A systematic review was employed utilizing Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, to analyze all primary clinical data on the efficacy of spinal cord stimulation (SCS) in the treatment of multiple sclerosis (MS) induced spasticity. Databases include: Embase, PubMed, Scopus, Cochrane, and Web of Science. The review included case series, case studies, and clinical trials. Outcomes of interest were spasticity reduction. Grading of Recommendations Assessment, Development and Evaluation criteria was utilized to grade the certainty of evidence. Five hundred thirty-two articles were retrieved following database systematic review. One hundred eighty-eight articles were removed as duplicates utilizing the “Detect Duplicates” function on Rayyan.ai. A further 344 articles were excluded following abstract and title appraisal. As a result, 16 articles were subjected to full text appraisal. The dates of publication ranged from 1973 to 2019. Although a unique modality, there is not enough evidence to support the employment of SCS over current medical standard of care. Further high-quality randomized control trials are required to elucidate SCS’s role in MS induced spasticity algorithm.

Background: Recent studies suggest that surgical diathermy shows better clinical outcome in the context of incision time, wound related postoperative pain, postoperative wound infections, and length of postoperative hospital stay and cosmetic outcome of scar in cases of elective surgical patients. Objectives: Compare the efficacy and safety of surgical diathermy versus conventional surgical blade for making skin incisions in elective mid-line laparotomy and to evaluate weather cutting diathermy is an effective and better alternative to surgical blade incision. Materials and Methods: This prospective study was carried out in the department of surgery at BSMMU, Dhaka over a period of one year. Sample size was 64 with a follow up duration for 6 month. In Group I (D), skin incision was taken with diathermy, and in Group II (S), incision was taken with surgical blade. Results: Compared with a scalpel incision, cutting diathermy resulted in significantly shorter incision times and reduced post-operative wound related pain (P = <0·001), shorter duration of postoperative hospital stay (P = 0.003) with no differences in the wound complication rate and cosmetic outcome of scar. Conclusions: The study has demonstrated that surgical cutting diathermy is a safe and effective method to make skin incisions in elective surgery KYAMC Journal Vol. 10, No.-3, October 2019, Page 143-146

Background: Cholecystectomy is one of the commonest surgeries in medical practice. Sometimes malignant condition cannot be assessed pre-operatively. Histopathology require for tissue diagnosis. Objective: To assess whether the histopathogical examination is really needed for all bladder specimens resected for cholelithiasis and cholecystitis. Materials and Methods: This observational study was carried out in the General A total number of 95 patients were included in this study. Results: Total of 95 gallbladder specimens were submitted for histopathological examination where 33.7% were males and 66.3 % were females with mean age of 46+12.86 years. Chronic cholecystitis was the most common finding in 91.6% of cases whereas Xanthogranulomatous 2.1%. Six of the gall bladders showed adenocarcinoma (6.3%), of which four had changes on ultrasound and macroscopic gall bladder analysis (MGAS) disturbances were found in 5 cases and 1 case was found incidentally on histopathological examination. On ultrasound, only four (66.66%) and peroperative macroscopic examination by surgeon only 5(83.3%) had a clue of carcinoma. Conclusion: It could be concluded that , routine histopathological examination of gallbladder after cholecystectomy is necessary as USG sometimes can not differentiate neoplastic lesion from inflammatory one.

Background: Preoperative biliary drainage before pancreaticoduodenectomy is a controversial issue. Proponents are in favor of preoperative biliary drainage by ERCP with stent to reduce surgical jaundice with an anticipation of better surgical outcome. Objective: Compare the outcome with or without pre-operative biliary drainage before pancreaticoduodenectomy. Materials and Methods: This observational comparative study was conducted in department of Surgery and Hepatobiliary and pancreatic surgery of BSMMU. Twenty three patients presented with obstructive jaundice due to periampulary carcinoma who subsequently underwent pancreaticoduodenectomy were selected by purposive sampling and finalized by eligibility criteria. Results: Patients with preoperative biliary drainage (PBD) group required a longer operative time (mean 4.12 hours versus 3.83 hours) and had more intra-operative blood loss (mean 662 mL versus 495 mL) compared with non PBD group (P=0.009 and 0.010). No differences were found with respect to operative mortality (4.3%) and incidence of pancreatic leakage (P=0.281). PBD was significantly associated with positive bile culture (P=0.019) and high incidence of wound infection (p=0.029). Conclusion: Preoperative biliary drainage did not increase major postoperative morbidity and mortality but associated with increased operative time, intraoperative blood loss, and incidence of wound infection. Preoperative biliary drainage should be used selectively in patients undergoing pancreaticoduodenectomy. KYAMC Journal Vol. 10, No.-4, January 2020, Page 196-201