Laparoscopic Repair of Duodenal Perforation by "Hanging Method" -Technique and Benefits

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An exploratory study to evaluate the utility of an adapted Mother Generated Index (MGI) in assessment of postpartum quality of life in India

<p>Abstract</p> <p>Background</p> <p>Given the postulated advantages of mother generated index (MGI) in incorporating the patients' viewpoint and in the absence of a validated India specific postpartum quality of life assessment tool we proposed to evaluate the utility of an adapted Mother-Generated-Index in assessing postpartum quality of life (PQOL) in India.</p> <p>Methods</p> <p>The study was integrated into a community survey conducted in one district of Delhi by two-stage cluster randomized sampling to recruit women who delivered in the last 6 months. PQOL was assessed using MGI. Physical morbidity and Edinburgh- postnatal-depression-scale (EPDS) were also recorded for validation purposes.</p> <p>Results</p> <p>All subjects (249 of 282 eligible) participating in the survey were approached for the MGI evaluation which could be administered to 195 subjects due to inadequate comprehension or refusal of consent. A trend towards lower scores in lower socioeconomic stratum was observed (Primary index score-2.9, 3.7 and 4.0 in lower, middle and higher strata; Secondary Index Score-2.6, 3.2 and 3.0 in lower, middle and higher strata). 59.4% mothers had scores suggestive of possible depression (EPDS; n = 172). Primary index score had a good correlation with validator scores like EPDS (p = 0.024) and number of physical problems (p = 0.022) while the secondary index score was only associated with EPDS score (p = 0.020).</p> <p>Conclusion</p> <p>The study documents that the MGI, with its inherent advantages, is a potentially useful tool for postpartum quality of life evaluation in India especially in the absence of an alternative pre-validated tool.</p

'If I do 10-15 normal deliveries in a month I hardly ever sleep at home.' A qualitative study of health providers' reasons for high rates of caesarean deliveries in private sector maternity care in Delhi, India.

BACKGROUND: Although the overall rate of caesarean deliveries in India remains low, rates are higher in private than in public facilities. In a household survey in Delhi, for instance, more than half of women delivering in private facilities reported a caesarean section. Evidence suggests that not all caesarean sections are clinically necessary and may even increase morbidity. We present providers' perspectives of the reasons behind the high rates of caesarean births in private facilities, and possible solutions to counter the trend. METHODS: Fourteen in-depth interviews were conducted with high-end private sector obstetricians and other allied providers in Delhi and its neighbouring cities, Gurgaon and Ghaziabad. RESULTS: Respondents were of the common view that private sector caesarean rates were unreasonably high and perceived time and doctors' convenience as the foremost reasons. Financial incentives had an indirect effect on decision-making. Obstetricians felt that they must maintain high patient loads to be commercially successful. Many alluded to their busy working lives, which made it challenging for them to monitor every delivery individually. Besides fearing for patient safety in these situations, they were fearful of legal action if anything went wrong. A lack of context specific guidelines and inadequate support from junior staff and nurses exacerbated these problems. Maternal demand also played a role, as the consumer-provider relationship in private healthcare incentivised obstetricians to fulfil patient demands for caesarean section. Suggested solutions included more support, from either well-trained midwives and junior staff or using a 'shared practice' model; guidelines introduced by an Indian body; increased regulation within the sector and public disclosure of providers' caesarean rates. CONCLUSIONS: Commercial interests contribute indirectly to high caesarean rates, as solo obstetricians juggle the need to maintain high patient loads with inadequate support staff. Perceptions amongst providers and consumers of caesarean section as the 'safe' option have re-defined caesareans as the new 'normal', even for low-risk deliveries. At the policy level, guidelines and public disclosures, strong initiatives to develop professional midwifery, and increasing public awareness, could bring about a sustainable reduction in the present high rates

Direct Cost of Maternity-care Services in South Delhi: A Community Survey

The study was conducted to estimate the direct maternity-care expense for women who recently delivered in South Delhi and to explore its sociodemographic associations. A survey was conducted using the two-stage cluster-randomized sampling technique. Two colonies each from high-, middle- and low-income areas were selected by simple random sampling, followed by a house-to-house survey in each selected colony. Information was collected by recall of healthcare expenses for mother and child. In total, 249 subjects (of 282 eligible) were recruited. The mean expense for a normal vaginal delivery (n=182) was US$370.7, being much higher in a private hospital (US$ 1,035) compared to a government hospital (US$61.1) or a delivery in the home (US$ 55.3). Expenses for a caesarean delivery (n=67) were higher (US$ 1,331.1). Expenses for the lowest-income groups were ∼10% of their annual family income at government facilities and ∼26% at private hospitals. The direct maternity expense is high for large subsections of the population

Direct Cost of Maternity-care Services in South Delhi: A Community Survey

The study was conducted to estimate the direct maternity-care expense for women who recently delivered in South Delhi and to explore its sociodemographic associations. A survey was conducted using the two-stage cluster-randomized sampling technique. Two colonies each from high-, middle- and low-income areas were selected by simple random sampling, followed by a house-to-house survey in each selected colony. Information was collected by recall of healthcare expenses for mother and child. In total, 249 subjects (of 282 eligible) were recruited. The mean expense for a normal vaginal delivery (n=182) was US$370.7, being much higher in a private hospital (US$ 1,035) compared to a government hospital (US$61.1) or a delivery in the home (US$ 55.3). Expenses for a caesarean delivery (n=67) were higher (US$ 1,331.1). Expenses for the lowest-income groups were ~10% of their annual family income at government facilities and ~26% at private hospitals. The direct maternity expense is high for large subsections of the population

Laparoscopic Repair of Congenital Diaphragmatic Hernia in Adults

Background, Aims, and Objectives. Congenital diaphragmatic hernia typically presents in childhood but in adults is extremely rare entity. Surgery is indicated for symptomatic and asymptomatic patients who are fit for surgery. It can be done by laparotomy, thoracotomy, thoracoscopy, or laparoscopy. With the advent of minimal access techniques, the open surgical repair for this hernia has decreased and results are comparable with early recovery and less hospital stay. The aim of this study is to establish that laparoscopic repair of congenital diaphragmatic hernia is a safe and effective modality of surgical treatment. Materials and Methods. A retrospective study of laparoscopic diaphragmatic hernia repair done during May 2011 to Oct 2014. Total n=13 (M/F: 11/2) cases of confirmed diaphragmatic hernia on CT scan, 4 cases Bochdalek hernia (BH), 8 cases of left eventration of the diaphragm (ED), and one case of right-sided eventration of the diaphragm (ED) were included in the study. Largest defect found on the left side was 15 × 6 cm and on the right side it was 15 × 8 cm. Stomach, small intestine, transverse colon, and omentum were contents in the hernial sac. The contents were reduced with harmonic scalpel and thin sacs were usually excised. The eventration was plicated and hernial orifices were repaired with interrupted horizontal mattress sutures buttressed by Teflon pieces. A composite mesh was fixed with nonabsorbable tackers. All patients had good postoperative recovery and went home early with normal follow-up and were followed up for 2 years. Conclusion. The laparoscopic repair is a safe and effective modality of surgical treatment for congenital diaphragmatic hernia in experienced hands