The Incidence of Pelvic and Low Back Pain in Patients with Pelvic Organ Prolapse

INTRODUCTION AND HYPOTHESIS

To define the prevalence and incidence of pelvic/low back pain in patients with pelvic organ prolapse (POP).

METHODS

Patients presenting for POP to three urogynecology centers in the US, UK, and Chile were enrolled in an IRB-approved cross-sectional study assessing pain, GU, GI and sexual function symptoms. For prevalence, symptoms were noted as present if the participant recorded the symptom and reported the degree of bother as "somewhat," "a moderate amount," or "a lot." For incidence, participants were queried if the symptom's onset concurred with the POP. We also queried if they perceived the symptom was worsened by their POP.

RESULTS

Two hundred five participants were recruited: 100 from the US, 46 from the UK, and 59 from Chile. One US participant was excluded due a missing examination. The prevalence of pelvic pain was 42%. Seventy-three percent of these participants reported the onset of pelvic pain coinciding with prolapse onset, and 81% endorsed worsening pelvic pain with POP. The prevalence of low back pain was 46%, with 30% reporting the onset coincided with the onset of POP and 44% responded that prolapse worsened their pain.

CONCLUSION

A higher proportion of participants than expected endorsed pelvic/low back pain. Among patients with pelvic pain, the majority experienced symptom onset with POP onset and a worsening of pain with POP. While roughly half of participants reported low back pain; a minority correlated this to their POP. These findings highlight a high incidence of pelvic pain, challenging the perception of POP as a painless condition.

Technical aspects of inguino scrotal hernia surgery in developing countries

PURPOSE

Technical aspects of inguinoscrotal herniorrhaphy performed in low to middle income countries (LMICs) are described here to help surgeons who will operate on these challenging hernias in austere settings.

METHODS

Technical considerations related to operative repair were delineated with the consensus of 7 surgeons with extensive experience in inguinoscrotal hernia repair in LMICs. Important steps and illustrations were prepared accordingly. The anatomical and pathologic differences and technical implications of operating in limited resource settings are emphasized with suggestions to approach anticipated challenges. Pre-operative evaluation, anesthetic considerations, and technical guidelines are offered in context.

RESULTS

The authors have cumulatively performed over 1775 inguinoscrotal Lichtenstein operations in LMICs. While dedicated, reliable, long-term follow-up is unavailable from LMICs, one author reports outcomes with 5 year follow-up from the HerniaMed registry using the identical technique in similarly classed hernias. In 90 inguinoscrotal Lichtenstein repair patients (78.3% follow-up), there was one recurrence, low rates of chronic pain (2.2% at rest, 4.4% with activity), and low rates of reintervention (1.1%).

CONCLUSION

There is a difference between inguinal hernias found in LMICs and those seen in high-income countries with larger, chronic, and more technically challenging pathology. The consequences of intra-operative complications can be catastrophic in a LMIC. Technical measures are offered to improve outcomes, avoid and manage complications, and provide optimal care to this important population.

Investigation on the Removal of Chromium from Wastewater using Electrocoagulation

Nowadays, treatment of chromium wastewater is very critical also important. The current study investigates the influence of electrocoagulation process parameters to reduce the chromium from wastewater. It has been observed that the initial pH (6), current density (25 mA/cm2), electrode distance (4 cm) and electrolysis time (30 min) were found to be optimum for a 97 % chromium removal. For the above said optimum condition, the electrical energy consumption was found to be 0.12 kWh/m3. A comparison between BBD and ANN shows high correlation coefficient values (R2 (ANN) > 0.90 and R2 (RSM) > 0.90). Results indicated that electrocoagulation process is a cheap and effective method to treat chromium wastewater.

Performance evaluation of chemical coagulation process to treat bagasse wastewater: modeling and optimization

In this present study, chemical coagulation process (CC) treatment process was investigated under different conditions such as pH, ferric chloride dose, agitation time and settling time to treat bagasse wastewater using response surface methodology (RSM). The outcomes were evaluated using Pareto analysis of variance (ANOVA) and second order polynomial models were created with the aim of being able to predict the responses. Ideal conditions were observed to be as per the following: agitation time of 25 min, pH of 7, ferric chloride dose of 6 g/L and settling time of 60 min. Under these conditions, turbidity removal of 62%, COD removal of 67%, TDS removal 53% and sludge production of 32 mL/L were obtained with operating cost of 3.50 Rupee/L. The mechanism of CC was analyzed using XRD spectrum and founds to be adsorption.

Focused versus operating room-wide recovery of unused supplies for overseas reconstructive surgery

Proliferation of programs that recover surplus operating room supplies may effectively address the needs of volunteer overseas surgical efforts. However, these programs tend to garner supplies highly heterogeneous in nature. In order to evaluate the nature and quantity of supplies generated by plastic and reconstructive procedures, we extrapolated the inventory of 71 consecutive cases from our 33,000-case database. Additionally, we examined the recovery of 7 specific supplies from all cases performed at Yale-New Haven Hospital over a 3-year period. Though consistency is unlikely when only plastic and reconstructive surgical cases are examined, operating room-wide recovery may be a reliable source of usable materials.

A comparison of morphine-perphenazine and midazolam on preoperative sedation and arterial oxygen saturation

The effectiveness of midazolam and a mixture of morphine-perphenazine premedication to produce sedation and their effects on preoperative oxygen saturation (SaO2) were examined. Eighty-five patients whose SaO2 measured with a pulse oximeter was greater than 90% and who were not receiving narcotic sedatives or oxygen were randomized to three groups. Each patient had his SaO2 recorded before premedication with placebo (saline), midazolam 0.08 mg.kg-1 or morphine 0.15 mg.kg-1 with perphenazine 2.5-5.0 mg im. From 30-90 min later, prior to anaesthesia SaO2 was repeated, and a sedation score was obtained by a blinded observer using a seven point scale. Median sedation scores were greater for midazolam (4) than for morphine-perphenazine (2) and placebo (1) (P less than 0.0001). As well, there was a decrease in the SaO2 in the morphine-perphenazine group (1.7 +/- 2.7%, P less than 0.001) but not in the midazolam and placebo groups (0.1 +/- 2.3%, -0.8 +/- 2.1%). In conclusion midazolam produced greater sedation than morphine-perphenazine and placebo without effect on SaO2 whereas morphine-perphenazine showed a decrease in SaO2 preoperatively.

Is cardiac ultrasound mandatory in patients with transient ischaemic attacks?

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A teaching evaluation questionnaire for postmyocardial infarction patients

The above report is primarily a methodologic presentation of a questionnaire designed to assess the knowledge of patients with a recent myocardial infarction (MI) concerning the nature of their disease, emergency treatment, diet and smoking, resumption of physical activity, psychological factors important in heart disease, and problems encountered when returning home and to work. This questionnaire was designed to asses an in-hospital teaching program for post-MI patients in these areas. Test, re-test results from our first group of 24 patients indicated they significantly increased their knowledge about problems surrounding their return home and to work during their time in the hospital. The failure of these patients to demonstrate a learning effect in the other areas covered has stimulated changes in the teaching program.