Background: Anal fissure is common condition in general population which cause severe pain at the anal region while defecation and associated with bleeding. These symptoms cause reduction in quality of life with considerable morbidity. The objective of this study was to compare the difference in outcome between open lateral anal sphincterotomy and application of topical 0.2% nitroglycerin ointment for the treatment of chronic anal fissure and their individual efficacy.Methods: 68 cases with a clinical diagnosis of anal fissure were recruited in the study. All selected patients met with inclusion criteria. Thus, selected cases were assigned to one of the other groups by odd and even method. Group A was managed conservatively using topical 0.2% nitroglycerin ointment, whereas Group B underwent open lateral anal sphincterotomy. Both groups were followed up at 3 week, 6 weeks, and 12 weeks, after the treatment.Results: Among all the 68 patients, all patients had come with complaint of pain whereas 31 patients had bleeding per rectum along with pain. On clinical examination, hypertonic anal sphincter elicited in 47 patients, sentinel skin tag was noted in the 23 patients. Group A included 34 patients treated with topical 0.2% nitroglycerin ointment and group B included 34 patients who underwent lateral internal sphincterotomy. In group A, 25 (73.5%) patients treated successfully, 9 (26.4%) patients were uncured who underwent lateral anal sphincterotomy, with no fresh complaints during follow up. By contrast, all patients in group B were successfully treated and only one (0.03%) patient came with unexplained discomfort and one patient suffered from flatus incontinency.Conclusions: This prospective study, demonstrates that open lateral internal sphincterotomy is superior to topical nitroglycerin application in the treatment of anal fissure with good symptomatic relief, high rate of healing with very low rate of early incontinence. Patients who are not willing to undergo surgery the glycerin trinitrate ointment can be used as medical line for fissure in ano.
Background: Anorectal malformations constitute a wide spectrum of congenital anorectal abnormalities ranging from absent anus to anal membranes and fistulae. It is one major indication for the creation of colostomy in early neonatal life. This study was aimed at o describe and highlight the place of colostomy in the management of anorectal malformations. This article also reviews the issues relating to the choice of colostomy in anorectal malformation and common complications. Methods. The study was a prospective study carried put at a tertiary medical centre in Nigeria. It involved patients with a anaorectal malformation requiring the creation of colostomy. Results: A total of 19 neonates with anorectal malformation was seen over the period. The male to female ratio was approximately 1:2 with a female preponderance. Rectovestibular fistula was the commonest indication in females while recto-urethral fistula was commonest indication in males. Elective colostomy accounted for 78.9%. Conclusion: Anorectal malformation is the commonest indication for the creation of colostomy; this is closely followed by hircshsprungs disease. It is usually a part of the staged repair of anorectal malformation. The use of colostomy is acceptable as important in the initial management of patients with anorectal malformation. This affords the neonates the ability to feed and evacuate from the stoma. Complications are common and not life-threatening.
Purpose:This study is to assess the attitude of the medical interns toward psychiatry, psychiatrists and patients with mental health problems.Materials and Methods:A personal data sheet and the Balon et al. questionnaire was used to assess the attitude among medical interns (n = 44) of a medical college in Northern Kerala.Results:There was modestly good attitude toward psychiatry throughout the study. Data were compared between interns who have completed their posting in psychiatry and those who have not. There was no significant difference except for their awareness about consultation liaison services and the authoritative power of psychiatrists in mental health field. The stigma toward psychiatry is on the decline at least among medical professionals, and more interns are interested in taking up psychiatry as a future specialty.Conclusion:Although the study has evidenced a positive attitude to psychiatry, there is still room to improve. A clearer picture could be attained by conducting similar studies in a bigger sample size. A structured curriculum and compulsory internship during the undergraduate course have greatly contributed toward building a more positive opinion of the subject.
Abstract:Behavioral addiction and substance use are on a rise among adolescents throughout the world and co-occurring psychiatric morbidities is an obstacle for treatment seeking and prognosis. The current study aims to find out the prevalence of substance use disorders, excessive internet use among adolescent school students and the factors responsible for it. Adolescents from various schools in a northern district from Kerala were recruited in the study and assessed using Young's Internet Addiction Test, CRAFFT substance use screening test and revised Kuppuswamy's Socio-economic Scale along with a semi-structured questionnaire assessing demographic profile of the individual. On evaluating 803 adolescents, 97 students (13.4%) were positive for IAT with 1.2% of total positives rated as severe, 32.9% rated as moderate positive while rest 65.9% were mild positive. Forty-two students use alcohol i.e. 5.2% of the students sampled. Fifteen students abuse marijuana or hashish while 12 students use other substances (sniffing glue, prescription drugs) Overall prevalence of substance use screened by CRAFFT questionnaire is 8.3%; 1.8% fulfilled criteria for substance dependence according to Diagnostic and Statistical Manual of Mental disorders-Fourth Edition (DSM IV) from total samples. A significant association between substance use disorders and excessive internet study is reported from the current study. Prevalence of substance use disorders and internet addiction is an emerging entity among adolescents and has serious repercussions on the developing brain. A long term effect of internet use on the brain is an area to be explored in the future.
Colorectal cancer is the third most commonly diagnosed cancer and third leading cause of cancer death in both men and women in the world. Metastasis is common in case of carcinoma rectum due to the late arrival of the patient to the doctor. The common sites for metastasis are liver, lung or ovary. But metastasis to the scalp is very rare. A 65-year-old female patient who presented to the casualty with sub-acute intestinal obstruction of four days duration was managed conservatively. Incidentally the patient noticed a swelling over the scalp which was initially of size 1 × 1 cm which progressed to the size of 3 × 3 cm over a period of 2 weeks. FNAC from the swelling showed features of skin adnexal tumor. Excision of the swelling was done, and histopathological examination revealed features of metastatic adenocarcinoma. Colorectal carcinoma can be controlled or treated with frequent screening of any individual who has crossed 50 years with occult stool for blood or by colonoscopy. In this way metastasis can be controlled if we treat at the early stages.
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