Clinical profile of patients undergoing abdominal hysterectomy at a medical college in Nepal

2021 ◽  
Vol 12 (2) ◽  
pp. 6-10
Author(s):  
Mahendra Raj Pandey ◽  
Arnab Ghosh ◽  
Prashant Chaulagain ◽  
Kamal Kandel
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Teaching Hospital ◽  
Rural Areas ◽  
Urban Areas ◽  
Preoperative Diagnosis ◽  
Abdominal Hysterectomy ◽  
The United States ◽  
Duration Of Hospital Stay ◽  
Ovarian Pathology

Background: Hysterectomy, removal of the uterus, is one of the most frequently performed gynecological surgeries, with approximately six hundred thousand women undergoing this procedure annually in the United States. Indications of hysterectomy vary from benign conditions to malignancies of the genital tract. Hysterectomy is also associated with intraoperative and postoperative complications. Aims and Objectives: The aim of the current study was to analyze indications, complications, duration of hospital stay, blood loss during surgery and correlation of preoperative diagnosis with final histopathology report of all abdominal hysterectomies performed at a teaching hospital. Materials and Methods: This study involved all patients who underwent abdominal hysterectomy at Manipal Teaching Hospital, Pokhara, Nepal over a span of 18 months (from 1st January, 2018 to 31st June, 2019). It was a retrospective study. All the patients undergoing abdominal hysterectomy during the study period were taken without any exclusion criteria. Results: There were 101 cases of abdominal hysterectomies performed during the study period. Majority of the patients were from urban areas than rural areas (67.3% vs 32.7%). Mean age of patients undergoing abdominal hysterectomy was 45.48 years with 2 standard deviation (SD) of 8.75. The youngest patient aged 26 years and the eldest aged 67 years. Mean parity was 2.50 with 2 SD of 1.197. Majority of the patients presented with pain abdomen (49.5%) and menstrual disorders (38.6%). The most common indication for hysterectomy was uterine fibroids (51.5%) followed by ovarian pathology (16.8%). The histopathology report of the patients showed that majority of the patients had fibroid uterus (51.4%) and ovarian pathology (16.8%). Mean intraoperative blood loss was 239.60 ml with 2 SD of 197.144. Mean hospital stay was: 7.29 days with 2SD of 3.144. The maximum hospital stay was 18 days in two patients and most patients had hospital stay between 5 to 8 days. The commonest complication was surgical site infection (9.9%) needing resuturing followed by urinary tract infection (7.9%). Conclusion: Wide spectrums of lesions were encountered during the surgery. The preoperative diagnosis, duration of hospital stay, average blood loss, surgical complications and histopathological reports correlated with various others studies.

scholarly journals Comparison between Laparoscopic Hysterectomy and Abdominal Hysterectomy

2014 ◽  
Vol 9 (1) ◽  
pp. 26-28
Author(s):  
R Shrestha ◽  
LH Yu
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Laparoscopic Hysterectomy ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Total Laparoscopic Hysterectomy ◽  
Short Hospital Stay ◽  
Early Recovery ◽  
Duration Of Hospital Stay ◽  
Operative Recovery

