scholarly journals Vesico-Salpingo Fistula Masquerading as Hydrosalpinx with Neurogenic Bladder - An Interesting Case Report

2021 ◽  
Vol 10 (34) ◽  
pp. 2942-2944
Author(s):  
Senthil Kumar Thiagarajan
Keyword(s):  
Developing Countries ◽  
Bladder Neck ◽  
Developed Countries ◽  
Fistula Formation ◽  
Delayed Presentation ◽  
Rare Type ◽  
Obstructed Labour ◽  
Delayed Repair ◽  
Urogenital Fistula ◽  
Adjacent Structures

A fistula is an abnormal connection between two luminal structures of different epithelium. The majority of urological fistulas in developed countries are consequences of iatrogenic injury most commonly laparoscopic hysterectomies, or from radiotherapy in the treatment of pelvic cancers.1 Contrary to this, most obstetric fistulas in developing countries result from obstructed labour during childbirth.2 Common factors that contribute to obstructed labour in developing countries are delayed presentation after trial labour at home, cephalopelvic disproportion and poor nutrition. Due to prolonged compression by head on the pelvic tissues there happens ischemic necrosis of vagina, bladder neck, and urethra3 called obstructed labour complex. Necrosis and fibrotic healing lead to fistula formation with adjacent structures. The vesicovaginal fistula was the most frequent one (78 %) and the common site involved was trigone (51 %) and based on the level it could be a high or low fistula. Others are vesicouterine fistula, vesicourethral fistula, vesicoureteral fistula and rarely vesico-salpingo fistula. During the acute phase of fistula, tissue oedema, hypovascularity, infection, and nonviable tissue hinder proper tissue healing and hence delayed repair is done after 3 months. Recent literature advises early repair for simple fistulas to reduce patient morbidity and delayed repair of complex fistula, multiple fistulas, infected fistulas, post-radiotherapy, fistula due to foreign bodies, immunocompromised patients, hypoproteinaemia patients, urosepsis patients. 4 Fistula repair is preceded by contrast evaluation of ureter and bladder by CT –IVU and cystogram or MRI followed by cystoscopy or retrograde pyelography. Apart from fistula closure, bilateral ureteric implantation may be needed if ureters are close to the fistula. 5 Abdominal hysterectomy is done in uterovesical fistulas. Huge fistulas close to the bladder neck cannot be repaired without compromising continence hence bladder neck closure is done with the Mitrofanoff procedure. 6 A vesico-salpingo fistula is an abnormal epithelial-lined communication between the urinary bladder and the fallopian tube. This rare type of urogenital fistula has only 7 previously published cases in the literature.

scholarly journals Factors affecting the outcome of neonates with anorectal malformation in a developing country

2021 ◽  
Vol 1 (2) ◽  
Author(s):  
Muhammad Umar Nisar ◽  
Asad Iqbal ◽  
Noshela Javed ◽  
Samer Sikander ◽  
Sadia Asmat Burki ◽  
...  
Keyword(s):  
Developing Countries ◽  
Intensive Care ◽  
Birth Weight ◽  
Postoperative Complications ◽  
Low Birth Weight ◽  
Anorectal Malformations ◽  
Developed Countries ◽  
Delayed Presentation ◽  
Contributing Factors ◽  
The Mean

Background: The survival and outcome of neonates with anorectal malformations (ARM) have much improved in the developed countries due to optimal perioperative and postoperative care but in developing countries, sepsis, low birth weight, delayed presentation, and lack of intensive care for neonates are still important in affecting the outcome. This study was carried out to evaluate factors of poor outcome (mortality) in neonates with ARM. Method: This is a prospective analytical study. A total of 44 consecutive neonates with Anorectal malformations (ARM) presenting to the Department of Pediatric Surgery, The Children’s Hospital, Pakistan Institute of Medical Sciences, Islamabad, were included. Variables studied included age at presentation, gender, birth weight, type of malformation, sepsis at presentation, type of surgery performed, postoperative complications, and their relationship to the outcome. The statistical analysis was performed using SPSS version 21. Results: A total of 44 neonates with ARM were included in the study. In the study population, 56.8 % (25) were males and 43.2% (19) were females. The mean age at presentation was 2.1 ± 0.5 days. The mean birth weight was 2.5 ± 0.6 kg. Overall mortality was 29.5% (13) with 13.63% (6) patients died pre-operatively. The most common cause of death in postoperative patients was sepsis (40%). There was a statistically significant relationship between low birth weight (P= <0.01) and sepsis at presentation (P=0.001) with mortality. No statistically significant association was found when the outcome was compared with age at presentation (P=0.21) and postoperative complications (P=0.16). Conclusion: In developing countries, the lack of resources, lack of trained midwives/LHVs, intensive care are contributing factors to sepsis and delayed presentation, and ultimately mortality. Good antenatal care, awareness of the midwives/Lady Health Visitors to refer such patients in time, and provision of adequate intensive care can improve the outcome of surgery in ARMs.

