation with voiding dysfunction. Pre-operative voiding dysfunction resolved after vaginal hysterectomy and pelvic floor repair.
Background: Neonatal sepsis is a major problem worldwide. Positive blood culture, the diagnostic gold standard is expensive, time consuming and yields result in limited cases. Hence reliable surrogate markers are needed. Aims and Objective: To ascertain haematological parameters which are reliable adjuvants to blood culture for diagnosing Neonatal Sepsis. Materials and Methods: A retrospective observational study was carried over two years in a level 3 NICU among neonates admitted with suspected sepsis. Data on demographics, clinical background, blood laboratory results were extracted from medical records and statistically analysed by multivariate regression analysis to identify surrogate markers for sepsis. Results: Over two years, 182 neonates admitted with Suspected Sepsis were enrolled in the study. In all clinical examination followed by laboratory investigations viz CBP (TLC, ANC, ITR, degenerative changes, platelet count), CRP and blood culture was carried out prior to treatment. A total of 64 (35.2%) were blood culture positive. On multivariable regression analysis, ITR >0.2 [OR 16.3; 95% CI (1.5-176.8), platelet count < 150,000/ml (OR 15; CI, 6.4-35.2) and cytotoxic degenerative changes in neutrophils (OR 4.34; CI, 1.82-10.4), were significantly associated with culture proven neonatal sepsis. ANC<1500/mm 3 showed a trend towards higher culture positivity though statistically insignificant. Conclusions: The study revealed that Immature to total neutrophil ratio >0.2, platelet count< 150,000/ml and cytotoxic degenerative changes in neutrophils were significantly associated with blood culture positive neonatal sepsis. ANC<1500/mm 3 showed a trend towards higher culture positivity though statistically insignificant. These are reliable surrogate markers of Neonatal Sepsis which would enable us to identify and treat the neonate at risk with early antibiotic therapy. Key Messages: 1. Blood culture, the gold standard for diagnosing neonatal sepsis is expensive, time consuming and yields positive results in limited cases. 2. Effective surrogate markers are Immature to total neutrophil ratio (ITR), thrombocytopenia and cytotoxic degenerative changes in neutrophils. 3. These surrogate markers would identify the neonate at risk requiring early antibiotic therapy.
Background: The objective of the present study was to observe the post void residual volume (PVRV) in women with pelvic organ prolapse (POP) pre and postoperatively and to correlate stage of prolapse with lower urinary tract symptoms and quality of life in women with pelvic organ prolapse.Methods: This is a prospective observational cohort study of 100 women with symptomatic pelvic organ prolapse of stage II or greater. Patients were admitted for Vaginal hysterectomy with pelvic floor repair for pelvic organ prolapse in Gynaecology Department at Christian Medical College Hospital, Vellore, India over one year were recruited. This study was approved by the institutional review board and ethical committee of the hospital. Pre- and post-operative PVR were measured. The statistical analysis was done by using SPSS version 21 and P value < 0.05 was considered as statistically significant.Results: In this study 100 patients were recruited and 11% of women had pre-operative high post void residual volume of more than 100 ml. Stages of POP did not correlate with severity of LUTS and QOL. Pre-operative elevated PVR resolved post operatively in 91%, the P value <0.000 which was highly significant.Conclusions: 11% of women had preoperative high PVR. Stages of POP did not correlate with severity of lower urinary tract symptoms (LUTS) and quality of life(QOL). Pre-operative elevated PVR resolved post operatively in 91%, the P value < 0.000 which was highly significant. Majority of the patient with severe pelvic organ prolapse had elevated pre-op PVR which resolved post- operatively after surgical correction.
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