Comparison of lateral anal sphincterotomy with 0.2% GTN in chronic anal fissure

Objective: To compare fissure healing and complications in chronic anal fissure with use of lateral anal sphicterotomy and 0.2% GTN. Study Design: Randomized controlled trial. Place and Duration of Study: Combined Military Hospital Rawalpindi and Combined Military Hospital Kohat over a period of 15 months

Material and Methods: Chronic anal fissure was treated with use of lateral anal sphicterotomy after admission to surgical ward and by application of 0.2% glyceryltrinatrate as an outdoor case on 202 patients over a period of 15 months. Sample size was calculated by sample size calculator. Pain was measured using visual analog scale and incontinence to flatus and faeces was inquired from the patients. All cases were called for regular follow up visits but 10 patients failed to report back. Informed written consent was taken from each patient. Inclusion and exclusion criteria were followed. Analysis was done by SPSS version 13 and Chi Square test was applied

Results: Total 202 patients were included in the study and randomly divided into two groups of 101 patients each using random numbers table. Both GTN and sphincterotomy groups revealed significant, but comparable results. Pain relief, fissure healing and incontinence were significantly higher in group B [Lateral anal sphincterotomy] as compared to group A [0.2% GTN]. At the end of 8th week pain relief and incontinence became comparable between both the groups but fissure healing remain significantly higher in group B as compared to group A

Conclusion: GTN when applied to patients produces comparable results if used in long term i.e. eight weeks. It produces adequate symptomatic control and healing of the anal fissures and can be considered equivalent to and one of the recommended treatment options along with lateral anal sphincterotomy in treatment of chronic anal fissure if use for more than 8 weeks. Lateral anal sphincterotomy gives early resolution of symptoms and healing

Intraperitoneal and local infiltration of bupivacaine for pain relief after laparoscopic cholecystectomy

Objective: To compare the effectiveness of intraperitoneal and local infiltration of bupivacaine on pain relief in postoperative period after laparoscopic cholecystectomy. Study Design: Randomized controlled trial. Place and Duration of Study: Combined Military Hospital Multan, from Jan to Dec 2014

Material and Methods: In this study, 72 adult patients of either gender with age between 20 to 60 years having symptomatic gallstones scheduled for elective laparoscopic cholecystectomy were divided into two groups. Patients in group A received intraperitoneal and local infiltration of bupivacaine at the end of surgery. Group B was administered placebo. Postoperatively, intensity of pain was recorded by using 10 points' Visual Analogue Score at 3, 9, 12, 24 hours. A p-value

Results: In group A, there were 27 male and 9 female patients while in group B, there were 22 male and 14 female patients. Mean age was 37.75 +/- 12.49 years and 41.92 +/- 12.73 years in groups A and B respectively. The mean postoperative pain score was 8.18 +/- 1, 6.36 +/- 0.98, 4.98 +/- 1.11 and 3.89 +/- 1.11 in group A and 8.72 +/- 1.05, 6.91 +/- 0.96, 5.92 +/- 0.96 and 4.47 +/- 1.05 in group B at 3, 9, 12 and 24 hours post operatively. The difference in mean pain scores was significant; 0.0286, 0.0188, 0.0001 and 0.0258 at 3, 9, 12 and 24 hours respectively

Conclusion: Intraperitoneal and local infiltration of 0.25% bupivacaine significantly reduces the intensity of postoperative pain and analgesic requirement in the early postsurgical hours following laparoscopic cholecystectomy

frequency of metabolic complications in infant of a diabetic mother

Introduction: Diabetes mellitus is the most common metabolic disorder complicating pregnancy. About 1-14% of all pregnancies are complicated by diabetes mellitus. Metabolic complications are frequently occurring complication in infants of diabetic mother

Objective: To determine the frequency of metabolic complications in infant of diabetic mother

Study Design: Cross sectional study

Duration of Study: January 2016 to June 2016

Setting: Department of Pediatric Medicine Unit-1, Allied Hospital, Faisalabad. Sample size: The total sample size is 295 cases