Aims: Hysterectomy can be performed by abdominal, vaginal and laparoscopic methods. Laparoscopic hysterectomy has been reported as an alternative to traditional abdominal hysterectomy with benefit of early recovery, short hospital stay and less operative complications. This study compared laparoscopic versus abdominal hysterectomy in terms of surgery time, blood loss, post-operative recovery, and duration of hospital stay. Methods: This is a retrospective comparative study among sixty patients who underwent laparoscopic or abdominal hysterectomy for various indications in the Department of Obstetrics and Gynaecology of the Third affiliated hospital of Zhengzhou University from January to March 2007. The data of the patients meeting the set criteria were obtained from the hospital records and hospital based computerized coding system. Enrolled cases were divided in two groups with thirty in each arm. Group TLH (total laparoscopic hysterectomy) was designated for patients who underwent total laparoscopic hysterectomy and group TAH (total abdominal hysterectomy) for those who underwent total abdominal hysterectomy. Results: There was comparatively less blood loss in TLH group (60.2±5.17 ml versus 75.7±7.12 ml) but it was statistically insignificant (p=0.12). The laparoscopic hysterectomy took longer time (107.6±32.4 min versus 74.9±31.1 min) than the abdominal (p<0.001). There was early recovery among TLH group 1.6±0.6 days versus 2.1±0.5 days in TAH group (p=0.001). Mean duration of hospital stay was significantly shorter in TLH group 7.6±1.9 days versus 10.1±2.1 days in TAH group (p<0.001). Conclusions: Laparoscopic hyserectomy is an effective alternative to abdominal hysterectomy with the advantage of less intra-operative blood loss, fast recovery and short hospital stay. DOI: http://dx.doi.org/10.3126/njog.v9i1.11183 NJOG 2014 Jan-Jun; 2(1):26-28

scholarly journals Comparison of morbidity associated with non-descent vaginal hysterectomy and total abdominal hysterectomy

2018 ◽  
Vol 7 (4) ◽  
pp. 1554
Author(s):  
Ranjita Ghadei ◽  
Gupteswar Mishra
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Vaginal Hysterectomy ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Intraoperative Blood Loss ◽  
Duration Of Hospital Stay ◽  
Duration Of Surgery ◽  
Stay Time ◽  
Normal Work

Background: In the present scenario of importance non-invasive surgery, there is increase in interest and requirement of vaginal hysterectomy for non-prolapsed uterus, i.e. non-descent vaginal hysterectomy (NDVH) due to its scarless surgery. it has much more advantages than that of abdominal hysterectomy in term of cosmesis, lesser duration of surgery, lesser intraoperative complication, lesser post-operative morbidity and early resumption to work. The aim of the present study is to asses and compare various factors like duration of surgery, intraoperative blood loss, intraoperative and postoperative complication postoperative morbidities, pain perception on 3rd post-operative day, post-operative ambulation, duration of hospital stay, time taken to resume normal work, follow up complains and afterall to decide the appropriate route of hysterectomy for benign conditions.Methods: Hundreds of patients were selected as per the criteria. They were divided into two groups NDVH (non-descent vaginal hysterectomy) and TAH (total abdominal hysterectomy) according to the inclusion criteria. Above mentioned factors are compared between the two groups.Results: Duration of surgery, intraoperative blood loss, intraoperative complications, post-operative morbidities and complications, duration of hospital stay, time required to resume normal work are less in NDVH group.Conclusions: Non-descent vaginal hysterectomy is a better alternative to abdominal hysterectomy for benign conditions.

An Epidemiological, Diagnostic and Therapeutic Study of Giardia lamblia in Anbar Province – Iraq

2019 ◽  
Vol 9 (01) ◽  
pp. 39-45
Author(s):  
Suad Shallal Shahatha
Keyword(s):  
Teaching Hospital ◽  
Rural Areas ◽  
Giardia Lamblia ◽  
Urban Areas ◽  
Culture Media ◽  
Age Groups ◽  
Stool Samples ◽  
Women And Children ◽  
Teucrium Polium L ◽  
Therapeutic Study

This study was carried out to investigate the epidemiology of Giardia lamblia parasites in patients who visited some of the hospitals in Anbar province, which included (Fallujah Teaching Hospital, Ramadi Teaching Hospital, Ramadi Teaching Hospital for Women and Children and Hit Hospital) during by examining 864 stool samples in a direct examination method, The results revealed the infection rate was 41.7 % and the percentage of infection among males 47.8% is higher than that of females 35.4% with significant differences (p≤0.05). The age groups (1-9) years recorded the highest rates 55.4% and the lowest rate 13.6% in the age group (40-49) years. The highest rate of infection was 62.5% during the month of June, while the month of October was the lowest rate 5% and significant differences. The incidence rate in rural areas was 50.6% higher than in the urban areas 32.5%. The study also included the effect of Teucrium polium L. on the parasite in the culture media HSP-1, the concentrations of 0.5-3 mg / mL significantly affected Giardia, it was noted whenever the greater the concentration, the greater the effect during different treatment periods (1-4) days, as the highest concentration 3 mg/ml killed all Giardia parasites on the fourth day of treatment.

