Objective: To assess the role of topical antibiotic (mertronidazole) in the treatment of acute anal fissure. Study Design: Randomized Control Trial. Setting: General Surgery Outpatient Department of Aziz Fatima Hospital. Period: January 2020 and March 2021. Material & Method: In this study, patients were divided into two groups randomly. Patients in Group 1 were given only 0.2% GTN ointment and those in Group 2 were given 0.2% GTN ointment and metronidazole cream. All patients’ VAS scores for pain and healing of fissure by examining the peri anal area, as well as any adverse effects of the drugs, were recorded and statistically compared. Patients demographic characteristics, such as age and gender, were recorded. All patients were physically examined at the end of weeks 2, 4, and 6 of treatment. All statistical data analyses were performed using the Statistical Package for the Social Sciences (SPSS) version 23.0. Descriptive statistics were used for comparisons. t test, and chi-square test were used to assess independent samples. A p-value <0.05 was accepted as statistically significant. Results: There were 46 (92%) female and 4 (08%) male patients in Group 1 and 48 (96%) female and 2 (24%) male patients in Group 2. The mean ages of the patients were 35.4±3.7 years in Group 1 and 37.8±4.2 years in Group 2. The mean VAS scores of the patients at the time of presentation to the hospital (pretreatment) were 7.2±1.2 in Group 1 and 7.4±0.9 in Group 2 (p=0.058). The mean VAS scores of the patients at the end of week 2 were 4.6±0.8 in Group 1 and 4.2±0.9 in Group 2 (p=0.058). The mean VAS scores of the patients at the end of week 4 were 3.2±O.7 in Group 1 and 2.4±0.8 in Group 2 (p=0.00004). The mean VAS scores of the patients at the end of week 6 were 2.36+0.65 in Group 1 and 1.86±0.48 in Group 2 (p<0.00054). In Group 1, 6(12%) patients had recovery at week 4 and 26 (32%) patients at week 6 with no recovery seen in 18(36%) patients. In Group 2, 9 (18%) patients had recovery at week 2 and 33(66%) patients at week 4 with no recovery seen in 8(16%) patients. There was a statistically significant difference between these data (p=0.022). Conclusion: We have observed that topical metronidazole along with other traditional management is an fruitful, easy-to-use, safe, rapid and secure option that helps in further reducing pain associated with anal fissure and increasing the healing rate. It is also effective in preventing the anal fissure to become chronic.
Background: Thyroidectomy is one of the most difficult surgical procedures. The study aims to compare the thyroidectomy procedure with drain placement and without drain concerning the hospital stay, Postoperative complications, and pain assessment using a visual analog scale. Methods: A prospective comparative study was designed in the Department of otorhinolaryngology & Head Neck Surgery---removed for blind review----. A total of 117 patients were enrolled in the study from which 9 were excluded due to loss of follow-up. The patients were divided into two groups by using computer-generated randomized numbers containing sealed envelopes. Both groups contained 54 patients. Group A patients with a drain placed while group B contained patients without a drain. The patients with drain have a longer hospital stay and reported increased pain as compared to the patients with drainless thyroidectomy. Results: The mean age and standard deviation calculated for the patients enrolled in both groups after randomization was 13.28 42.5 and 12.18 43.9 in groups A and B respectively. The mean ages were statistically insignificant. However, Postoperative variables such as length of hospital stay and post-operative pain by visual analog scale were assessed. The hospital stays of the patients with a drain placed was found statistically significant with a P-value < 0.05 Postoperative pain assessed by visual analog scale was also significant having a P-value <0.05 for patients having stayed for 2 to 4 days. Conclusion: Placement of drain after thyroidectomy saves the patient from life-threatening complications but at the same time increases the post-operative pain on day one and increases the length of hospital stay of the patient. The routine practice of drain placement should be avoided unless there must be a risk of the development of hematoma or seroma.
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