Comparison of post-operative pain with topical glyceryl trinitrate cream versus lateral internal anal sphincterotomy after hemorrhoidectomy

Background: hemorrhoidectomy is the surgical treatment for grade III, IV hemorrhoids. Hemorrhoidectomy is notorious for postoperative pain which may be due to spasm of the internal anal sphincter

Objective: to compare mean post-operative pain with 0.2% topical Glyceryl Trinitrate cream versus lateral internal anal sphincterotomy after hemorrhoidectomy

Methodology: Setting: general Surgery ward, Sheikh Zayed Medical College/ Hospital Rahim Yar Khan. Duration: from 4[th] February to 4[th] August, 2015

Design: randomized Controlled Trials. A total of 60 patients with hemorrhoids were included in this study. Thirty patients were in group A and subjected to Milligan-Morgan open hemorrhoidectomy followed by post-operative application of 0.2% topical Glyceryl Trinitrate [GTN] using a measuring spoon, three times a day. 30 patients were included in group B and treated with Milligan-Morgan open hemorrhoidectomy along with lateral internal sphincterotomy. All the patients were followed up to one week for post-operative pain assessment and mean post-operative pain was noted for both groups at 7th day postoperatively. This all data was recorded on an especially designed Proforma. The data was entered in SPSS version 16 and analyzed

Results: mean post-operative pain score was significantly low in group B [2.07 +/- 0.9] as compared to group A [3.17 +/- 1.1] [p=0.0005]. Conclusion: Internal sphincterotomy with open hemorrhoidectomy is an effective method to reduce posthemorrhoidectomy pain as compared to 0.2% topical Glyceryl Trinitrate [GTN] cream

Effect of anterior nasal packing on middle ear pressure and hearing threshold

To evaluate the effect of anterior nasal packing on middle ear pressure and hearing threshold. Prospective study conducted between June and December 2007. Department of Otolaryngology, Al-Adan Hospital, Ministry of Health, Kuwait. Twenty patients of either sex in the age group 18 - 45 years admitted for septoplasty. Pure Tone Audiometry [PTA] and impedance audiometry [IA] were done in all patients preoperatively, 48 hours after surgery with nasal packs in position and seven days after removal of packs. PTA and IA before and after nasal packing. Normal middle ear pressure was observed preoperatively in most of the ears. Forty eight hours after septal surgery with nasal packs in position, 14 ears had abnormal negative middle ear pressure of 100 to 300 mm H2O. Seven days after pack removal, there was marked improvement in middle ear pressure. Hearing threshold remained normal before and after surgery. Nasal packing following septal surgery is a frequent cause of short-term eustachian tube dysfunction but rarely severe enough to cause symptoms of middle ear effusion. Tubal dysfunction is most likely due to peritubal inflammationorstasisofperituballymphaticsand reduced swallowing in the post operative period due to pain. Changes in middle ear pressure following nasal packing associated with most nasal surgeries were transient and not severe. Pure Tone Audiometry [PTA]

Estimation of lactic acid tq assess proper exercise protocols for patients undergoing cardiac rehabilitation therapies

Exercise regiments either for healthy life style or for Rehabilitation therapies, cause stresses resulting in physical and metabolic alterations. It is noted that if some of the extremes of exercise were continued for even prolonged periods, it might easily be fatal. In this regard, three metabolic systems are exceedingly significant in understanding the limits of physical activities, viz, the aerobic system, the phosphagen system and glycogen-lactic acid system. During anaerobic metabolism of glucose, and to acquire ATPs for muscular activities, pyruvate is converted into lactic acid, which diffuses out of the muscle cells into interstitial fluids and blood. A high level of lactic acid in blood is hazardous for acid-base balance of the body. Reconstitution of lactic acid, commonly known as removal of lactic acid from the system, is necessary to avoid metabolic acidosis state. This is especially important because lactic acid cause extreme fatigue. Reconstitution of lactic acid takes place mostly through lactic acid-oxygen debt system. Therefore, to monitor proper exercise protocols, lactic acid levels were analyzed in patients undergoing rehabilitation therapies, especially with cardiac and pulmonary abnormalities, such as COPD, CABG etc. Both male and females patients were selected and grouped according to their clinical conditions, age, exercise regiments and duration of rehab. Their blood samples were collected, pre and post-exercise, processed and analyzed according to prescribed methods Control subjects were also passed through same exercise pattern and their blood samples were also analyzed. The results suggest significant importance of this protocol in cardiac and pulmonary rehabilitation and discussed in light of the observations and outcomes

Effect of high and low isoniazid dosage in the combined treatment of pulmonary tuberculosis

Two randomly selected groups pf patients suffering from moderately advanced pulmonary tuberculosis were treated for six months with 300 or 600 mg. Of isoniazid daily combined with 12 g. of PAS daily. The patients with high-dosage isoniazid were also given 300 mg. of pyridoxine. The results of treatment were assessed as regards sputum conversion and changes in x-ray. There was no significant difference in therapeutic response between the two groups