Fistula In Patients Research Articles

Effect of Acacia catechu and alum hot sitzbath on post-operative pain in patients treated with herbal seton

BackgroundPost-operative pain is the major consequence of Kṣārasūtra, Seton technique employed in Ayurvedic management of Low anal fistula. Surgeons are forced to prescribe Opioids and NSAIDs with pronounced untoward effects. Non pharmacological measures like Balneotherapy are used to improve circulation and relieve spasm in contemporary sciences. AimTo compare the efficacy of Khadira (Acacia catechu) and Sphaṭika (Potash alum) hot sitzbath with plain hot sitzbath in patients of low anal fistula treated with Kṣārasūtra. MethodThe study was single blind, double armed; prospective, randomized control clinical trial in which 30 patients were randomly allocated into two groups of 15 each on the basis of inclusion and exclusion criteria. Group A received hot sitzbath using Acacia catechu and alum infusion twice daily for 21 days. Group B received hot sitzbath using warm water for 21 days. The assessments were made on pain, post-surgical satisfaction burning sensation, tenderness, discharge, constipation, itching and incontinence. ResultThe disease was prevalent in the 4th decade of life, more in males (86.67%) involved in sedentary work (53.33%) residing in urban domicile, consuming mixed diet (100%). Both groups showed statistically significant improvement in outcome measures like pain, burning sensation, tenderness, discharge, constipation and itching. ConclusionOn comparative analysis Acacia and Alum hot sitzbath was more effective in outcomes like pain, surgical satisfaction, burning sensation and discharge. There was no difference in the effect of both interventions with respect to outcome measures like constipation, itching and incontinence.

Epidemiological Aspects of Obstetric Fistula at the Northern Cameroon Lutheran Hospital, Ngaoundéré

Objective: To assess the epidemiological aspects of obstetric fistulas at the Ngaoundere Lutheran Hospital. Methods: We carried out a hospital-based cross sectional analytic study comparing women with fistulas (subjects) and those without the condition (controls). We compared information from 166 files of fistula patients (2013-2016) with those of 269 parous women recruited prospectively (Feb- April 2017). We used a modified pretested questionnaire with information on socio-demographic, clinical and reproductive characteristics. Crude odds ratios (OR) and their 95% CI were obtained after bivariate analysis, to determine the factors that were associated with obstetric fistula. Variables that were statistically significant (p<0.05) were modelled into final logistic regression analysis to determine the independent association. Findings: Variables unequally distributed among the two study populations included socio-demographic characteristics (age, occupation, marital status, region of origin, religion and level of education) as well as clinical ones (age at first childbirth, parity, prenatal care, duration of labour, weight and height), p≤ 0.001. Among women who consulted the gynaecologist / urologist, the prevalence of obstetric fistulas was 2.56% (95CI: 1.98-2.58). Factors independently associated with obstetric fistula status were, illiteracy (53% vs. 47%; A OR:7.2; 95% CI [1.8-28.2]), height 24 hours (71.6% vs. 28.4%; A OR:88.2; 95% CI [21.3- 364]) and the lack of the use of preventive Foley catheter (52.4% vs.47.6%; A OR:1.7; 95% CI [0.4-3.3]). Conclusion: Obstetric fistula is commonly associated with illiteracy, short stature, inadequate prenatal care, prolonged labour and the lack of use of preventive catheter. Funding Statement: The research did not receive any funding for this purpose. Declaration of Interests: The authors state: There is no conflict of interest. Ethics Approval Statement: This was a hospital-based cross sectional unmatched analytic study approved by the Institutional Ethical Board of the Faculty of Health Sciences, University of Buea.

Outcomes After Primary Arterio-venous Fistula Formation for Haemodialysis Access in End Stage Renal Disease: Four Year Follow-up of Patients at a Single Centre in New Zealand. Should we be Prioritising Success Over Vein Conservation in a Population With Short Life Expectancy?

