ABSTRACT
Background & objectives: Information on gastrointestinal manifestations and then response after curative parathyroid surgery is scarce in symptomatic primary hyperparathyroidism (PHPT). This study was carried out to analyse gastrointestinal manifestations in patients with PHPT and their associations with biochemical parameters. Methods: This retrospective study included 153 patients with symptomatic primary hyperparathyroidism (PHPT). The signs and symptoms pertaining to gastrointestinal system were analyzed. The difference of symptoms between men and women and difference in biochemical parameters in presence of different symptoms were evaluated. The relationship between serum calcium, phosphate and parathyroid hormone (PTH) levels with presence of gallstone and pancreatitis was also studied. Result: Of the 153 patients, 46 (30%) were men. The mean age was 39.2 ± 13.9 yr. Nearly 80 per cent of PHPT patients had at least one symptom/ sign related to gastrointestinal system. The most common gastrointestinal manifestations were abdominal pain 66 (43%), constipation 55 (36%), and nausea/or vomiting 46 (30%). Nearly one-fourth 34 (22%) of patients had a history of either gallstone disease or cholecystectomy or both. The prevalence of gallstone disease was higher in women (P<0.05). Imaging and biochemical evidence of pancreatitis was found in 27 (18%) patients. Pancreatitis was more common in men compared to women (P<0.05) despite the higher prevalence of gallstones in women. Serum calcium, phosphate or PTH levels were not associated with high risk for gallstone disease, however, serum calcium (P<0.05) was associated with 1.3 times higher risk of developing pancreatitis. In majority of patients, gastrointestinal manifestations resolved within three months of curative parathyroidectomy. Except two patients, none had recurrence of pancreatitis. Interpretation & conclusions: The study revealed that the gastrointestinal symptoms were common in patients with symptomatic PHPT. There was not much gender difference in gastrointestinal symptoms except higher occurrence of gallstones in women and pancreatitis in men. There was no difference in biochemical profile between those who had and did not have gastrointestinal symptoms.
ABSTRACT
Background: Provision of good quality care is the crux of the RCH Programme. Good quality of care ensures satisfied clients, who in turn come back for services and become advocates for others. Quality has not been given adequate attention in Government Health Care facilities, because of which there is underutilization of RCH services. Aims & Objective: The present study is an attempt to assess the perception of clients (women who delivered in last one year) regarding various aspects of maternal and child health care delivery components. Material and Methods: It was a community based cross sectional study carried out in ten primary health centre areas. Study subjects were the women delivered in last one year. Sample size was calculated considering the proportion of pregnant women who received at least three antenatal check-ups in district level household survey – 3. One hundred fifty such women were interviewed using pretested proforma from subcenter of each randomly selected PHC area. Data were entered and analyzed in epi info software version 3.3.2. Results: Majority of the women (80%) opined that the behaviour of health care providers was good while 21% of women felt that the communication skills of attending doctor / FHW were not good. Only two third of the women were satisfied with the quality of services provided to them at health facility. RCH indicators were better among the women who were satisfied with the behaviour and communication skills of the health care providers. Conclusion: Present study revealed that women’s perception about various indicators of quality of care, behaviour and communication skills of the health care providers affect the overall satisfaction of the women and in turn it significantly affects utilization of RCH services.