Sitz Bath Research Articles

Rare manifestations of cutaneous diphtheria: a case report

BackgroundThis case report presents an exceptionally rare and atypical presentation of diphtheria in a 17-year-old female of Hausa ethnicity residing in an area with an elevated incidence within Kano State, Nigeria. By the end of 39th epidemiological week of 2023, only two cases of cutaneous diphtheria have been reported among 5,811 cases managed at MMSH diphtheria treatment center (DTC), representing approximately 0.035% of all diphtheria cases during that time period.Case presentationA 17-year-old Hausa female presented with a 3-day history of throat discomfort, malaise, and muffled speech. Physical examination revealed a pseudomembrane covering the tonsillar pillars, grade 3 tonsillar enlargement, and an unusual genital manifestation characterized by extensive vulval edema, severe pain, and a large, greyish patch extending into the vaginal introitus. Her medical history was significant for recent exposure to diphtheria and the emotional impact of her sibling's death from the same disease. Diagnostic tests, including throat swab culture and histocytology, confirmed diphtheria in the throat and vulvovaginal regions. The patient was promptly initiated on diphtheria antitoxin, Azithromycin, and innovative sitz baths with hydrogen peroxide. After 4 days of Sitz bath therapy, complete pseudomembrane clearance was observed, and the patient's symptoms resolved.ConclusionThis case underscores the complexity of diphtheria presentations, particularly with rare pseudomembranes in both throat and vaginal regions. The successful management, combining traditional and innovative therapies, highlights the importance of recognizing and addressing unusual manifestations promptly. The potential role of auto-inoculation and the efficacy of interventions like hydrogen peroxide sitz baths warrant further investigation. Overall, this case contributes to the understanding of diverse diphtheria presentations, guiding future clinical strategies for management of diphtheria cases and emphasizing the imperative of comprehensive vaccination efforts.

Effects of Far Infrared Radiation and Sitz Bath on Perineal Wound Healing and Pain in Primiparous Women Undergoing an Episiotomy: A Randomized Prospective Parallel Arm Study.

Introduction Episiotomy is a common surgical procedure done during childbirth. The study aims to assess the efficacy of far-infrared (FIR) and sitz bath (SB) effects on pain relief and healing of perineal wounds in primiparous women who had undergone an episiotomy. Materials and methods A randomized prospective parallel arm study was conducted among 208 primigravida women who underwent episiotomy in a tertiary hospital in the southern part of India from December 2020 to March 2022. Participants were randomized into the FIR (n-104) and SB therapy groups (n-104) and their efficacy was assessed for pain relief and healing of perineal wounds using the Visual Analog Scale (VAS), Redness, Oedema, Ecchymosis, and Discharge, the Approximation Scale (REEDA) and the Modified Oxford Scale (MOS). The variables were compared using an independent two-sample t-test and chi-square test (p ≤ 0.05). Results Pain was evaluated using VAS, and by the sixth week postpartum, 90.4% (94) of the FIR group reported mild to no pain compared to 88.5% (92) of the SB group. Wound integrity assessment using the REEDA scale showed better results among the FIR group (94, 90.4%) than the SB group (93, 89.4%) on the second day postpartum. Perineal muscle tone, measured by the MOS, was slightly better in the FIR group (59, 62.8%) than the SB group (55, 59.8%) at the sixth week postpartum, although these differences were not statistically significant. Conclusion FIR therapy reduces postpartum discomfort, promotes wound healing, and improves perineal muscle tone better than SB therapy. FIR also enhanced patient compliance and efficacy.

Comparative Evaluation of Effects of Oral Diltiazem and Topical Diltiazem (2%) Ointment in the Treatment of Chronic Anal Fissure: A Prospective Randomized Study.

Fissure-in-Ano is a common condition of the anorectal region. Most of the time, it is managed non-surgically. There are various drugs used for the treatment of anal fissures. Calcium channel blockers are one of them that reduce the tone of sphincter muscles. The present study compares the efficacy of oral diltiazem and topical 2% diltiazem ointment in patients with chronic anal fissures. Patients were randomized into two groups. Group A (n=25) received treatment in the form of oral diltiazem, while group B (n=25) received treatment in the form of 2% (weight/volume) diltiazem ointment for local application in addition to other conservative methods like sitz bath and stool softeners. Outcomes in the form of success of treatment and complications were assessed. Statistical analysis was done using MedCalc software version 14.0. P value of<0.05 was considered significant. The mean age of patients was 32.00±10.67 years in group A and 30.64±9.53 years in group B. Pain relief was significantly better in group B than in group A at the end of the first week (P=0.00018), but at the end of 6th week, no significant difference was observed. Fissure healing was more significant in group B than in group A after 6 weeks (P=0.0152). Local diltiazem ointment is a better option than oral diltiazem for anal fissures with respect to better outcomes and lesser complications.

