Transabdominal and transvaginal repair of vesicovaginal fistula

Objective: To evaluate the results of surgical repair of VVF through transabdominal and transvaginal routes

Study Design: Prospective study

Place and Duration of Study: This study was carried out in Teaching Hospital, Ghazi Khan Medical College, DG Khan from June 2009 to May 2014

Patients and Methods: Total 26 patients of VVF with age range of 22-60years were included in the study.Fistulas had two types, simple and complex, according to site, size and aetiology . Simple VVFs were repaired through the vaginal route and complex ones through abdominal route. Patients were assessed at an interval of twoto three weeks to start with, twice after three-months and thereafter depending oncomplaints

Results: Sixteen [61%] patients had simple fistulas, while 10 [38%] patients had complex fistulas and one of the patients had complex fistula associated with rectal communication who was excluded . The most common cause was trauma during obstructed labour in 12[47%] patients, whereas the other common cause was hysterectomy. Sixteen [61%] patients were approached through transvaginal route, out of them 9 had supratrigonal and 7 trigonal fistulas. Ten [38%] patients with complex fistulas were approached by abdominal route. Duration of the surgery, blood loss, pain after surgery and stay in hospital was found to be shorter in transvaginal surgery. Two patients have failed repair with significant complications, a success rate of 92% was achieved. At a follow-up of one year 24 women had uneventful, active sexual life while 2 of them had some degree of pain during sexual intercourse

Conclusion: It's concluded that both the routes of VVF repair has a similar successrate

Congenital aganglionosis; single stage transanal pullthrough, a big relief to patients

To report early and late outcome after a one stage operation and comparison with others similar work and to see feasibility of this procedures in our limited resources. We have performed transanal pull through in department of Paediatric Surgery, Nishtar Hospital Multan during May 2010 to May 2013. Fifty patients out of 117 were selected, older than one year, non marasmic and diagnosed as short segment aganglionosis by barium enema were selected. Transanal Swenson's pull through was performed, aganglionic segment was decided on gross appearance [narrow] due to lack of frozen section facility, anastomosis made with 4/0 vicryl. Procedure completed on an average within one hour, without any transfusion. Feeding was started from day one, manageable complications were observed in 25% patients, no mortality seen. Hospital stay was on an average 6 days. Transanal one stage pull through is very practical, can be done without facility of frozen section

Patterns of argyrophilic nucleolar organiser regions in pleural and peritoneal effusions

To evaluate AgNOR size and dispersion as alternate methods to AgNOR counts in order to differentiate malignant from non-malignant effusions. Comparative study. Department of Pathology, Postgraduate Medical Institute, Lahore, from January 2003 to June 2004. A total of 240 samples of pleural and peritoneal effusions were centrifuged, deposits smeared on slides and stained with H and E and AgNOR stain. The diagnosis of malignancy or otherwise was made on H and E staining. AgNOR counts, variation in size and dispersion of AgNOR dots in smears were graded and compared in malignant and non-malignant effusions. Mean AgNOR counts of 11.47 +/- 3.60 and 11.04 +/- 3.89 in malignant pleural and peritoneal effusions, respectively, were significantly [p<0.0001] greater as compared with counts of 3.36 +/- 0.69 and 3.35 +/- 0.66 in non-malignant effusions. AgNOR size and dispersion were of higher grade in significantly greater proportion of malignant as compared with non-malignant effusions [p<0.0001]. Typing of AgNOR size and dispersion was found to be an easy and reproducible alternative to traditional AgNOR counts for differentiating malignant from non-malignant effusions. These parameters should be correlated with already established but expensive techniques of AgNOR area and size imaging by electron microscopy and flow cytometry, as an economical alternative

AgNOR staining in malignant and benign effusions

To evaluate the correlation of argyrophilic nucleolar regions[AgNORs] and malignancy in benign and malignant effusions. Design: The study group consisted of pleural and peritoneal effusion samples obtained from patients suffering from various benign or malignant diseases. The cytological smears were studied by conventional haematoxylin and eosin [H and E] and silver staining for AgNORs. Setting: The samples were obtained from patients admitted in Mayo Hospital, Services Hospital, Gulab Devi Chest Hospital and Institute of Nuclear Medicine and Oncology [INMOL]. Subjects: One hundred cases having either pleural or peritoneal effusions were selected. Fifty of these cases were positive for malignant cells and fifty had reactive mesothelial cells in them. Main Outcome Measures: Assessment of AgNOR count as a diagnostic marker of malignancy. AgNOR count was helpful in differentiating benign from malignant cells. AgNOR count in malignant cells was 10.62 t 3.36 and 3.04 t 0.64 in reactive mesothelial cells. AgNOR count is a rapid, easily reproducible method of differentiating reactive mesothelial cells and malignant cells