Introduction: Despite many studies reporting fistula patency rates and secondary interventions, few studies report longitudinal patient outcomes after first fistula formation. 23% of NZ haemodialysis patients are patients of Counties Manukau Health1. Many of these patients have a short life expectency due to co-morbidities, particularly in the older age group. The concept of conserving vein for future fistulas is therefore less valid. It is desirable to achieve a successful fistula with the first procedure. We assessed whether a vein conserving approach compromised successful outcome in Counties Manukau patients. Methods: A prospective analysis was undertaken of patients whose first fistula was formed between 1st January 2010 and 31st December 2014 by 2 surgeons at Counties Manukau Health, Auckland, NZ. Data collected included; demographics, dialysis status, fistula usage, reasons for not using the fistula, need for further fistula formation and patient outcome as at December 2018. Patients with prior attempt at fistula formation were excluded. The primary outcome was a successful fistula, defined as being the sole method of dialysis for over 6 months. Secondary outcomes were reasons for fistula failure. Results: Overall, 154 patients met inclusion criteria with ages ranging from 20 to 77 years (median 57) with 58% male. 78% were Maori or Pacific, compared with 59% in the NZ haemodialysis population1. Diabetes (71%) was one of the most prevalent co-morbidities, higher than the NZ haemodialysis population (58%). With respect to fistula formation, 2 patients had PTFE grafts, the rest were autologous vein. Radiocephalic fistulas comprised the majority 109(71%), with 17(16%) failed. There were 38(25%) brachiocephalic fistulas formed, with 14(37%) failed. Follow up for 2 patients could not be completed and all patients had a minimum of 4 years follow up. There were 4 outcome categories: 99(64%) fistulas were used until death, transplant or end of follow-up; 17(11%) were used for 6 or more months (median time to failure of 45 months); 32(21%) failed and had further procedures; and 6(4%) never used the fistula. Of the 17 that were used for over 6 months then failed, 1/3 were due to infection and secondary bleeding and 1/3 due to previously unrecognised central stenosis. 6 of the 32 failed fistulas(19%) were ligated due to steal syndrome all of which were brachiocephalic fistulas.16% of all brachiocephalic fistulas. Conclusion: The cohort of 154 patients had 64% requiring only one fistula formation and 11% had successful usage for a median of 45 months. Rates of infection and bleeding were higher than expected. This was surprising given the majority were autologous veins. There were also high rates of undiagnosed central stenosis indicating a need for central venous imaging preoperatively. Brachiocephalic fistulas had16% (6/38) risk of steal syndrome which could be attributed to the high rates of diabetes in the cohort, increasing the risk of microvascular complications. In summary, the current policy of a vein conserving approach is satisfactory. Moving to a larger more proximal vein is associated with increased risk of complication, in particular, steal syndrome. There is a role for further assessment of distal perfusion in these patients. Disclosure: Nothing to disclose

A Novel Technique for Prevention of Gastroesophageal Reflux in Staged Repair of Long Gap Esophageal Atresia with Tracheoesophageal Fistula.

Aim:The objective of the study is to report a novel technique of preventing gastroesophageal reflux and air leak from fistula to stomach in patients of tracheoesophageal fistula with long gap atresia, to buy time for the staged procedure.Methods:Seven patients of tracheoesophageal fistula with upper pouch of esophagus at 2nd thoracic vertebra were selected for the staged procedure. Weight ranged from 1.7 to 1.8 kg. During the 1st stage surgery for gastrostomy, midline strip of linea alba attached to xiphoid process was harvested and slinged around the gastroesophageal junction, along with right cervical esophagostomy. After radio-nuclear scan, the demonstration of abolition of gastroesophageal reflux, gastrostomy feed was started. The 2nd stage surgery performed after 6 weeks, included mobilization of esophagostomy, release of sling, thoracotomy, and tension-free esophageal anastomosis. Outcome measurement includes (1) prevention of air leak from esophagus into the stomach, (2) abolition of gastroesophageal reflux, (3) ability to start gastrostomy feeds, and (4) reversal of occlusion after release of the sling.Results:The placement of linea alba sling and elevation of gastroesophageal junction, abolished air leak from fistula to stomach in all. Radio nuclear scan demonstrated abolition of gastroesophageal reflux in 6 with weight gain after gastrostomy feeding. One patient expired due to sepsis. One patient underwent final repair with reversal of occlusion with release of the sling.Conclusion:Using a sling of the linea alba around the cardioesophageal junction, prevents gastroesophageal reflux and escape of air from esophagus into the stomach, gives time to improve the respiratory and nutritional status of the patient, for a subsequent safer delayed primary anastomosis.