scholarly journals A case series of urogenital fistulas

2017 ◽  
Vol 4 (5) ◽  
pp. 1731
Author(s):  
Dhananjay Selukar ◽  
Amit Narayan Pothare ◽  
Kunal Meshram ◽  
Nikhilesh Jibhkate ◽  
Vinay Rahangdale ◽  
...  
Keyword(s):  
Developing Countries ◽  
Success Rate ◽  
Fistulous Tract ◽  
Case Series ◽  
Developed Countries ◽  
Early Presentation ◽  
Urogenital Fistula ◽  
Duration Of Surgery ◽  
Voiding Pattern ◽  
Repair Attempt

Background: Urogenital fistula is an abnormal fistulous communication that occurs between the bladder and cervix or uterus; between the ureter and vagina, uterus, or cervix; and between the urethra and vagina. Most cases in developing countries are of obstetric etiology, resulting from prolonged neglected obstructed labour, and around 1–2 per 1000 deliveries may be affected. The majority of UGFs in developed countries are a consequence of gynecological surgery, mainly hysterectomies. Present study focuses on the various presentations and the different modalities of surgeries done for cases of urogenital fistulas at our institute.Methods: A total 19 cases of urogenital fistula were studied in detail as per proforma. Two patients were operated on emergency basis because of early presentation in postoperative period. For others a pre-operative waiting period of 3-6 months was followed after development of fistula. During this period initially bilateral DJ stenting was tried in all patients, in hope of spontaneous closure of fistulas. Two patients whose fistulas closed spontaneously are not subjected to surgery. Rest all cases were managed surgically by standard surgical procedures.Results: Study was conducted between, February 2015 to February 2017. A total 19 patients studied. In 2 patients, fistula healed spontaneously while in 17 patients, surgery was needed. Most common age group affected is 2nd decade of life about 47.36%. In our study gynecological surgeries predominate with 57.89% followed by obstetric cases in 26.31%. Most of patients presented with continues dribbling of urine through vagina with normal voiding pattern in about 78.94% of cases. Overall transabdominal procedures had nearly 100% success rate, mainly because of better dissection, visualization and use of vascularized graft which prevents recurrence. 1 recurrence was seen in transvesical extraperitoneal approach because of undiagnosed another fistulous tract. Ureteric reimplantation was 100% successful in ureterogenital fistulas. Vaginal approach with use of Mortius flap had 75% success rate with 1 recurrence because of flap necrosis. Mean duration of surgery was 120 minutes and mean hospital stay was 8 days..Conclusions: Urogenital fistulas are the most distressing complications of obstetric and gynecological surgeries. Obstetric causes predominate in developing countries while gynecological surgeries predominate in developed countries. Despite the good results of surgical repair, attempt should be focused on the prevention of VVF.

scholarly journals Delayed presentation or delayed diagnosis? A retrospective study of prospectively collected data of 482 foot and ankle injury cases

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0043
Author(s):  
Rajiv Shah
Keyword(s):  
Developing Countries ◽  
Delayed Diagnosis ◽  
Developed Countries ◽  
Ankle Injury ◽  
Ankle Injuries ◽  
Common Belief ◽  
Delayed Presentation ◽  
Foot And Ankle ◽  
Orthopaedic Surgeons ◽  
Presentation Group

Category: Trauma Introduction/Purpose: Delayed presentation of injury cases is common in developing countries due to lack of resources as well as lack of awareness. Such cases pose a great management challenge to clinicians. Study aimed to find out every possible responsible factor responsible for delayed presentations would guide towards targeted preventive measures. Foot and ankle orthopaedics being in infancy in developing country like India, foot and ankle injuries do present late. We took up a study to document and analyse the reasons for delayed presentations of foot and ankle injuries. Methods: Retrospective analysis of prospectively collected data from 482 foot and ankle injury cases treated at our three foot and ankle centres over past four years was done. Delayed presentation was defined as cases presenting to us at or after 3 weeks of injury and all these cases formed inclusion criteria. Delayed presenting cases without complete records and cases who were lost to follow up were excluded from this study. Reasons for delayed presentations were charted and further analysed. Results: Ninety eight delayed presenting cases (out of 482 cases) were divided in two groups. First group (28 cases) never got treated by orthopaedic surgeons, was labelled as ‘Direct delayed presentation group’. Second group (72 cases) who got treated by orthopaedic surgeons, but could not be diagnosed initially and presented late was labelled as ‘Indirect delayed presentation group’. Direct group cases initially followed home, quack or family physician’s remedies. Failure to suspect injury (5 cases) and failure to diagnose injury (67 cases) were reason subgroups in indirect group. Failure to diagnose injury was due to failure of clinico-radiological analysis (analytical failure (15 cases)) or due to failure of investigating case further (investigative failure (10 cases)). Forty two cases had combined analytical and investigative failures. Conclusion: In developing countries like India, many patients neglected their foot and ankle injuries and presented late. However clinicians were found to be more responsible for generating indirect delayed presentations by the way of failing to diagnose timely presented injury cases! This is contrary to common belief that in developing countries, patients would be solely responsible for delayed presentations! As delayed diagnosis by clinicians seemed more alarming than delayed presentation by patients, preventive education should also be imparted to clinicians over and above to patients. Study of such a scenario in developed countries would be interesting.