The Rural-Urban Continuum of Polarization: Understanding the Geography of the 2018 Midterms

The Forum ◽  
2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Kenneth M. Johnson ◽  
Dante J. Scala
Keyword(s):  
Rural Areas ◽  
Urban Areas ◽  
Metropolitan Areas ◽  
Political Attitudes ◽  
The United States ◽  
Rural America ◽  
Rural Regions ◽  
Urban America ◽  
Urban And Rural Areas ◽  
The Continuum

Abstract This study of the 2018 congressional midterms demonstrates how voting patterns and political attitudes vary across a spectrum of urban and rural areas in the United States. Rural America is no more a monolith than is urban America. The rural-urban gradient is better represented by a continuum than a dichotomy. This is evident in the voting results in 2018, just as it was in 2016. We found that the political tipping point lies beyond major metropolitan areas, in the suburban counties of smaller metropolitan areas. Democrats enjoyed even greater success in densely populated urban areas in 2018 than in 2016. Residents of these urban areas display distinctive and consistent social and political attitudes across a range of scales. At the other end of the continuum in remote rural areas, Republican candidates continued to command voter support despite the challenging national political environment. Voters in these rural regions expressed social and political attitudes diametrically opposed to their counterparts in large urban cores.

Housing Finance Reform: Should There Be a Government Guarantee?

2011 ◽  
Vol 01 (04) ◽  
pp. 811-822 ◽  
Author(s):  
Richard K. Green
Keyword(s):  
Rural Areas ◽  
Urban Areas ◽  
The United States ◽  
Economic Stress ◽  
Mortgage Market ◽  
Best Interest ◽  
Finance Reform ◽  
Fixed Rate ◽  
The Great Depression ◽  
The Republic

In 2007 and 2008, the mortgage market failed. It failed in a number of dimensions: Default rates rose to their highest levels since the great depression, and mortgage liquidity ground to a halt. This failure has produced recriminations: Blame has been laid at the feet of borrowers, brokers, lenders, investment banks, investors and government and quasi-government entities that guaranteed mortgages. These recent events have produced an important debate: Whether the U.S. mortgage market requires a federal guarantee in order to best serve consumers, investors and markets. My view is that such a guarantee is necessary. I will divide my argument into four areas: (1) I will argue that the United States has had a history of providing guarantees, either implicit or explicit, regardless of its professed position on the matter. This phenomenon goes back to the origins of the republic. It is in the best interest of the country to acknowledge the existence of such guarantees, and to price them appropriately before, rather than after, they become necessary. (2) I will argue that in times of economic stress, such as now, the absence of government guarantees would lead to an absence of mortgages. (3) I will argue that a purely "private" market would likely not provide a 30 year fixed rate pre-payable mortgage. I think that this is no longer a particularly controversial statement; what is more controversial is whether such a mortgage is necessary — I will argue that it is. (4) I will argue that in the absence of a federal guarantee, the price and quantity of mortgages will vary across geography. In particular, rural areas will have less access to mortgage credit that urban areas, central cities will have less access than suburbs. Condominiums already are treated less favorably than detached houses, and this difference is likely to get larger in the absence of a guarantee.

