Open versus closed haemorrhoidectomy: evaluation of morbidity and complications

To compare the outcome of open Milligan-Morgan haemorrhoidectomy [MMH] with that of closed Ferguson haemorrhoidectomy [FH] regarding post operative pain, wound healing and complications. Quasi Experimental study design. The study was conducted from 1st of May 2008 to 31st December 2013 at Islamic International Medical college Hospital Islamabad. Forty eight patients suffering from haemorrhoids were divided into two equal groups by consecutive sampling method. In 24 patients [group I] haemorrhoidectomy was done by open method [Milligan-Morgan], and remaining 24 patients [group II] were treated by close method [Ferguson]. Outcome in the two groups such as post operative pain, wound healing, anal stenosis and anal incontinence were compared. Post operative pain was less in group-ll [close] compared to group-l [open]. In group-ll pain score on VAS was 4.8 at 8 hours post operatively which subsided to 2.1 at 48 hours, mean score was 2.9. In group-l post operative pain on VAS was 7.2 at 8 hours which came down to 3.8 at 48 hours, mean score was 5.28. Wound healing in group-ll [close] took 7 to 12 days, while in group-l [open] it occurred in 15 to 25 days. Post operatively analgesia was required for an average 10 days in group-ll, and for 19 days in group-l patients. Anal stenosis and anal incontinence were not noted in either group within 6 months. Close haemorrhoidectomy has shown better outcome compared with open haemorrhoidectomy in terms of post operative pain, analgesic requirement and wound healing. Anal stenosis and anal incontinence are not seen in either group within observation period of 6 months

Medical students perception about the effectiveness of interactive session in small groups

To find out the perception of undergraduate medical students about the effectiveness of interactive sessions in smallgroups. A descriptive cross sectional study. This study was conducted at Islamic International Medical College Rawalpindi from 10[th] April to 12[th] June 2014. A total of 100 students from 3rd and 4th year MBBS were enlisted on first come first basis out of those who volunteered to participate in the study. They were provided with questionnaire [Table I] to give their opinion about the effectiveness of interactive sessions in small groups as learning tool during undergraduate medical studies. Out of the 100 participants 65% considered interactive small group discussions effective, 16.7% were indecisive, while 18.3% disagreed that interactive small group discussions were very effective at undergraduate level in medical education. In students' opinion sessions kept the students attentive [93%], promoted group interaction skills [95%] and promoted critical thinking [63%]. A majority [76%] thought that there was good retention of the subject discussed in an interactive session. In students'opinion it gave them a good chance to evaluate them [71%].It is concluded that interactive group discussions is an effective method of imparting education to medical students at undergraduate level

Early Nasogastric Enteral Nutrition in Acute Pancreatitis

To evaluate the effectiveness and safety of early Nasogastric Enteral Nutrition in patients with Acute Pancreatitis. Randomized controlled trial. The study was conducted at IIMC Hospital Islamabad, and Railways Hospital Rawalpindi from June 2008 to April 2011. A total of 26 patients were studied over the course of 34 months who were admitted with the diagnosis of acute pancreatitis. Patients were divided randomly in two equal groups by consecutive sampling method. One group was given enteral nutrition [EN] through nasogastric tube beginning within 24 hours of admission [group-I], and the other group was provided nutrition through parenteral route [PN] only [Group-II]. Outcome in the two groups such as length of hospital and ICU stay, infective complications, nutrition related complications, metabolic and catheter related complications were compared. Baseline of the study regarding infective complications and mortality were comparable. Average hospital stay was shorter by 22.3% in enterally fed group. ICU stay was also shorter in group-I patients. Significant difference was seen in relief of abdominal pain amongst the two groups, enterally fed [group-I] patients had earlier relief of pain starting on the 3[rd] day, compared to 5[th] day in group-II. Majority of the patients in group-I [84.5%] had pain relief between 4[th] and 9[th] day, while in group-II, 76.8% had pain relief between 7[th] and 12[th] day. Mean pain relief in enterally fed patients was in 7.5 days and in parenteral nutrition group in 10.2 days. Nutrition related complication of diarrhoea was noted in 2 enterally fed patients. Metabolic complications [hyperglycaemia], and catheter related septic complications were seen only in parenterally fed patients. Acute pseudocyst formation occurred in one patient of enterally fed group as noted on follow up. Early enteral nutrition is safe and effective in the management of acute pancreatitis. Enterally fed patients show advantage of shorter hospital and ICU stay, and earlier relief of symptoms compared to patients managed on parenteral nutrition. Our study considers early enteral nutrition feasible and desirable

Honey compared with 1% silver sulfadiazine cream in the treatment of superficial and partial thickness burns

To assess the efficacy of honey compared with 1% silver sulfadiazine cream as a burn dressing for the treatment of superficial and partial thickness burns covering less than 15% of the body surface. In a randomized comparative clinical trial, carried out at the Surgical Department, of Combined Military Hospital, Bahawalpur, from September, 2002 to August, 2003, 50 patients were selected for the study. They were randomly assigned to two groups. Each group contained 25 patients. Patients in group-I were treated with pure honey which was applied once daily after the wound was cleaned with normal saline. Patients in group-II were similarly dressed with a layer of 1% silver sulfadiazine cream once daily. The effectiveness of the two modalities of treatment was judged on the basis of time taken for the wounds to heal, to be relieved of pain and to get sterile. In group-I [treated with honey], 52% of the patients had all the burns healed after 2 weeks and 100% got cured after 4 weeks. In group II [treated with 1% silver sulfadiazine], 20% of the patients had their burns healed after 2 weeks, 60% after 4 weeks and 100% by the end of 6 weeks of the treatment. As regards pain relief, all the patients of group-I were relieved of pain after 3 weeks of the treatment. On the contrary it took 4 weeks for all the patients of group-II to be free of pain. Lastly, it took 3 weeks and 5 weeks for positive swab culture from the wound to get sterile with honey and 1% silver sulfadiazine cream, respectively. With all the three criteria used to compare the effectiveness of the two modes of burn wound treatment, honey was found superior to silver sulfadiazine