Rectal Flap Experience in High Transsphincteric Cryptoglandular Anal Fistula

Aim: Despite many treatment modalities, anal fistula disease remains an important problem. High recurrence rates have been reported in the surgical treatment of complicated anal fistulas. We hereby present complicated anal fistula patients treated with rectal advancement flaps. Methods: Patients who underwent rectal advancement flap surgery by a single surgeon between 2009 and 2019 were analyzed in this retrospective cohort study. Demographic data, number of previous operations, recurrence rate and complications were recorded. Results: Twenty patients (15 males and 5 females) underwent surgery with the rectal advancement flap technique. Nine patients had more than one previous operation. Seton, partial fistulectomy and curettage were the most performed operative techniques in their previous surgeries. The mean follow-up period was 31 months (3-74). Among 13 patients with follow up periods longer than 12 months, 3 patients had recurrences (23%), all of which had been previously operated twice or more. Conclusion: Although rectal advancement flap is not the first choice in the treatment of complicated and high transsphincteric fistulas, it still maintains its importance. Experienced surgeons prefer this method due to its sphincter-sparing nature. In our study we detected a recurrence rate of 23% and incontinence rate of 5%, which was thought to be related to previous surgeries.

Predictive Factors for the High Perianal Fistula Recurrence After Placement of Seton

Background: The placement of seton is one of the common sphincter-saving procedures for high fistula-in-ano (FIA). It has been described since Hippocrates who first used horse hair as a seton for the treatment of anal fistula. Objective: The aim of this study is to investigate the predictive factors for recurrence and to evaluate the efficacy and complications of seton treatment for high transsphincteric perianal fistula. Patients and methods: Our study was a prospective study, on a sample size of 50 patients (43 males and 7 females) of high perianal fistula, carried out in Bab-Alsharia University Hospital. Results: In our study 66.7 % of recurrent cases had history of previous fistula surgery. Fecal incontinence was recorded in 3/50 (6%) patients in our study. Factors associated with higher rates of fecal incontinence (FI) after fistula surgery included high transsphincteric or suprasphincteric fistula, horse-shoe fistula, female patients, and patients older than 45 years. Conclusion: Factors that significantly predicted the recurrence of FIA were previous fistula surgery, anterior anal fistula, and presence of secondary tracks or branches as with supralevator extension, and horse-shoe fistula. Female patients and horse-shoe fistula were the significant risk factors for developing FI after the placement of seton.

Thrombophilic risk factors in hemodialysis: Association with early vascular access occlusion and patient survival in long-term follow-up.

ObjectiveThrombophilic risk factors (TRFs) occur rather frequently in hemodialysis (HD) patients. However, little is known about their significance in HD patients, besides their potential impact on arteriovenous (AV) access failure, with varying results. We examined the effects of a wide variety of TRFs on both early AV fistula occlusion and survival among HD patients in long-term follow-up.MethodsIn this single-center, observational study, 70 consecutive HD patients from our dialysis center were examined with respect to shunt occlusion within the first 2 years after fistula creation and patient survival in a long-term follow-up (at least 16 years). We examined the presence of factor V, prothrombin, and MTHFR mutations using real-time fluorescence polymerase chain reaction. Furthermore, antithrombin (AT), protein C, protein S, and antiphospholipid antibodies (APL-Abs) were assessed.ResultsAmong the 70 patients, 32 had MTHFR mutations, 10 had heterozygous factor V Leiden mutations, 4 had prothrombin mutations, 4 had protein S deficiency, 2 had protein C deficiency, 9 had AT deficiency, and 14 had APL-Abs. 40 patients had shunt occlusion. TRFs were associated with a significantly increased risk for shunt thrombosis (P<0.02). Kaplan–Meier analysis with a log-rank test revealed significantly shorter survival in HD patients with TRFs (P<0.02). Cox regression analysis showed that the presence of TRFs (P<0.05; hazard ratio, 1.94; 95% CI: 1.07–3.56), but not early shunt occlusion, was associated with short patient survival.ConclusionsTRFs in hemodialysis patients have a strong impact on patient survival and early AV fistula failure; however, patient survival is not significantly affected by early shunt occlusion.