Extensive Fournier’s Gangrene Due to Delayed Management of Perianal Abscess in Uncontrolled Diabetes: A Case Report

Abstract Fournier’s gangrene is a rapidly spreading gangrene predominantly affecting the genital and perianal region. It has the highest mortality and is more common in immunocompromised and diabetic patients. Poorly controlled diabetes is one of the common risk factors for Fournier’s gangrene. Delayed diagnosis and treatment increase mortality by nearly 100%. In our case, the patient was initially managed for a perianal abscess and later progressed to Fournier’s gangrene. A 48-year-old male diabetic presented with erythematous swelling in the right-side scrotal region for one-week duration. He had a recent perianal abscess and underwent incision and drainage at another hospital He also reported fever with chills and rigors for the past two days. The patient is now in a state of septic shock. He has a history of irregular medication for type 2 diabetes mellitus. Clinical examination confirmed Fournier’s gangrene resulting from a perianal abscess in the context of uncontrolled diabetes. The patient underwent an emergency wound debridement under spinal anesthesia. Extensive wound debridement was performed on the right hemiscrotum. Necrotic tissue was debrided on the right perianal region. The patient was initiated on empirical antibiotics, receiving a calculated dose of cefoperazone with sulbactam and metronidazole. Additionally, the patient underwent sitz baths and received regular wound dressing. Following wound debridement and glycemic control with insulin, the patient showed signs of improvement. Four weeks post-debridement, the patient underwent split-skin grafting for the raw area on the scrotum, while the fistula site was allowed to heal by secondary intention. The cornerstone in managing perianal abscess with Fournier’s gangrene in diabetic patients is extensive wound debridement, antibiotic coverage, and proper management of diabetes. Early diagnosis and prompt surgery of perianal abscess can reduce the risk of developing Fournier’s gangrene in diabetic patients. Post-surgical raw areas can be effectively managed with split-skin grafts.

A case report of primary complex anal fistula with six external openings (Shataponaka bhagandara) treated with interception of fistulous tract with application of Ksharasutra technique

Complex anal fistulae, particularly those with six external openings, are rare, with limited documented cases in medical literature, highlighting the clinical novelty of such presentations. Managing these complex fistulae possesses a significant challenge, often requiring intricate surgical procedures that carry a heightened risk of postoperative damage and recurrence, with traditional approaches potentially compromising patients’ quality of life due to the risk of anal incontinence. In this report, a unique case of a 65-year-old male admitted with recurrent perianal boils and on-and-off pain fortwo years is presented. Visual and digital rectal examinations revealed a complex fistula-in-ano with six external openings, emphasizing the rarity of such cases. Conventional treatments were deemed suboptimal for this complex presentation. The patient underwent the Interception of the Fistulous Tract with Application of Ksharasutra (IFTAK) procedure, involving the interception of the fistulous tract and the application of Ksharasutra. Postoperative care included sitz bath, topical application of Jatyadi taila, and oral administration of Triphala guggulu. The patient’s recovery was marked by a gradual reduction in discharge, drying of external openings, and complete healing within eight weeks, with no recurrence observed at the six month follow-up. The IFTAK procedure proves to be a promising and effective intervention for managing rare cases of complex anal fistulae with multiple external openings, showcasing its potential in achieving satisfactory outcomes and rapid wound healing.

Heat Therapy: Concept, Mechanism and Application in Unani Medicine

Background: Application of heat either generalised or localised is among various means employed in Unani medicine for promoting health, preventing as well as treating diseases. The concept of hotness (Ḥarārat) and application of physical heat have been in vogue during different periods of human civilization and it exists even today with certain modifications. Heating Modalities: Unani medicine offers various methods for the application of mild to moderate heat that includes Turkish bath (Ḥammām), massage (Dalk), cupping (Ḥijāma), sitz bath (Ābzan), inducing diaphoresis (Ta‘rīq), douche (Naṭūl), vapour bath (Inkibāb) and footbath (Pāshoya). Application of Heat: Heating modalities are commonly used by Unani physicians for relieving pain and stiffness, relaxing muscles, increasing blood circulation, liquefying the sticky and adherent humours lodged in the peripheral tissues and reducing inflammation. Application of severe heat also finds a place among various modes of treatment mentioned in Unani medicine. Cauterisation (Kayy) is the mode that is employed for the stoppage of bleeding, removing putrefactive matter and destroying lesions. Conclusion: Unani medicine offers classical methods and instruments for heat therapy used for centuries for the promotion of health, prevention and management of diseases. Heat therapy has been found considerably effective in managing certain health problems and diseases.

