Comparison of Topical Glyceryl Trinitrate and Nifedipine in Management of Chronic Anal Fissure

To compare the complete healing of chronic anal fissure by using 2% nifedipine paste and 0.5% glyceryl trinitrate ointment each applied locally for 6 weeks. Randomized Controlled Trail. Surgical Unit-I, Pakistan Railway Hospital Rawalpindi spanning over a period of 06 months starting from March 2011 to August 2011. Seventy six patients of chronic anal fissure were included in the study. Non-probability convenience sampling was used for the enrolment of patients. Patients were divided equally into two treatment groups A and B. Group [A] was treated with topical 2% nifedipine paste and Group [B] was treated with 0.5% glyceryl trinirate ointment. Patients were asked to come for the follow up after six weeks to look for symptomatic improvement and healing rate. All 38 patients included in the study completed the follow up after 06 weeks of treatment in either group. Three patients from Group B experienced intractable headache and were managed by analgesics accordingly but they went on to complete the treatment. None of the patient in group A had any significant side effect causing any adjustment in the treatment. At the end of 06 weeks of treatment, 28 patients in Group A and 25 in Group B showed complete healing of anal fissure. The overall healing rate was 69.75% [n=76]. There was statistically no significant difference at the end of 06 weeks of treatment [p=0.454]. It is concluded that 2% nifedipine paste is as effective as 0.5% GTN ointment in terms of healing of chronic anal fissure

Relation of pain and operative findings in acute gall bladder diseases

Objective: To observe whether duration of pain is a true reflector of operative findings in patients with acute gall bladder diseases

Study Design: Observational analytical

Place And Duration: Surgical Unit-ll, Pakistan Railway Hospital Rawalpindi spanning over a period of 02 years from May 2010 to may 2012

Methodology: 60 patients with acute gall bladder diseases were included through non probability convenience sampling. A proforma was designed to include clinical features, diagnostic work up, treatment plan and operative findings

Diagnostic work up included complete blood picture, liver function tests, hepatobiliary ultrasound. HIDAscan and CTscan was done if needed. Routine hematological and radiographic studies as indicated were performed

Results:: A total of 60 patients were studied and among them majority 83.3%[n=50] were females. In Patients with biliary colic group 41.7%[n=25], Murphy's sign was positive in 56%[n=14] and pathology on ultrasound scan was detected in 84%[n=21] of the patients. In patients with acute cholecystitis, fever 71.4%[n=25], Positive Murphy's sign 71.4%[n=25] and raised total leukocyte count 88.5%[n=31] were the commonest findings. Per operatively 68%[n=17] patients had chronically inflamed gall bladder and 16%[n=4] had acutely inflamed gall bladder among patients having symptoms of less than 12 hours duration. Acute inflammation of gall bladders commonly observed 65.7% [n=23], followed by chronically inflamed gall bladder 28.5%[n=10]

Conclusion: Duration of pain is a strong indicator of operative findings and thus patients outcome

Medications used in the treatment of diarrhoea in children by general practitioners

Diarrhoea is a leading cause of child morbidity and mortality in Pakistan. The optimum management of diarrhoea is therefore of crucial importance for the prevention of deaths and chronic malnutrition in children. This study was carried out to document the current diarrhoea management practices of general practitioners, in order to identify weak areas. This will hopefully help planners of training programmes to develop better targeted training strategy. The drug prescribing practices are being reported in this paper. Our study shows that there is gross overuse of new, expensive and injectable antibiotics. Antidiarrhoeals, which are excessively. Although the prescription of ORS/ORT is high, intravenous fluids are being over used as well. This paper discusses the factors which may be responsible for these prescribing practices

Hazards of asbestos in NWFP magnitude of the problem

Irregularly controlled, small scale mining of asbestos, without any attention to safety measures, is going on in certain areas of North West Frontier Province of Pakistan. Asbestos inhalation can cause asbestosis [one of the pneumoconioses], lung cancer and mesothelioma of the pleura. Therefore, some concern has arisen regarding the hazards to the workers and the surrounding community of this uncontrolled mining of asbestos. A survey was undertaken to asses the magnitude of the problem. Consultant physicians, chest physicians, selected general practitioners, oncologists, and histopathologists were interviewed to document the approximate number of cases related to asbestos inhalation seen by them over different periods of time. The records of the histopatholoy departments of the two teaching hospitals of Peshawar and Institute of Radiotherapy and Nuclear Medicine [IRNUM] were checked for the histologically diagnosed cases of mesothelioma over the past 10 years. The results show that 9 cases of mesothelioma were diagnosed over the last 5 years and 4 of the 9 cases belong to the Mardan area where in Tangi mining is being carried out. The report points to the concern regarding hazards of asbestos in NWFP and urgent measures for controlling mining of asbestos

Usefulness of antibiotics for prevention of post-operative wound infection

A randomized trial was conducted in the Surgical Unit of Khyber Hospital, Peshawar to evaluate the role of prophylactic use of antibiotics in preventing post-operative wound infection among surgical patients. The study was intended as a pilot project, which might suggest the need fur further investigation or at least offer some evidence for or against the routine prophylactic use of antibiotics. A group of 95 patients of varying age and socio-economic background, who were operated upon by surgeons of comparable experience, were carefully studied and followed upto five weeks post-operatively. Among the study group, which received antibiotics during post-operative period 15% developed wound infection, whereas in control group which did not receive any antibiotic only 6% developed wound infection. This study failed to demonstrate any benefit which may cuni pensate for the discomfort, expenses and possible dangers associated with the prophylatic use of antibiotics following most surgical procedures