p53 Immunostaining in benign and malignant effusions

To evaluate p53 immunostaining as a marker of malignancy in pleural and peritoneal effusions and to compare the results with HE staining. Design: Pleural and peritoneal effusion samples were obtained from patients suffering from benign and malignant diseases. H and E staining and p53 immunostaining were performed on smears prepared from these samples. Setting: The samples were obtained from patients admitted in Mayo Hospital, Services Hospital, Gulab Devi Chest Hospital and Institute of Nuclear Medicine and Oncology [INMOL]. Subjects: One hundred cases having either pleural or peritoneal effusions were selected. Fifty of these cases were positive for malignant cells on H and E staining. Fifty cases contained only mesothelial cells. Main outcome measures: To compare the specificity and sensitivity of p53 immunostaining with HE stain as a diagnostic marker of malignancy. Out of the 50 malignant cases, 31 [62%] were found to be p53 positive. None of the benign cases showed positive staining. p53 was found to have a specificity of 100%, sensitivity of 62%, a positive predictive value of 100% and a negative predictive value of 72.4%. Conclusions: p53 is a highly specific and moderately sensitive marker of malignancy

Risk of malaria transmission through blood transfusion and its detection by serological method

To assess the risk of transmission of malaria through blood transfusion, and compare efficacy of testing by immunochromatographic[ICT] devices vis a vis peripheral blood film [PBF]. Design: 300 blood samples were tested divided into three equal groups of healthy volunteers, voluntary non-remunerated blood donors and patients suffering from malaria. Testing was carried out by a serological screening method, together with observation of peripheral blood films. Setting: Samples were collected from different sites and tested at the Institute of Haematology and Blood Transfusion Service, Punjab. Subjects: One hundred blood donors were selected from persons donating blood at the Institute or on mobile sessions. An equal number of healthy controls were students and staff of different colleges and the Institute. Samples of 100 patients of pyrexia and diagnosed clinically as suffering from malaria were collected from multiple clinics, laboratories and hospitals in Lahore. Main outcome measures: Assessment of the risk of transmission of malaria through blood and blood products and the comparison of serological testing for malaria with conventional peripheral blood film detection. Amongst healthy blood donors we did not find even a single case of malaria and there was no report of persistent post transfusion pyrexia. We are unable to comment on species frequency in blood donors. However, amongst known patients of malaria we found a higher frequency of Plasmodium vivax[P.v] as compared to Plasmodium falciparum[P.f]. Testing by serological method, helped us to diagnose 5% of our patients who were missed by peripheral blood films. Between properly selected voluntary non-remunerated blood donors the incidence of malaria transmission is zero and the blood is safe for transfusion. Serological testing shows good correlation with peripheral blood film detection. In fact, it can detect the disease even when film detection has been unsuccessful. If proper donor selection criteria are observed there is little risk of transmitting malaria through transfusion. However, as the donor pool in the Service is not necessarily totally that of voluntary non-remunerated donors and substantive numbers of replacement/first time, occasionally uneducated/unaware donors, are being bled, screening for malaria will not be totally unrewarding

Safe blood begins with safe donors

To identify the safest group of blood donors demographically with regard to risk of transmission of diseases in order to develop effective recruitment and retention strategies. Design: Demographic data and the results of screening for HIV, HBV l3 HCV in three different groups of blood donors have been analysed to identify the safest group of blood donors. All donors were subjected to medical interview and examination to exclude any donor who responded in the affirmative for any recognized risk factors or was considered unfit to donate blood as per national standards and guidelines. Additional data regarding educational and socio-economic status was also obtained and analysed. Subjects: Initially 703 donors registered to donate blood. None responded in the affirmative for any of the risk factors. 65 [9.25%] were deferred for different reasons and 638 donors were bled from the following three groups: 1] Healthy college going first time volunteers, 2] Healthy factory workers also first time volunteers and 3] Healthy voluntary non-remunerated donors [VNRD] who had donated at least twice in the calendar year at a hospital based blood bank. Setting: Blood from groups 1 and 2 were collected on mobile bleeding sessions, while data for group 3 was obtained from two busy teaching hospital blood banks. Testing for HIV, HBV, and HCV were carried out by rapid serological screening methods. All initially reactive donors were confirmed on EIA at the laboratories of the Institute of Haematology and Blood Transfusion Service, Punjab. All false positive, initially reactive, donors were excluded from the study. Main Outcome Measures: Identification of safest blood donor group. We found that generally younger people in our society posed a lesser risk to transmission of diseases as blood donors. The frequency of HCV positivity is alarmingly high amongst the poor in our society. Even amongst repeat donors the incidence of infectious disease markers are considerable. If appropriately motivated, women are equally poised to donate blood altruistically. Conclusions: There is a need to target younger people in recruitment and retention programmes for blood donations. Incentives like free hepatitis B vaccination should be given to preserve the existing repeat donor pool. Donor deferral registers need to be created and placed for easy reference at all blood banks. Due to the high risk of HCV transmission through blood obtained from the less fortunate class in our society, large scale HCV screening of the general population should be started and epidemiological studies undertaken to identify causes of such high frequency in order to curtail impending catastrophe