An Academic-Community Collaboration to Deliver Medication Therapy Management (MTM) Services to Patients Living in Rural Counties of a Southwestern State in the United States

2021 ◽  
pp. 089719002110002
Author(s):  
David Rhys Axon ◽  
Melissa Johnson ◽  
Brittany Abeln ◽  
Stephanie Forbes ◽  
Elizabeth J. Anderson ◽  
...  
Keyword(s):  
Rural Areas ◽  
Urban Areas ◽  
Program Effectiveness ◽  
Small Town ◽  
The United States ◽  
Small Towns ◽  
Academic Community ◽  
Service Needs ◽  
Medication Therapy

Background: Patients living in rural communities often experience pronounced health disparities, have a higher prevalence of diabetes and hypertension, and poorer access to care compared to urban areas. To address these unmet healthcare service needs, an established, academic-based MTM provider created a novel, collaborative program to provide comprehensive, telephonic services to patients living in rural Arizona counties. Objective: This study assessed the program effectiveness and described differences in health process and outcome measures (e.g., clinical outcomes, gaps in care for prescribed medications, medication-related problems) between individuals residing in different rural-urban commuting area (RUCA) groups (urban, micropolitan, and small town) in rural Arizona counties. Methods: Subjects eligible for inclusion were 18 years or older with diabetes and/or hypertension, living in rural Arizona counties. Data were collected on: demographic characteristics, medical conditions, clinical values, gaps in care, medication-related problems (MRPs), and health promotion guidance. Subjects were analyzed using 3 intra-county RUCA levels (i.e., urban, micropolitan, and small town). Results: A total of 384 patients were included from: urban (36.7%), micropolitan (19.3%) and small town (44.0%) areas. Positive trends were observed for clinical values, gaps in care, and MRPs between initial and follow-up consultations. Urban dwellers had significantly lower average SBP values at follow-up than those from small towns (p < 0.05). A total of 192 MRPs were identified; 75.0% were resolved immediately or referred to providers and 16.7% were accepted by prescribers. Conclusion: This academic-community partnership highlights the benefits of innovative collaborative programs, such as this, for individuals living in underserved, rural areas.

scholarly journals Stroke Incidence and Case Fatality According to Rural or Urban Residence

Stroke ◽  
2019 ◽  
Vol 50 (10) ◽  
pp. 2661-2667 ◽  
Author(s):  
Olivier Grimaud ◽  
Yacine Lachkhem ◽  
Fei Gao ◽  
Cindy Padilla ◽  
Mélanie Bertin ◽  
...  
Keyword(s):  
Rural Areas ◽  
Urban Areas ◽  
Healthcare Access ◽  
Case Fatality ◽  
The United States ◽  
Stroke Severity ◽  
Day Case ◽  
Stroke Incidence ◽  
Stroke Registry ◽  
Stroke Type

Background and Purpose— Recent findings suggest that in the United States, stroke incidence is higher in rural than in urban areas. Similar analyses in other high-income countries are scarce with conflicting results. In 2008, the Brest Stroke Registry was started in western France, an area that includes about 366 000 individuals living in various urban and rural settings. Methods— All new patients with stroke included in the Brest Stroke Registry from 2008 to 2013 were classified as residing in town centers, suburbs, isolated towns, or rural areas. Poisson regression was used to analyze stroke incidence and 30-day case fatality variations in the 4 different residence categories. Models with case fatality as outcome were adjusted for age, stroke type, and stroke severity. Results— In total, 3854 incident stroke cases (n=2039 women, 53%) were identified during the study period. Demographic and socio-economic characteristics and primary healthcare access indicators were significantly different among the 4 residence categories. Patterns of risk factors, stroke type, and severity were comparable among residence categories in both sexes. Age-standardized stroke rates varied from 2.90 per thousand (95% CI, 2.59–3.21) in suburbs to 3.35 (95% CI, 2.98–3.73) in rural areas for men, and from 2.14 (95% CI, 2.00–2.28) in town centers to 2.34 (95% CI, 2.12–2.57) in suburbs for women. Regression models suggested that among men, stroke incidence was significantly lower in suburbs than in town centers (incidence rate ratio =0.87; 95% CI, 0.77–0.99). Case fatality risk was comparable across urban categories but lower in rural patients (relative risk versus town centers: 0.76; 95% CI, 0.60–0.96). Conclusions— Stroke incidence was comparable, and the 30-day case fatality only slightly varied in the 4 residence categories despite widely different socio-demographic features covered by the Brest Stroke Registry.

