R. P. Herath

Validation of the International Consultation on Incontinence Questionnaire-Vaginal Symptoms (ICIQ-VS) in two south- Asian languages

IntroductionThe multifaceted nature of pelvic floor disorders means that a systematic evaluation is required for optimal treatment outcome. It is also generally acknowledged that a valid tool is necessary to objectively assess symptoms reported by affected women.MethodsThe International Consultation on Incontinence Questionnaire—Vaginal Symptoms (ICIQ-VS) questionnaire was translated to Sinhala and Tamil and a validation study carried out among women attending gynecology clinics at North Colombo Teaching Hospital, Ragama, and the district general hospitals Mannar and Vavuniya.ResultsContent validity was assessed by the level of missing answers, which was < 4% and 2% for each item in Sinhala and Tamil, respectively. Construct validity was assessed by the ability of the questionnaire to differentiate between patients and controls. Both differentiated patients from controls on vaginal symptoms score (VSS) (p < 0.001), sexual symptoms score (SSS) (p < 0.01), and quality of life (QoL) (p < 0.001). There was a strong positive correlation between Pelvic Organ Prolapse Quantification (POP-Q) scores and VSS (Sinhala rs = 0.64, p < 0.001, Tamil rs = 0.65, p < 0.001), and QoL (Sinhala rs = 0.49, p < 0.001, Tamil rs = 0.60, p < 0.001). Internal consistency as assessed using Cronbach’s coefficient alpha: 0.78 (0.76–0.78) and 0.83 (0.80–0.84) in Sinhala and Tamil, respectively. Test–retest reliability was assessed by weighted kappa scores (Sinhala 0.58–0.88 and Tamil 0.76–0.90). Both questionnaires were sensitive to change and showed that VSS and QoL improved following surgery (Wilcoxon matched-pairs signed-rank test p < 0.001).ConclusionThe validated Sinhala and Tamil translations of ICIQ-VS will be useful for assessing vaginal and sexual symptoms among women speaking Sinhala and Tamil.

Methylene Blue Induced Bluish Discoloration Mimicking Cyanosis, at Diagnostic Laparoscopy

Methylene Blue Induced Bluish Discoloration Mimicking Cyanosis, at Diagnostic Laparoscopy Methylene blue is commonly used to check patency of Fallopian tubes and tracking fistulae. Intraversation of methylene blue is a recognized complication of diagnostic laparoscopy and dye test. Although a case of cyanosis due to methaemoglobinaemia following methylene blue use is a known complication, cyanosis without methaemoglobinaemia is unknown.

Challenges of Costing a Surgical Procedure in a Lower–Middle-Income Country

BackgroundIt is vital to enquire into cost of health care to ensure that maximum value for money is obtained with available resources; however, there is a dearth of information on cost of health care in lower–middle-income countries (LMICs). Our aim was to develop a reproducible costing method for three routes of hysterectomy in benign uterine conditions: total abdominal (TAH), non-descent vaginal (NDVH) and total laparoscopic hysterectomy (TLH).MethodsA societal perspective with a micro-costing approach was applied to find out direct and indirect costs. A total of 147 patients were recruited from a district general hospital (Mannar) and a tertiary care hospital (Ragama). Costs incurred from preoperative period to convalescence included direct costs of labour, equipment, investigations, medications and utilities, and indirect costs of out-of-pocket expenses, productivity losses, carer costs and travelling. Time-driven activity-based costing was used for labour, and top-down micro-costing was used for utilities.ResultsThe total cost [(interquartile range), number] of TAH was USD 339 [(308–397), n = 24] versus USD 338 [(312–422), n = 25], NDVH was USD 315 [(316–541), n = 23] versus USD 357 [(282–739), n = 26] and TLH was USD 393 [(338–446), n = 24] versus USD 429 [(390–504), n = 25] at Mannar and Ragama, respectively. The direct cost of TAH, NDVH and TLH was similar between the two centres, whilst indirect cost was related to the setting rather than the route of hysterectomy.ConclusionsThe costing method used in this study overcomes logistical difficulties in a LMIC and can serve as a guide for clinicians and policy makers in similar settings.Trial registrationThe study was registered in the Sri Lanka clinical trials registry (SLCTR/2016/020) and the International Clinical Trials Registry Platform (U1111-1194-8422) on 26 July 2016.