Transfusion transmitted HIV and HBV infections in Punjab, Pakistan

To assess the prevalence and risk of transfusion transmitted HIV and HBV infections in Punjab. The retrospective sero epidemiological data of the Institute of Haematology and Blood Transfusion Service, Punjab from 1996-2000 was analysed with regard to: a] Number of donors bled, b] Percentage of screening coverage, c] Percentage prevalence of HIV and HBV, d] Probability of receiving an infective unit P[R], probability of transmitting infection P[I] and spreading index evaluation and e] Cost assessment. The data was obtained regularly from 71 field units established in the government hospitals throughout the Province of Punjab from 1996- 2000. A total of 1176284 directed first time or replacement blood donors as well as voluntary non-remunerated blood donors who donated blood at these blood banks or at mobile sessions have been included in this study. Assessment of prevalence of HIV and HBV in blood donors and risk estimation. The screening coverage on the average has been 77.42% for HIV and 86.84% for HBV. The prevalence of HIV is 0.001% and of HBV is 2.259%. The probability of receiving an infective unit P[R] per 10000 donations is 0.023 for HIV and 29.72 for HBV. The probability of transmitting infection P[I] per 10000 donations is 0.021 for HIV and 26.75 for HBV The spreading index for both viral infections combined is 26.75 per 10000 donations. The cost of collecting and screening a single unit is Rs.350, while the cost of preventing the transfusion of a single infective unit is Rs.17836. Efforts should be made to extend 100% screening coverage, with development of altruistic voluntary non-remunerated blood donor registries, donor deferral registries and donor counseling service. There is a need to move away from hospital based blood donation system to a community-based system which would mean moving to a central and regional service concept in blood transfusion. An independent external QA programme or monitoring system is needed. The target should be to decrease prevalence to a minimum to ensure blood safety

Seroprevalence of hepatitis-C antibodies in blood donors

To assess the prevalence of anti HCV antibodies in blood donors. Design: The retrospective sero-epidemiological data of the Institute of Haematology and Blood Transfusion Service, Punjab over a period of one year after starting HCV screening, was analysed to estimate the percentage prevalence. The data was obtained regularly from the blood units established by this Institute at the public sector hospitals and retesting on initially reactive serum samples by EIA was done at the Institute. A total of 166183 directed first time donors or replacement blood donors aged 18-60 years who donated blood at these blood banks or at mobile sessions have been included in the study. All initially reactive donors who tested non-reactive on EIA were excluded from the study. Main Outcome Measures: Assessment of prevalence of HCV in blood donors. 4.45% of the total donors initially tested reactive; of these 0.36% were falsely reactive on initial screening. Further testing by EIA, indicated the correct prevalence of HCV in blood donors at 4.1%. The blood transfusion service started screening for HCV in April 2000 and the prevalence of HCV, amongst the transfusion transmitted infections [TTIs] being screened for in the Punjab, is the highest. It is almost double the prevalence of HBV and several thousand times that of HIV. Meticulous and total screening coverage is needed to curtail impending catastrophe. With experience, the choice of testing methodology might have to be reviewed

Seroprevalence of syphilis in the blood donors in Lahore

To assess the prevalence of syphilis in blood donors in Lahore. Design: Serum samples were obtained from prospective predominantly first time blood donors who consented to testing for syphilis from June to September 2000. TPHA test was conducted on the samples. Setting: The blood donors were bled and tested at the blood banks attached to the teaching hospitals in Lahore and at the Institute of Haematology and Blood transfusion Service, Punjab. Subjects: 8161 prospective predominantly first time blood donors aged 18-60 years. Main Outcome Measures: Assessment of the prevalence of syphilis in the blood donors. 0.78% of the blood donors tested were found to be positive. Conclusions: Blood safety is compromised due to lack of screening for syphilis and TPHA testing should be started in routine practice

audit of blood ordering pactices in Hospital Queen Elizabeth, Kota Kinabalu, Sabah, Malaysia

To audit the blood ordering practices in an attempt to alleviate shortage of blood, improve percentage utilization and cross match transfusion ratio. Design: The blood bank reviewed all requests for blood to ensure: a] adherence to hospital guidelines for transfusion, b] adherence to type and screen or group, screen and hold [TS/GSH] ordering schedule for defined elective surgeries and c] automatic cancellation of orders if not utilized within 24 hours. Setting: The blood bank and clinical departments of Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia. Subjects: During the span of four months in 1996, 9581 orders for request of blood and blood products were subjected to audit. No distinction was made between different products and each unit request was counted as one. Main outcome measures: Availability of blood, percentage utilization and cross match transfusion ratio. The number of requests decreased by 38.5%; compliance by the blood bank increased by 12.7%, while percentage utilization by end users improved by 24.0%. The cross match/transfusion ratio [CT ratio] came down to 2.0:1. Conclusions: Without prejudice to the need for increased collection of blood, we would like to suggest that systems used in this study are helpful tools in busy blood banks for overcoming relative shortage, attaining better utilization and CT ratio