Sampling Technique: Non probability purposive sampling

Methodology: After taking permission from ethical committee of the hospital total 295 patients who fulfilled the inclusion and exclusion criteria were enrolled in the study. Informed consent was obtained from parents. Demographic details like name, age, gestational age at birth and gender was obtained. Neonates were assessed for presence of metabolic complications by drawing 3 ml venous blood and sending it to pathology lab for blood glucose levels, serum calcium and magnesium. Hypocalcaemia, hypomagnesaemia, and hypoglycemia were assessed as per operational definition

Results: In our study, out of 295 cases, mean age was calculated as 14.09 +/- 4.75 days, 46.44%[n=137] were male while 53.56%[n=158] were females. Frequency of metabolic complications in infant of diabetic mother was recorded as 18.31%[n=54], 7.11%[n=21] had hypomagnesemia and 39.66%[n=117] had hypoglycemia

Conclusion: We concluded that the frequency of hypoglycemia is more common in infant of diabetic mother. However, early diagnoses and start of early treatment may help in reduction of mortality and morbidity of these patients

Appendiceal duplication presenting as acute Appendicitis

Anomalies of appendix are a rare and are usually discovered incidentally during surgery. A 23 year old female was operated for acute appendicitis and per operatively two appendiceal lumen were found. Appendiceal duplication should be kept in mind in patients presenting with acute appendicitis especially when appendix is found non inflamed and in cases where patient has previous history of appendicectomy and presents with signs and symptoms of acute appendicitis

Anti-Tuberculosis therapy induced Liver injury in children

Introduction: Tuberculosis has remained and is one of the major issues of the under developed world including Pakistan. About 10-11 percent cases of tuberculosis are from pediatric population. Isoniazid, rifampicin and pyrazinamide constitutes generally used therapeutic regime. Directly observed treatment short course [DOTS] is now much popular strategy. Ant tuberculosis drug-induced liver injury creates obstacles in treatment and also exerts socioeconomic strain on resources

Objective: To determine the frequency, severity and pattern of the Anti-tuberculosis Drug-Induced Liver Injury in children under 14 years of age

Study Design: Case series study

Duration of Study: 02-10-2015 to 03-10-2016

Setting: Department of Pediatric Medicine Unit-1, Allied Hospital, Faisalabad. Sample size: The total sample size is 100 cases. Sampling Technique: Non-probability purposive sampling. Methodology: Total of 100 patients with either sex from 1 to 15 years of age, on anti-tuberculosis therapy due to any variety of tuberculosis having normal liver anatomy and function initially were studied. Patients already having hepatobiliary disease regardless of etiology were not enrolled in study. Initial diagnosis was confirmed using set criteria. All patients underwent detailed medical history and physical examination followed by investigations. Data comprising age, sex, type of tuberculosis, treatment interval, and hepatotoxicity etc. was collected using designed Performa by the researcher. The data was analyzed through SPSS-20 by means of descriptive statistic

Results: In our study, out of 100 children, minimum age was 6 months and maximum age was 156 months and Mean + SD was calculated as 38.07+/-37.368 months, 51 [53.1 percent] were male and 45 [46.9 percent] were females, ventilator associated pneumonia was recorded in 19 [19.8 percent] while 77[80.2 percent] had no findings of the ventilator associated pneumonia

Conclusion: The frequency of TB DILI was 14.0 percent in this study, indicating the importance of keeping index of suspicion high for the development of hepatotoxicity with anti-tuberculosis therapy in children being treated for any variety of tuberculosis

Morbidity associated with treatment of chronic anal fissure

Objective: To assess the effectiveness of different modes of treatment of chronic anal fissure as regards improvement of symptoms and complications

