Objectives: To evaluate the validity of Fournier gangrene severity index in the assessment of disease severity. Materials and Methods: This Retrospective study was conducted in Pakistan Institute of Medical Sciences Islamabad. In this study we enrolled 35 patients with FG. The primary outcome in our study was mortality rate. Fournier’s Gangrene Severity Index was used to evaluate the severity of disease. The patients were divided into two group survival group and deceased group. Results: Total 36 patients with FG were enrolled, 80.6% were male and 29.4% were female with mean age of 43.30 ±10.5 years. The mortality rate was 19.4%. 41.7% patients had DM, 22.2% patients were smoker and 13.9% patients had high blood pressure. 61.1% cases had anal pain while 33.3% had scrotal pain. The patients were also distinguishing on the basis of origin and it was found that Proctological (72.2%), Urological (19.4%) and Gynecological (8.3%). Using an FGSI cut-off value > 9.5, we find out that the mortality rate was significantly higher in the group with a FGSI score >10 (100%). Practical implication: In this study we find out that FGSI is a reliable and excellent tool for the initial diagnosis of disease. So this study will help the clinical practioner to easily and at initial stages diagnose the disease. Conclusion: It is concluded that FGSI is a reliable and excellent tool for the initial diagnosis of disease. Keywords: Fournier's gangrene, Fournier's gangrene severity index, mortality
Objectives: To compare the effectiveness of 0.2% glyceryl trinitrate ointment versus lateral sphincterotomy in management of patients with chronic anal fissure. Materials and Methods: This Comparative study was done in Irfan general hospital THQ Charsadda, and the duration of this study were from April 2022 to September 2022. In this study 80 patients with anal fissure were enrolled. All the patients were divided into two group by lottery method. Group A patients were treated by lateral sphincterotomy while group B was treated by ointment of 0.2% glyceryl trinitrate. A predesign questionnaire were used to collect data. Results: Total 80 patients were enrolled equally divided in to two groups. Group A had 29 (72.5%) male and 11 (27.5%) female while group B had 23 (57.5%) male and 17 (42.5%) female with mean age of 40.47±10.94 years. Group A had 18 (45%) mild pain and 22 (55%) had severe pain while group B had 19 (47.5%) mild pain and 21 (52.5%) severe pain. 23 (57.5%) and 25 (62.5%) patients had bleeding before treatment. The final comparison after 6 weeks of treatment shows the 65% of patients healed with the lateral sphincterotomy and 52.5% of patients healed with ointment of glyceryl trinitrate. The healed proportion was measured high for the lateral sphincterotomy treatment as compared to the ointment of GTN. Practical implication: In our study we find that lateral sphincterotomy is more effective so this study will help the clinical practioner to select the better treatment option inorder to cure the anal fissure soon. Conclusion: It is concluded that for the treatment of anal fissure, the lateral sphincterotomy is considered an effective treatment as compared to ointment of GTN. Keywords: Chronic anal fissure; Glyceryl trinitrate ointment; Lateral internal sphincterotomy
Objectives: To determine the diagnostic role of ERCP in the management of obstructive jaundice. Materials and Methods: This cross-sectional study was done in Lady Reading Hospital Peshawar. In this study 60 patients with obstructive Jaundice were enrolled from April 2022–September 2022. All the enrolled patients were undergoing ERCP. Results: Total 80 patients were enrolled with mean age of 47.08±12.1 years. Out of total patients 68.3% were male and 31.7% were female. Stenting was done in 43.3% of patients and success rate was 88.5% and failure rate was 11.5%. Stone extractions were done in 20% of patients and success rate was 75.0%. Warm extractions were done in 10% and success rate was 100.0%. Sphincterotomy was done in 13.3% of patients and success rate was 100%. Some post complications were found, and the most common complication was acute pancreatitis that was 6.7%, followed by perforation that was 5%. Other post procedure complication were bleeding and acute cholangitis. Practical implication: In our study we find out that ERCP is an important diagnostic and therapeutic modality for evaluation of patients with obstructive jaundice. In our study the success rate is acceptable for ERCP in the management of obstructive jaundice. So this study will help the health practioner to choose better treatment option inorder to treat Obstructive Jaundice. Despite of its associated complication, ERCP is a reliable method in treating obstructive jaundice. Conclusion: It is concluded that ERCP is a best procedure having an affective role in the management of obstructive jaundice despite of complication. The success rate is in acceptable domain for ERCP in the management of obstructive jaundice. Keywords: Endoscopic retrograde cholangiopancreatography, Obstructive jaundice, Acute pancreatitis, Complication
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