Visual impairment in high flow and low flow carotid cavernous fistula

Our aim is to study the varied posterior segment manifestations, level of visual impairment (VI) and its causes in carotid cavernous fistula (CCF) patients. A retrospective study was done, wherein data was obtained from 48 digital subtraction angiogram (DSA) proven CCF patients. CCF was classified according to Barrow et al., based on DSA into type A (high flow) and types B, C and D (low flow). High flow CCF was present in 8 (16.7%) and low flow CCF was present in 42 (83.3%). Compared to low flow group, patients in high flow group were younger and had a history of trauma (p < 0.05). Posterior segment findings ranged from familiar stasis retinopathy and optic neuropathy (both, glaucomatous and ischemic) to uncommon findings of central retinal artery occlusion, Terson syndrome and combined retinal and choroidal detachment. Retinal vein dilatation was the most common finding in both groups. The high flow CCF group had 6 (75%) patients that had VI. This was acute in 4 (50%) patients and delayed in 2 (25%). In the low flow group 10 (23.8%) of patients had delayed VI. The identification of “3 point sign” is a novel finding of this study, not described before. While none of three findings (disc hyperaemia, retinal vein dilatation and intra-retinal haemorrhage) in isolation were predictive of visual loss, but when present together results in visual loss. Posterior segment changes were varied, some are uncommon and can occur in various combinations. “3 point sign” must be identified at the earliest to prevent visual impairment. The incidence of VI in CCF patients is high.

Association of Race and Ethnicity with Vascular Access Type Selection and Outcomes

Black patients with end-stage renal disease (ESRD) represent 30.5% of the prevalent ESRD population in the United States, despite only accounting for 18% of the total population. Black patients are less likely to have pre-ESRD care compared with their white counterparts and are 3-4 times more likely to progress from chronic kidney disease to ESRD than whites, suggesting that black patients are particularly vulnerable to disparities in outcomes related to hemodialysis and ESRD. The objective of this study is to examine the association of race with outcomes of hemodialysis access and selection of arteriovenous fistula (AVF) versus arteriovenous graft (AVG). Patients with chronic kidney disease who initiated dialysis through a tunneled hemodialysis catheter (THC) were identified in the Optum's De-identified Clinformatics® Data Mart (OptumInsight, Eden Prairie, MN) claims database (2011-2017). The odds of AVF versus AVG creation and the odds of repeat vascular access creation were analyzed using logistic regression. Time from initial AVF/AVG to THC removal and time to repeat AVF/AVG were analyzed using Cox proportional hazards. About 7,584 vascular access patients met the inclusion criteria: 5,852 (77%) AVF and 1,732 (23%) AVG. Median follow-up was 583days overall (range, 1-2,543), 589days among AVF patients (range, 1-2,543), and 260days among AVG patients (range, 1-2,529). Between races, there was no clinically significant variation in characteristics or comorbidities, with the exception of a much lower rate of obesity among Asians. Black patients had 36% lower odds of AVF index versus AVG index (P<0.001). Patients 70 years or older and patients with diabetes had lower odds of AVF index, whereas men and obese patients had greater odds of receiving AVF. Overall, graft patients were 73% more likely to have a shorter time to THC removal than fistula patients, but Hispanic graft patients were 25% more likely to have a shorter time to THC removal than whites. Patients with diabetes, patients with cardiac arrhythmia, and obesity were more likely to have a longer time to THC removal. About 1,589 (21%) patients underwent a repeat vascular access creation during the follow-up period: 19% of whites (n=802), 26% of blacks (n=483), 19% of Hispanics (n=250), and 19% of Asians (n=54) (P<0.001). Multivariate analysis demonstrated that black patients had 58% greater odds of requiring a second access than white patients (P<0.001). Graft patients, patients 70 years or older, and men had lower odds of repeat access. Black patients were 45% more likely to have a shorter time until second access creation. Graft patients, patients aged 70 years or older, and men were more likely to have a longer time until second access. Patients with obesity were more likely to have a shorter time until second access. This study's findings suggest that after initial vascular access, compared with whites, blacks have no difference in time to index access success, but their access fails earlier and more frequently, independent of access type, age, and comorbidities. Given blacks constitute 30.5% of the hemodialysis population in the United States, it is imperative that future research investigate the root causes of these disparities.