Methods: This prospective study included 129 consecutive patients with chronic anal fissures presented to the Surgical Outpatients' Department of Islam Teaching Hospital Sialkot, Pakistan; from September 2010 to November 2012. Patients were distributed in three groups. In "OBG group", patients had attended Gynae/Obs OPD and got treated and were then referred to surgical OPD for failure of treatment or recurrence. Patients who presented with history of treatment by GPs were included in "GP Group". "SGR Group" included those who directly reported to surgical OPD for treatment. Patients were managed both pharmacologically as OPD patients and surgically as admitted patients. Patients were instructed to apply small amounts of 0.2% GTN paste in soft white paraffin, to the anoderm with finger tips three times a day. Patients were evaluated at two-week intervals and at each visit the symptoms control, adverse effects and fissure status were recorded. If there was symptomatic relief or the fissure healing was in progress, the treatment was continued for a total duration of eight weeks. Operated patients were nursed in wards after surgery i.e Internal Anal Sphicterotomy. They were advised to report to OPD weekly for one month or earlier if they experienced any symptoms suggestive of complications. Patients were declared cured in case of complete symptomatic relief with fissure healing. Success, failure and associated problems were recorded and analysed to get results

Results: This study included 129 patients who could be followed up for a minimum of three months. These patients were referred by gynaecologist i.e. 22 [17%] for treatment failure while 5 patients with wrong diagnosis were not included in statistical analysis; similarly 41 [32%] patients were referred by general practitioners and 9 patients with wrong diagnosis were excluded. Sixty six patients i.e. 51% were those who directly reported to surgical OPD and had no previous treatment. With surgical treatment, pain, bleeding per rectum and constipation showed significant improvement as compared to GTN ointment application. Fissure healing was 100% in surgical group as compared to 74% in medical group. Complications were recorded and were found to be headache with medical treatment; while the most feared complication with surgical treatment i.e. permanent incontinence was not encountered in our study

Conclusion: Topical glyceryl trinitrate is economical, has a good healing rate, and faecal incontinence has not been reported. Its effectiveness, however, depends on patients' compliance which may be poor in view of associated headaches and a local burning sensation. It is first line of treatment for anal fissure but lateral internal sphincterotomy is superior, more effective and curative than the chemical sphincterotomy. Surgery is reserved for people with anal fissure who have tried medical therapy for at least one to three months but failed

comparative study of physical examination and ultrasonography in determining the size of primary tumours of breast carcinomas

Purpose: This study was conducted to know the role of physical examination and ultrasonography in determining the size of primary breast carcinomas in reference to the pathological size as the size of tumors is important for accurate staging, choosing appropriate treatment options and assessing prognosis

Patients and methods: This was a descriptive study carried out at Jinnah Hospital, Lahore from 01-07- 2001 to 30-03 -2002. A total number of 60 female patients suffering from breast cancer were included in this study. All patients were confirmed by FNAC or biopsy

Results: The mean tumor size [Pathological] was 4.29 cm Ultrasonic size [4.13] was more close to the pathological size as compared to that of measured by physical examination. In the majority of cases ultrasonography under estimated the size while it as over estimated by physical examination [4.85]

Conclusion: We may recommend to sub start some fraction [0.558 cm] from the size, measured by physical examination for the better assessment of the original size. In the same way, we can add some fraction [0.17 cm] to the ultrasonic size for the better anticipation of the original size

Infections in pre-term babies; role of intravenous immunoglobulins

Objective: To determine the effectiveness of I/V immunoglobulins for prophylaxis against sepsis in preterm newborn. Design of study: Prospective study Setting: Department of Pediatrics at Allied Hospital, Faisalabad. Period: From October 1999 to August 2001

Material and Methods: Seventy newborns of either sex, weighing 1000 gms to 2000 gms [mean 1450 gms] with gestational age 28 to 35 weeks [mean 31 weeks] were included and assigned into 2 groups [35 babies in each group]. On alternate basis one group [study group] was given I/V immunoglobulins 500 mg/kg on day 1, 3 and 10 and the other was not [control group]. The serum level of Immunoglobulins was not determined

Results: Maternal and neonatal risk factors for infection did not differ between the two groups. There was a significant difference in development of sepsis [both culture positive and negative] as well as mortality in the study group as compared to control group. The drug was well tolerated without any significant adverse reactions

Conclusion: It is recommended to give intravenous immunoglobulins to preterm babies, for prophylaxis against infections especially in high risk group