scholarly journals Safety of laparoscopic management of ovarian dermoid cyst

2017 ◽  
Vol 5 (1) ◽  
pp. 18-22
Author(s):  
Nira Singh Shrestha ◽  
Junu Bajracharya ◽  
Rachana Saha
Keyword(s):  
Laparoscopic Surgery ◽  
Hospital Stay ◽  
Dermoid Cyst ◽  
Preoperative Diagnosis ◽  
Laparoscopic Approach ◽  
College Teaching ◽  
Laparoscopic Management ◽  
Duration Of Hospital Stay ◽  
Chemical Peritonitis ◽  
Ovarian Dermoid Cyst

Background: In the recent years, with the advancement of laparoscopic surgery, management of ovarian dermoid cysts is possible with laparoscopic approach. Concerns regarding safety of the procedure has been raised.Objective: To analyze the safety of laparoscopic surgery done for ovarian dermoid cyst at Kathmandu Medical College Teaching Hospital.Methods: This is a descriptive study done from July 2012 to June 2015. All the cases with the diagnosis of ovarian dermoid cyst managed laparoscopically during the study period were enrolled in the study. Thorough history, clinical examination fi nding and diagnostic modalities were noted. Three port laparoscopy was done for the management of dermoid cyst. Thorough peritoneal lavage with warm saline was done at the end of the procedure in the cases with spillage.Variables like preoperative diagnosis, postoperative diagnosis, and type of surgery performed, rate of spillage, features of chemical peritonitis if any and duration of hospital stay were noted and analyzed.Results: Total 52 cases with the preoperative diagnosis of dermoid cyst were managed with laparoscopy during the study period. Of these, only 46 cases (88.46%) were dermoid cyst on laparoscopy. In majority of the cases (45.65%) diagnosis was incidental by Ultrasound scan done for other indications. Cystectomy was performed in 42 cases (91.30%) and in 4 cases (8.69%) oophorectomy was done. Spillage occurred in approximately 89% of the cases but there were no cases of chemical peritonitis. Duration of hospital stay ranged between 2 to 5 days.Conclusion: Laparoscopic management of ovarian dermoid cyst is a safe procedure.Journal of Kathmandu Medical CollegeVol. 5, No. 1, Issue 15, Jan.-Mar., 2016, Page: 18-22

scholarly journals A Comparative evaluation of Non-descent vaginal hysterectomy versus total Abdominal hysterectomy: A hospital based case control study

2019 ◽  
Vol 17 (1) ◽  
pp. 20-22
Author(s):  
Durga BC ◽  
Aseem Sharma ◽  
Binod Mahaseth ◽  
Nirmala Sharma
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Vaginal Hysterectomy ◽  
Operating Time ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Benign Pathology ◽  
Operative Complications ◽  
Control Study ◽  
Post Operative Complications

Background: Hysterectomy is a common surgery performed by gynecologist worldwide. It can be done either by vaginal, abdominal or laparoscopic route. Non decent vaginal hysterectomy (NDVH) is less invasive, less time consuming and scar less surgery. The blood loss during surgery, intra-operative and post-operative complications are less in NDVH compare to TAH (total abdominal hysterectomy). Aim and objective: to compare the clinical outcome between NDVH and TAH. Method: A hospital based prospective study was done at Nepalgunj medical collage Kolhapur between March 2018–March 2019, 60 cases fulfilling selection criteria were selected, 30 cases underwent NDVH next 30 cases underwent TAH. Outcome is measured on the basis of operating time, blood loss during surgery, hospital stay and post-operative complications. Result: The most common indication for hysterectomy was fibroid uterus in both the groups (NDVH and TAH). The operating time, blood loss, hospital stay and post-operative complications were less in NDVH as compare to TAH. Conclusion: NDVH is a choice of surgery over TAH for freely mobile uterus with benign pathology and uterus size less than twelve weeks and without adenexal pathology.

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