Injection sclerotherapy versus rubber band ligation for second degree hemorrhoids

Objective: To compare the efficacy of injections Sclerotherapy [IST] and rubber band ligation [RBL] for the treatment of 2nd degree haemorrhoids in terms of improvement in symptoms severity score [SS score] in OPD patients

Study Design: Randomized controlled trial

Place and Duration of Study: It was conducted in surgical OPD of CMH Kohat, from 15th October 2010 to 10th April 2011

Material and Methods: A total of 116 patients with symptomatic 2nd degree haemorrhoids were randomly divided into two groups, RBL and IST [58 patients each] respectively and a baseline symptoms severity score was noted for each patient. Patients in RBL group were treated with RBL while in IST group were treated with IST. The outcome measures were relief of symptoms and improvement in SS score

Results: In RBL group, baseline SS score was 4.67 +/- 2.01 which reduced to final mean SS score of 1.34 +/- 0.96 whereas in IST group the baseline SS score was of 4.31 +/- 2.13 which reduced to a final mean SS score of 1.6 +/- 0.97. 44 [75.95%] patients had complete recovery and control of bleeding in RBL group; whereas in IST group 32 [55.1%] of the patients had this response by the end of two weeks

Conclusion: Rubber band ligation was found to have better patient outcomes as compared to injections sclerotherapy in treatment of 2nd degree hemorrhoids

Socio-demographic and Clinical Profile of Substance Abusers Attending a Regional Drug De-addiction Centre in Chronic Conflict Area: Kashmir, India

Background: The menace of substance abuse is not only a socially unacceptable reality, but in its entirety is a disease and emerging as a major public health challenge. Objective: To study the socio-demographic and clinical profile of patients attending the drug de-addiction centre. Methods: A descriptive study was undertaken in a drug de-addiction centre at the Police Hospital in Srinagar, and all patients (198) who were admitted during this period were interviewed. Results: The mean (SD) age of patients was 26.8 years (SD 7.37), and over half (56%) belonged to the lower-middle social class. Poly-substance abuse was seen in 91.9%; medicinal opioids and cannabis were the most common substances abused. Most common age of initiation was 11–20 years (76.8%), with peer pressure and relief from a negative mood state being the most common reasons given for starting the drug(s). Prevalence of a co-morbid psychiatric disorder was high, on the order of 49.5%. A high rate of volatile substance use was observed among adolescents (54.5%). Conclusion: A pattern of poly-substance abuse was found to be quite common in patients, and use of volatile substances at a very young age emerged as a new trend. The dreadful repercussions of substance abuse justify the urgency to evolve a comprehensive strategy.

Infrared coagulation versus rubber band ligation in the treatment of internal haemorrhoids - a randomised, prospective study

The aim of the study was to compare the effectiveness, patient tolerance, need and complications of infrared coagulation [IRC] versus rubber band legation in the treatment of uncomplicated internal haemorrhoids. Randomised Control Trial. Study was done at surgical outpatient department of Combined Military Hospital [CMH], Multan, from January 2001 to April 2002. A total of 150 patients with uncomplicated internal haemorrhoids without any concomitant ano-rectal disease were randomized and treated by infrared coagulation [IRC] or rubber band ligation [RBL] in two groups [75 patients in each group]. Infrared coagulation or RBL was performed in one or more session with four weeks interval until symptoms [bleeding and or prolapse] were resolved. Treatment outcome and complications were assessed by proctoscopy and questionnaire. Follow up was made at three months, six months and twelve months. Treatment outcome was assessed in 150 patients. For IRC 71 [94%] patients and for RBL 66 [88%] patients were symptom free after twelve months. Pain following treatment was more common and more severe after RBL than after IRC. Bleeding occurred in both IRC and RBL patient without any significance. IRC and RBL were equally effective in the treatment of internal haemorrhoids. The rate and severity of pain was higher after rubber band ligation. Infrared coagulation should be the first line of treatment for haemorrhoids

Invasive mole as acute abdomen

The disease spectrum in gestational trophoblastic disease [GTD] varies from benign to malignant. In most cases it can be treated successfully but sometimes even a hydatidiform mole can be fatal if it remains unattended. It is an important condition that can be diagnosed and cured with chemotherapy. The gestational trophoblastic disease [GTD is a proliferative anddegenerative disorder of placental elements and includes complete and partial mole [90%] invasive mole [5-8%] choriocarcinoma [1-2%] and placental site tumour [1-2%].[1] World Health Organization classification divides GTD into the premalignant disorders which include partial and complete hydatidiform moles and the malignant disorders of invasive mole which, include choriocarcinoma and placental site tumours. Incidence is higher in Africa and Asia with geographical and racial variations.[2] The reported incidence of molar pregnancies in Europe and North America is 0.2-1.5per 1000 live births