Pull-through technique combined with percutaneous angioplasty for treating high-grade arteriovenous fistula stenosis.

The aim of this study was to investigate the effectiveness of a new pull-through technique through a brachial artery approach combined with angioplasty for the treatment of arteriovenous fistula. In this retrospective study, a total of 56 arteriovenous fistula patients with high-grade stenosis induced by arteriovenous fistula, which was divided into pull-through technique through a brachial artery approach (pull-through group, n = 28) and solely through a venous approach (control group, n = 28), were analyzed. Both groups underwent percutaneous transluminal angioplasty treatments simultaneously. The success rate of the pull-through group (89.3%, 25 out of 28) was similar to that of the control group (75.0%, 21 out of 28, p = 0.296). Fistula restenosis occurred with time in both groups but no significant differences in the post-operative fistula patency were found between the pull-through and control groups in follow-ups at 3, 6, and 12 months (71.4% vs 67.9%, 57.1% vs 60.7%, and 20.0% vs 30.0%, respectively, p > 0.05). No significant difference in the post-operative patency rate in patients with diabetes, hypertension, or coronary disease was found between the pull-through and control groups in the follow-ups at 3 and 12 months, respectively. The pull-through group had significantly shorter operation times compared with the control group (45 ± 9 min vs 65 ± 15 min, p < 0.001). No surgical complications were reported in the pull-through group in contrast to three cases (11%, 3 out of 28) with puncture hematoma and acute occlusion in the control group. The pull-through technique combined with percutaneous transluminal angioplasty is an effective, safe and lasting option to treat high-grade arteriovenous fistula stenosis in the upper limb.

Maturation of arteriovenous fistulas in patients with ventricular assist devices.

Postoperative renal dysfunction necessitating hemodialysis after implantation of ventricular assist devices presents a challenge with respect to establishment of hemodialysis access. Lack of pulsatile flow has led to concerns that arteriovenous fistulas will not mature. This study aims to evaluate arteriovenous fistula as a method of hemodialysis. Consecutive patients who underwent implantation of a ventricular assist device between 1988 and 2016 with a subsequent need for hemodialysis were identified. Retrospective data were collected for patients requiring hemodialysis through an arteriovenous fistula or arteriovenous graft. Access flow rates and duration of patency are reported. Sixty-four patients were identified (10 required long-term hemodialysis, 5 via arteriovenous fistula, 1 via arteriovenous graft). All six patients receiving long-term hemodialysis access were on continuous-flow ventricular assist devices. Brachiocephalic arteriovenous fistulas were performed in all arteriovenous fistula patients, and the average preoperative vein diameter was 4.1 ± 0.9 mm. On 30-day follow-up, the average flow rate was 1262 ± 643 mL/min (880-2220). In arteriovenous fistula patients, one died at 30 days, one arteriovenous fistula required ligation for steal syndrome at 5 months, and one was abandoned after 10.7 months for low flow. Of remaining fistulas, one was converted to an arteriovenous graft at 1.7 years for malfunction (with 5.3 month patency), and one remains open at 4.0 years. Arteriovenous fistulas should be considered in selected patients with ventricular assist devices as a means of long-term hemodialysis access to avoid use of catheters. Maturation and usage of primary arteriovenous fistulas is possible despite lack of pulsatile flow.

Prevalence of anal fistula in the United Kingdom.

