Comparison of the incidence of post-ERCP pancreatitis between combined rectal indomethacin and sublingual nitroglycerin with that of rectal indomethacin alone

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is now widely accepted as a therapeutic modality for benign and malignant diseases of the pancreaticobiliary tree. Acute pancreatitis is the most common and feared complication of ERCP, associated with substantial morbidity and mortality. This study aimed to compare the incidence of post-ERCP pancreatitis in combined rectal indomethacin and sublingual nitroglycerin with that of rectal indomethacin alone. Methods: This was a randomized controlled trial conducted in the Department of Gastroenterology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh during the period from July, 2019 to September, 2020. In this study, 100 hospitalized patients of >18 years age undergoing ERCP based on clinical indication and proper investigation were included. The study population was randomly divided into two groups - group A (patients who were given indomethacin suppository plus sublingual glyceryl trinitrate) and group B (patients who were given indomethacin alone). Results: In this study, we found that PEP developed in 11 out of 100 patients (11%). Post-ERCP pancreatitis developed in 2 (4%) in group A and 9 (18%) in group B (p=0.025), which was statistically significant. Mild PEP developed in none in group A and 4 (8%) in group B whereas moderate in 2 (4%) in group A and 3 (6%) in group B. Severe pancreatitis occurred in none in group A and 2 (4%) in group B (p=0.231) which was not statistically significant. Conclusions: This study showed that the combination of indomethacin suppository and sublingual GTN is superior to indomethacin suppository alone in preventing post-ERCP pancreatitis.

Effects of Estrogen and Folic Acid on High Fat Induced Hypercholesterolemic Mice.

Aims: To elucidate the effect of estrogen and folic acid on high fat (butter) induced lipid profile (total cholesterol (TC), low density lipoprotein (LDL), high density lipoprotein (HDL), and triglyceride (TG)) and on tissue texture changes in mice. Designs: Randomized block design. Place and Duration of Study: Department of Physiology and Department of Pathology, Faculty of Veterinary Science, Bangladesh Agricultural University, Mymensingh-2202, Bangladesh between January 2012 and April2012. Methodology: 2 months old 50 male Swiss Albino mice (Mus musculus) were used for this study and divided into equal groups. Group A (control) was fed with normal rat pellet. Mice in the group B was fed with butter; group C was fed with butter and estrogen; group D was fed with butter and folic acid and group E was fed with butter, estrogen and folic acid. The atheroprotective effect of estrogen and folic acid was evaluated based on weight gain, biochemical parameters and histopathology. Results: The highest body weight gain was detected in group B (P<0.001). In biochemical study, group B showed the increase in total plasma cholesterol, especially low density lipoprotein (LDL), and triglyceride (TG) (P<0.001) compared to other treated groups. Group C, D and E showed a lower level of total plasma cholesterol (P<0.001) compared to group B. Among them group E showed the lowest total plasma cholesterol level (P<0.001). In histopathological study, the aorta of butter treated group showed sloughing of lining endothelium, increased aortic wall thickness and loss of integrity of tunica intima. It also revealed fatty changes in liver in animal models fed with butter, compared with those on a normal diet. Conclusions: 20% butter supplementation would be able to cause a rise in lipid profile and produce degenerative changes in aorta and liver and addition of estrogen or folic acid in butter supplemented diet counteracts the adverse effect.

Urogenital anomalies associated with anorectal malformations in children.

The urogenital tract is the most severe and common site of associated defects in anorectal malformations (ARM). Urogenital anomalies and their complications significantly increase the morbidity in these children after the ARM is corrected. The purpose of this study was to estimate the incidence of different types of urogenital anomalies with various types of anorectal malformations and to discuss the possible management and outcome. A retrospective study of patients with ARM and associated urogenital abnormalities admitted in the department of paediatric surgery of Sylhet MAG Osmani Medical College Hospital between 1998 and 2002 was undertaken. A total of 155 patients with Anorectal malformations were admitted of which 47 (30.32%) patients had associated anomalies involving other systems. Urogenital abnormalities were found in 25 (16.13%) patients. Patients of Anorectal malformations with urogenital abnormalities require careful assessment and well-timed intervention to minimize the morbidity.

Congenital Penile Urethrocutaneous Fistula.

Congenital Penile Urethrocutaneous Fistula (CPUF) is an extremely rare anomaly. Commonly congenital urethrocutaneous fistulae are associated with anorectal anomalies and urethral duplication. The posterior urethra is the part, which is mostly affected. To the best of our knowledge, only 11 such cases have been reported so far in the English literature. A case of CPUF with a short review of literature.