Vesicovaginal fistula at tertiary care center in eastern Nepal.

Vesicovaginal fistula is physically, socially and psychologically devastating to the women who suffer from it. The aim of this study is to create some awareness about VVF, to describe the profile of the patients, etiology, and success rate of surgery in our institute. A retrospective analysis of a total of 23 cases of vesicovaginal fistula admitted to the Department of Gynecology and Obstetrics, BPKIHS over a period of three years were included in the study. The cause of VVF in all was obstructed labor except in one, which followed abdominal hysterectomy. Twenty-three subjects underwent VVF repair, of which 14 (56.5%) had successful outcome.

Factors influencing mortality in perforated duodenal ulcer following emergency surgical repair.

Duodenal perforation is a common abdominal catastrophe with excellent outcome if prompt resuscitation and surgical repair of perforation are done. The aim of this study was to identify factors associated with death after surgery in patients with duodenal perforation. One hundred and forty-five patients who underwent Graham's patch repair for perforated duodenal ulcer between 14 April 2002 and 31 December 2004 were studied. The mean age was 45.99 years and 61 patients (42.07 %) were referrals. There were 124 (85.52 %) males and 21 (14.48 %) females. There were 10 deaths (6.9 %). The mean time delay was 2.46 days. It was 2.37 days in survivors, 3.7 days in non-survivors. The time delay was 3.25 days for females and 3.13 days for patients referred from another hospital. The mortality was significantly associated with time delay between perforation and operation (p<0.01), presence of co-morbid conditions (P<0.04), respiratory rate (p<0.02), raised blood urea (p<0.01) and serum creatinine (p<0.001), size of perforation (p<0.005), amount of peritoneal fluid (p=0.003) and requirement of postoperative intensive care unit support (p=0.003). Time delay between perforation and operation, preoperative blood urea and serum creatinine, size of perforation and amount of peritoneal fluid, presence of co-morbid conditions and need for post operative ICU support are the important predictors of outcome after emergency surgery for duodenal perforation.

Sympathetic ophthalmia : a blinding complication of ocular injury.

Sympathetic Ophthalmia is a rare and blinding ocular complication due to ocular injury. This condition in a male patient aged 25 years, is reported. The role of early recognition and management of this condition to preserve good vision is discussed.

Doctor's role in early detection of diabetic retinopathy and prevention of blindness from its complications.

Diabetic retinopathy (DR) is a microangiopathy, which is caused by chronic hyperglycemia, affecting the retinal arterioles, capillaries and venules, complications of which lead to incurable blindness. Approximately 10% of the diabetic population has type I diabetes mellitus (DM) which is diagnosed before the age of 30 years and rest is type II which is diagnosed after the age of 30 years. In UK 2% general population is affected by DM. In developed countries, diabetic retinopathy is an important and leading cause of blindness in working age group where as in developing western countries this figure occupy 12% of the blindness. In developing countries like Nepal, cataract still remains a main cause of blindness and diabetes is not considered as a major problem. However due to a rapid urbanization and modernization of population, diabetes mellitus is becoming an endemic disease and bringing a new challenge in blindness reduction program.