BACKGROUNDAnal fistula is a pathological connection between the anal canal and perianal skin, which most commonly develops from an infected anal crypt. While the majority of anal fistulas are idiopathic, they are also associated with Crohn’s disease (CD) and other inflammatory conditions. The prevalence of anal fistula is estimated to be 1-2 per 10000 patients, but population-based studies on anal fistula epidemiology are limited and outdated.AIMTo assess the prevalence of anal fistula and relevant comorbidities, with and without CD in the United Kingdom and Europe.METHODSA retrospective population-representative observational cohort study was performed in The Health Improvement Network (THIN), a United Kingdom primary care database. Mid-year point prevalence of anal fistula was calculated on the first of July for each year between 2014 and 2017. Estimates were calculated for anal fistula overall and by CD status and standardized to the United Kingdom and European population. Prevalence of relevant comorbidities including lymphogranuloma venereum, hidradenitis suppurativa, anal presentation of sexually transmitted diseases, diabetes mellitus, and radiation in the pelvic area was reported.RESULTSThe United Kingdom-standardized overall point prevalence of anal fistula was 1.80 (95%CI: 1.65-1.94) per 10000 patients in 2017, while the Europe standardized estimate was 1.83 (95%CI: 1.68-1.98) per 10000 patients. Both these standardized point prevalence estimates ranged from 1.89 to 2.36 between 2014-2016. The United Kingdom-standardized point prevalence of anal fistula without CD was 1.35 (95%CI: 1.23-1.48) per 10000 patients, while the Europe-standardized estimate was 1.39 (95%CI: 1.26-1.52) per 10000 patients. In contrast, the standardized point prevalence estimate of anal fistula with CD was lower for both United Kingdom and Europe (0.44; 95%CI United Kingdom: 0.37-0.52, 95%CI Europe: 0.37-0.51) per 10000 patients in 2017. In 2017, 19% of anal fistula patients without CD and 13% of anal fistula patients with CD had at least one relevant comorbidity. These results show that anal fistulas are infrequent in the general population. 24.5% of prevalent anal fistulas are associated with CD, but other potentially etiological comorbidities are rare.CONCLUSIONThis real-world evidence study estimated the United Kingdom-standardized prevalence of anal fistula was 1.80 per 10000 patients in 2017. Approximately 25% of cases may be associated with CD, while other comorbidities are rare.

Assessing quality of life in obstetric fistula patients: Validation of the urogenital distress inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7) in Lingala and Kikongo in DR Congo.

The Urogenital Distress Inventory (UDI-6) and the Incontinence Impact Questionnaire (IIQ-7) are both well-known. In obstetric fistula (OF) repair outcome is usually assessed by the surgical team. The patient perspective is often neglected. Therefore we translated both questionnaires in Lingala and Kikongo, official languages in DR Congo. Secondly used the questionnaires in an OF population to assess the real life continence status and the impact of fistula repair surgery. UDI-6 and IIQ-7 were translated and underwent content validity checks using focus groups. The final versions were tested in a normal population and in an OF population (33 for Kikongo, 35 for Lingala) for internal consistency and test-retest reliability. The responsiveness was tested in an OF population and effect sizes were calculated. Both questionnaires showed good internal consistency and reliability. The Cronbach's α for UDI-6 in both languages was 0.47 for the IIQ-7, 0.96 for Lingala and 0.94 for Kikongo in an OF population. The test-retest reliability was high in all cohorts. Both questionnaire scores improved significantly after fistula repair. The effect size for UDI-6 was -1.09 and -1.6 for IIQ-7. Both IIQ-7 and UDI-6 questionnaires have been translated in Lingala and Kikongo, two languages of DR Congo. The questionnaires have been validated in an obstetrical fistula population, showing good content validity and test-retest reliability. The questionnaires show a highly significant effect size, demonstrating the dramatic positive effect of fistula surgery on urogenital symptoms and on the quality of live in an obstetric fistula population.

