ABSTRACT
Background: Fissures are common, but are often confused with other anal conditions, such as haemorrhoids. Fissures are usually caused by trauma to the inner lining of the anus from a bowel movement or other stretching of the anal canal. Aim: This study evaluated the efficacy of 0.2% glyceryl trinitrate versus lateral internal sphincterectomy in treatment of chronic anal fissure. Materials and Methods: This was a study which included 80 patients between November 2014 to September 2017. In this study, based on computer generated randomization, the patients were divided into two groups. Group A consisted of 40 patients with chronic anal fissure who were treated with 0.2% glyceryl trinitrate ointment, which was applied twice daily for 5 weeks. Group B included 40 patients who were treated by lateral internal sphincterotomy. Results: The mean duration of symptoms was 15.35±10.87 weeks in group A, it was 15.02±11.7 weeks in group B. Mean pain score during defecation was 7.89±1.58 in group A, it was 7.52±2.41 in group B. Bleeding during defecation was observed in 82% of patients in group A, 75% of patients in group B. Constipation was present in 27 patients i.e. 67% in group A and it was present in 31 patients i.e. 77% in group B. In Group A, 36 (90%) patients had posterior midline fissure, 4 (10%) had anterior midline fissure, In group B, 40 (100%) had posterior midline fissure. In group A, 24 (60%) had anal tag, in group B, 22 (56%) had anal tag. The VAS score in both the groups decreased gradually but the decrease was more in group B compared to group A at the end of 7th week which was statistically significant (p<0.05). Hence, the number of patients who had pain relief after surgical treatment was statistically significant as compared to patients who were treated with 0.2% glyceryl trinitrate ointment Awais Ghori, Bhooma Reddy M, Rajendra Prasad. Comparative study of glyceryl trinitrate ointment versus surgical management of chronic anal fissure. IAIM, 2017; 4(12): 188-194. Page 189 application. At the end of the 1st week, none of the patients were healed completely. But at the end of the 4th , in group A, only 14 patients were completely healed, 38 patients were completely healed in group B. At the end of the 7th week, all patients in group B were healed i.e. 100% were healed and in group A, 32 patients were healed completely. Conclusion: Chemical treatment by applying glyceryl trinitrate is also advantageous in that it doesn’t cause any complications. Surgical treatment by lateral sphincterotomy is most effective when patients fail to respond to chemical treatment.
ABSTRACT
Background: Recent evidence incidence that low level of lead exposure, previously thought to be safe, have adverse effects on neurobehavioural and cognitive development of the child. Aim: This study was a clinical study composed of children who were likely to be at higher risk for lead exposure. To correlate Blood lead levels with the clinical profile, developmental and behavioral profile and bio-chemical parameters of these children. Materials and methods: Patients attending Niloufer hospital, Hyderabad were evaluated for pica were considered to be at risk for inorganic lead poisoning and Children who working at petrol bunks were at risk of Organic Lead poisoning Results: Children of lower socio-economic state of classes of 3 and 4 and those living poor housing conditions are associated with high blood lead levels than children of higher and those in good housing conditions. Pica children had significantly higher blood levels, more behaviour problems and lower hemoglobin levels than controls. Pica particularly for multiple (mud, plaster, coal) and duration of habit for more than 6 months are associated with high blood lead levels. Children working in petrol bunks for more than 1 year showed a high Blood Pb levels and low hemoglobin levels than those working for less than 1 year and controls. Children of petrol bunk group, showed more behavioural problem and significant organic impairment and low intelligence than controls. Children of petrol bunk group, similar to pica group showed a high Blood Lead levels. Conclusion: Present study suggests that oral ingestion in an important route of inorganic poisoning in children with pica, where inhalation through respiratory passages and absorption through intact skin is an important route of organic lead poisoning in children working in petrol bunks or automobile garages-by virtue of their occupation.