Emerging Nutrition Gaps in a World of Affluence - Micronutrient Intake and Status Globally

2011 ◽  
Vol 81 (4) ◽  
pp. 238-239 ◽  
Author(s):  
Manfred Eggersdorfer ◽  
Paul Walter
Keyword(s):  
Developing Countries ◽  
Human Health ◽  
Old Age ◽  
Molecular Basis ◽  
Health Benefit ◽  
Developed Countries ◽  
Micronutrient Deficiencies ◽  
New Science ◽  
Health And Nutrition ◽  
Micronutrient Intake

Nutrition is important for human health in all stages of life - from conception to old age. Today we know much more about the molecular basis of nutrition. Most importantly, we have learnt that micronutrients, among other factors, interact with genes, and new science is increasingly providing more tools to clarify this interrelation between health and nutrition. Sufficient intake of vitamins is essential to achieve maximum health benefit. It is well established that in developing countries, millions of people still suffer from micronutrient deficiencies. However, it is far less recognized that we face micronutrient insufficiencies also in developed countries.

Country Rankings of Women's Status: An Alternative Index

1995 ◽  
Vol 34 (4III) ◽  
pp. 1025-1039 ◽  
Author(s):  
Yasmeen Mohiuddln
Keyword(s):  
Developing Countries ◽  
Composite Index ◽  
Developed Countries ◽  
Women's Status ◽  
Current Status ◽  
Implicit Assumption ◽  
Women’S Status ◽  
Country Rankings ◽  
Population Crisis ◽  
Status Of Women

The purpose of the present paper is to formulate a composite index of the status of women and to rank both developed and developing countries on the basis of that index. This index is presented as an alternative or complement to the current status of women index, published by the Population Crisis Committee (PCC) and used by the World Bank and the United Nations, which focuses on indicators measuring health, education, employment, marriage and childbearing, and social equality. The paper argues that these indicators have a poverty-bias and measure women's status in terms of structural change rather than in terms of their welfare vis-ii-vis men. The PCC index is also based on the implicit assumption that women's status in developing countries ought to be defined in a similar way as in developed countries, thus including primarily only those indicators which are more relevant for developed countries. To remedy these defects, the paper presents an alternative composite index, hereafter labelled the Alternative Composite (AC) index, based on many more indicators reflecting women's issues in both developed and developing countries. The results of the statistical analysis show that the ranking of countries based on the AC index is significantly different from the PCC index.

International Economic Assistance in the 1970's — A Critique of Partners in Development (Review Article)

1970 ◽  
Vol 10 (4) ◽  
pp. 469-490
Author(s):  
Nurul Islam
Keyword(s):  
Developing Countries ◽  
Foreign Aid ◽  
International Aid ◽  
Developed Countries ◽  
Armed Conflicts ◽  
Economic Assistance ◽  
Self Help ◽  
Service Charge ◽  
The Developed Countries ◽  
Defence Expenditure

Foreign economic aid is at the cross-roads. There is an atmosphere of gloom and disenchantment surrounding international aid in both the developed and developing countries — more so in the former than in the latter. Doubts have grown in the developed countries, especially among the conservatives in these countries, as to the effectiveness of aid in promoting economic development, the wastes and inefficiency involved in the use of aid, the adequacy of self-help on the part of the recipient countries in husbanding and mobilising their own resources for development and the dangers of getting involved, through ex¬tensive foreign-aid operations, in military or diplomatic conflicts. The waning of confidence on the part of the donors in the rationale of foreign aid has been accentuated by an increasing concern with their domestic problems as well as by the occurrence of armed conflicts among the poor, aid-recipient countries strengthened by substantial defence expenditure that diverts resources away from development. The disenchantment on the part of the recipient countries is, on the other hand, associated with the inadequacy of aid, the stop-go nature of its flow in many cases, and the intrusion of noneconomic considerations governing the allocation of aid amongst the recipient countries. There is a reaction in the developing countries against the dependence, political and eco¬nomic, which heavy reliance on foreign aid generates. The threat of the in¬creasing burden of debt-service charge haunts the developing world and brings them back to the donors for renewed assistance and/or debt rescheduling.