Surveillance arterioveNous fistulAs using ultRasound (SONAR) trial in haemodialysis patients: a study protocol for a multicentre observational study

IntroductionArteriovenous fistulas (AVFs) are considered the best and safest modality for providing haemodialysis in patients with end-stage renal disease. Only 20% of UK centres achieve the recommended 80% target for...

The loss of dignity: social experience and coping of women with obstetric fistula, in Northwest Ethiopia

BackgroundObstetric fistula is a debilitating condition resulted from poorly (un) managed prolonged obstructed labor. It has significant psychosocial and economic consequences on those affected and their families. Data regarding experiences and coping mechanisms of Ethiopian women with fistula is scarce.MethodsQualitative design was employed with in depth interview technique by using open ended interview guide. Eleven fistula patients waiting for surgical repair at the fistula treatment center of Gondar Specialized Referral Hospital were selected with typical case selection. Thedata were audio-taped, transcribed and translated from Amharic to English. Open code version 4.03was used to organize data and identify themes for analysis.ResultsThe age of participants of the study ranged between 19 to 43 years. Ten of them were from rural areas. Regarding their educational status eight cannot read and write. Similar number were either separated or divorced. Six of them lived with obstetric fistula without treatment from one to five years. Five women related their condition to their fate. The women faced challenges in role performance, marital and social relationships and economic capability. Frequent bathing, use of stripes of old clothes as a pad, self-isolation and hiding from being observed, wearing extra clothes as cover, increasing water intake and reducing hot drinks and fluids other than water were the ways they have devised to cope with the incontinence.ConclusionThe study participants reported that they experienced deep sense of loss, diminished self-worth and multiple social challenges. They coped with the incontinence in various ways among which some were non effective and might have continuing negative impact on woman’s quality of life even after corrective surgery. Developing bridging intervention for early identification and referral could reduce period of women’s suffering.

Prevalence of fistula-in-ano in patients attending tertiary care institute of Gujarat: a cross-sectional study

Background: Present research was done to study the evidence, etiology signs, symptoms, pathogenesis and management and follow up of the patient for a period of 6 months after surgery.Methods: This was a clinical study of fistula in ano done at medical institute for the period of 1 year. 50 cases, clinically diagnosed, fistula in ano were selected randomly utilizing the closed envelope method and studied. Clinical examination including per rectal and proctoscopic was done in required patients. Patients were treated with fistulectomy or fistulotomy for fistulae. Patients were followed up for a period of 3 months to 1 year.Results: In this present series, 44% of patients were in the age group of 31-40 years. 70% of patients were, discharging wound was the presenting the complaint. 20% of patients with pain and swelling around the anal region. In the study of 50 cases were randomly selected patients of fistula in ano, 84% of them had only one external opening, while 10% had 2 external opening and another 6% had more than 2 openings, hence fistula in ano with a single external opening is commonest in occurrence.Conclusions: On the basis of observations, we can conclude that early diagnosis and appropriate management is the key to success. It not only reduces the complications but also improve the quality of life among these patients.

Factors affecting arteriovenous fistula dysfunction: A narrative review.

Vascular access dysfunction is one of the most important causes of morbidity and mortality in haemodialysis patients, contributing to up to one third of hospitalisations and accounting for a significant amount of the health care costs of these patients. In the past decades, significant scientific advances in understanding mechanisms of arteriovenous fistula maturation and failure have contributed to an increase in the amount of research into techniques for creation and strategies for arteriovenous fistula dysfunction prevention and treatment, in order to improve patient care and outcomes. The aim of this review is to describe the pathogenesis of vascular access failure and provide a comprehensive analysis of the associated risk factors and causes of vascular access failure, in order to interpret possible future therapeutic approaches. Arteriovenous fistula failure is a multifactorial process resulting from the combination of upstream and downstream events with consequent venous neo-intimal hyperplasia and/or inadequate outward remodelling. Inflammation appears to be central in the biology of arteriovenous fistula dysfunction but important triggers still need to be revealed. Given the significant association of arteriovenous fistula failure and patient's prognosis, it is therefore imperative to further research in this area in order to improve prevention, surveillance and treatment, and ultimately patient care and outcomes.