IMPACT OF NATIONAL DISASTER COVID-19, INDONESIA TOWARDS ECONOMIC RECESSION

2020 ◽  
Author(s):  
endang naryono
Keyword(s):  
Developing Countries ◽  
Economic Recession ◽  
Developed Countries ◽  
Social Distancing ◽  
Poor Countries ◽  
Corona Virus ◽  
The World ◽  
History Of ◽  
National Disaster

Covid-19 or the corona virus is a virus that has become a disaster and a global humanitarian disaster began in December 2019 in Wuhan province in China, April 2020 the spread of the corona virus has spread throughout the world making the greatest humanitarian disaster in the history of human civilization after the war world II, Already tens of thousands of people have died, millions of people have been infected with the conona virus from poor countries, developing countries to developed countries overwhelmed by this virus outbreak. Increasingly, the spread follows a series of measurements while patients who recover recover from a series of counts so that this epidemic becomes a very frightening disaster plus there is no drug or vaccine for this corona virus yet found, so that all countries implement strategies to reduce this spread from social distancing, phycal distancing to with a city or country lockdown.

A Decade of the World Trade Organization and the Trade Performance of Muslim Countries

2010 ◽  
Vol 27 (4) ◽  
pp. 23-44
Author(s):  
Ruzita Mohd. Amin
Keyword(s):  
Developing Countries ◽  
World Trade Organization ◽  
World Trade ◽  
Developed Countries ◽  
Playing Field ◽  
Muslim Countries ◽  
The World ◽  
The Developed Countries ◽  
Merchandise Trade ◽  
Wto Agreements

The World Trade Organization (WTO), established on 1 January 1995 as a successor to the General Agreement on Tariffs and Trade (GATT), has played an important role in promoting global free trade. The implementation of its agreements, however, has not been smooth and easy. In fact this has been particularly difficult for developing countries, since they are expected to be on a level playing field with the developed countries. After more than a decade of existence, it is worth looking at the WTO’s impact on developing countries, particularly Muslim countries. This paper focuses mainly on the performance of merchandise trade of Muslim countries after they joined the WTO. I first analyze their participation in world merchandise trade and highlight their trade characteristics in general. This is then followed by a short discussion on the implications of WTO agreements on Muslim countries and some recommendations on how to face this challenge.

The cost implication of primary prevention in the HOPE 3 trial

2019 ◽  
Vol 5 (3) ◽  
pp. 266-271
Author(s):  
Andre Lamy ◽  
Eva Lonn ◽  
Wesley Tong ◽  
Balakumar Swaminathan ◽  
Hyejung Jung ◽  
...  
Keyword(s):  
Developing Countries ◽  
Primary Prevention ◽  
Cost Saving ◽  
Developed Countries ◽  
Sensitivity Analyses ◽  
Clinical Trial Registration ◽  
Pressure Lowering ◽  
The Cost ◽  
Care Costs ◽  
Country Specific

Abstract Aims The Heart Outcomes Prevention Evaluation-3 (HOPE-3) found that rosuvastatin alone or with candesartan and hydrochlorothiazide (HCT) (in a subgroup with hypertension) significantly lowered cardiovascular events compared with placebo in 12 705 individuals from 21 countries at intermediate risk and without cardiovascular disease. We assessed the costs implications of implementation in primary prevention in countries at different economic levels. Methods and results Hospitalizations, procedures, study and non-study medications were documented. We applied country-specific costs to the healthcare resources consumed for each patient. We calculated the average cost per patient in US dollars for the duration of the study (5.6 years). Sensitivity analyses were also performed with cheapest equivalent substitutes. The combination of rosuvastatin with candesartan/HCT reduced total costs and was a cost-saving strategy in United States, Canada, Europe, and Australia. In contrast, the treatments were more expensive in developing countries even when cheapest equivalent substitutes were used. After adjustment for gross domestic product (GDP), the costs of cheapest equivalent substitutes in proportion to the health care costs were higher in developing countries in comparison to developed countries. Conclusion Rosuvastatin and candesartan/HCT in primary prevention is a cost-saving approach in developed countries, but not in developing countries as both drugs and their cheapest equivalent substitutes are relatively more expensive despite adjustment by GDP. Reductions in costs of these drugs in developing countries are essential to make statins and blood pressure lowering drugs affordable and ensure their use. Clinical trial registration HOPE-3 ClinicalTrials.gov number, NCT00468923.

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