Mucosal-associated invariant T cells and oral microbiome in persistent apical periodontitis

Opportunistic bacteria in apical periodontitis (AP) may pose a risk for systemic dissemination. Mucosal-associated invariant T (MAIT) cells are innate-like T cells with a broad and potent antimicrobial activity important for gut mucosal integrity. It was recently shown that MAIT cells are present in the oral mucosal tissue, but the involvement of MAIT cells in AP is unknown. Here, comparison of surgically resected AP and gingival tissues demonstrated that AP tissues express significantly higher levels of Vα7.2-Jα33, Vα7.2-Jα20, Vα7.2-Jα12, Cα and tumour necrosis factor (TNF), interferon (IFN)-γ and interleukin (IL)-17A transcripts, resembling a MAIT cell signature. Moreover, in AP tissues the MR1-restricted MAIT cells positive for MR1–5-OP-RU tetramer staining appeared to be of similar levels as in peripheral blood but consisted mainly of CD4+ subset. Unlike gingival tissues, the AP microbiome was quantitatively impacted by factors like fistula and high patient age and had a prominent riboflavin-expressing bacterial feature. When merged in an integrated view, the examined immune and microbiome data in the sparse partial least squares discriminant analysis could identify bacterial relative abundances that negatively correlated with Vα7.2-Jα33, Cα, and IL-17A transcript expressions in AP, implying that MAIT cells could play a role in the local defence at the oral tissue barrier. In conclusion, we describe the presence of MAIT cells at the oral site where translocation of oral microbiota could take place. These findings have implications for understanding the immune sensing of polymicrobial-related oral diseases.

Right Coronary Artery-Superior Vena Cava Fistula Manifesting as NSTEMI: Case Report, Review of Imaging, and Summary of Guidelines.

Coronary artery fistulas (CAFs) represent a spectrum of abnormal connections between a coronary artery and another coronary artery, vein, or major blood vessel, known as coronary-vascular fistulas, or between a coronary artery and a cardiac chamber, known as coronary-cameral fistulas. While CAFs generally remain asymptomatic into the fifth decade of adult life, they can present with a diverse symptomatic profile, typically with angina from abnormal myocardial perfusion, or in the setting of larger fistulas, as right- or left-heart failure from pulmonary or left ventricular circulatory overload. CAFs rarely manifest as myocardial infarction in the absence of thrombosis within the fistula. When clinically suspected based on a continuous murmur on physical exam or an accidental finding on radiology, computed tomography angiography (CTA) and coronary angiography are the preferred diagnostic imaging modalities. Fistula anatomic and patient specific characteristics guide clinical decisions on transcatheter or surgical management strategies. We present the case of a right coronary artery-superior vena cava fistula manifesting as a non-ST elevation myocardial infarction. We also present a review of the imaging techniques available for evaluation of CAFs, and a summary of the major national and international cardiology society guidelines on the diagnosis and management of CAFs.

Low temperature plasma minimally invasive treatment of children piriform fossa fistula

Objective: To observe the clinical efficacy of lowtemperature plasma minimally invasive treatment of piriform fossa fistula in children at the infection stage and non-infection stage. Method: Twenty-five pediatric patients of piriform fovea fistula were treated with low-temperature plasma minimally invasive treatment. These patients were divided into the infection stage group(16 cases) and the non-infection stage group(9 cases). In both groups, low-temperature plasma ablation was performed to close the piriform fossa fistula under laryngoscope supported by endotracheal intubation under general anesthesia. For patients in infection stage, simultaneous cervical abscess incision and drainage were performed. The efficacy, postoperative recurrence rate and complications of the two groups were compared. Result: In the non-infection stage group, 7 cases were cured by 1 operation, and 2 cases were cured by the reoperation. In the infection stage group, 10 cases were cured by 1 operation, 5 cases were cured by the reoperation, and 1 case was cured by external fistula resection due to repeated purulent discharge of neck infection. No recurrent laryngeal nerve injury, massive hemorrhage or other complications occurred in these patients. Conclusion: Low temperature plasma minimally invasive treatment is safe and effective for pediatric patients of piriform fossa fistula.