Myrrh sitz bath for wound healing after hemorrhoidectomy: A retrospective study of adverse effects and treatment outcomes.

Hemorrhoids affect 75% of people worldwide. surgical hemorrhoidectomy remains the definitive intervention for severe cases. Postoperative wound care is critical, and alternative treatments, like Myrrh, are of growing interest due to their potential wound-healing properties. This study aimed to compare the safety, efficacy, and treatment outcomes of Myrrh sitz baths with standard clinical care in promoting wound healing after hemorrhoidectomy. A retrospective cohort study was carried out using medical records from Abha Private Hospital for the period of January-December 2022. The data of patients who underwent hemorrhoidectomy were collected and categorized based on postoperative wound care into two groups: Group A for Myrrh-based wound care as a self-medication and Group B for standard wound care. The study included 67 patients who underwent hemorrhoidectomy. Out of these patients, 52 had standard wound care, while 15 used Myrrh-based wound care as self-treatment without medical advice. The Myrrh group patients were significantly older with more comorbidities. The Myrrh group had significant Grade III wound healing outcomes 9/15 (60%) compared to the standard care group 2/52 (3.8%) (p < 0.001). However, despite the better healing outcomes, the Myrrh group had a significantly higher complication rate 7/15(46.7%) than the standard care group 1/52 (1.9%) (p < 0.001). These results indicate that despite the good healing capacity of Myrrh, cautious usage must be considered. Myrrh sitz baths appear more effective than standard wound care in enhancing healing after hemorrhoidectomy. However, increased complications suggest the necessity for comprehensive evaluation and research on its safety profile. These findings can guide future research and clinical practices related to postoperative wound care.

Case study of Panchvalkala Kwath for Sitz Bath &amp; Abhayarishta, Kumaryasav &amp; Kshar sutra Application in management of Bhagandar w.s.r to Fistula- in- Ano

Fistula in Ano is a chronic inflammatory condition having a tubular structure with opening in the Anorectal canal at one end and surface of perineum or perianal skin on the other end. Any opening in perianal area with chronic pus discharge indicates fistulous tract. Prolong sitting, unhygienic condition, obesity, repeated irritation due to hair may increase the risk of occurrence. In Ayurveda it is correlated with Bhagandar and Acharya Sushruta mentioned five types of Bhagandar. He had explained Shastra karma along with Kshar karma and Bheshaja chikitsa for treatment. Here a case of fistula in Ano in a 21 years male patient was examined in Shalya OPD and treated with Ksharsutra, considering it as an ideal procedure in treatment of Bhagandar as it cuts and curettes the unhealthy tissue present inside the fistulous tract. An Anal fistula can heal more quickly after taking a sitz bath. The warm water helps ease pain and suffering while also reducing inflammation. Moreover, it can aid in maintaining cleanliness in the affected area, lowering the chance of infection. Abhayarishta and Kumaryasav can be used as a laxative to help manage constipation. Keywords: Bhagandar, Fistula-in-Ano, Kshar Sutra, Abhayarishta.

Determinants of the time of ring fall-off in plastibell circumcision: a systematic review

Background: Circumcision, a common surgical operation involving theremoval of the foreskin for religious, cultural, and medical reasons, is oneof the oldest surgical procedures. Delay in plastibell ring fall-off causesunacceptable sequelae such as penile necrosis, amputation, anxiety to thecarers. Several studies have documented the time of fall of plastibell ring;however, there is a dearth of systematic review on the factors that influencethe time of ring fall-off. Aim: In addition to determining the complication of plastibell circumcision,this review aimed to analyse the factors determining the time of ringfall off and how they correlate to the timing of fall off. Methodology: Data was collected from PubMed, EMBASE, and Scopusdatabases using the Preferred Reporting Items for Systematic Reviewsand Meta-Analyses guidelines. Results: The younger infants have an earlier average fall time with 7 daysand 9 days for 3 months and 8 months old infants respectively. Use of asitz bath ensures an average fall-off time of 7 days compared to 9 days ifthe sitz bath was not used. Polypropylene has a shorter fall-off time thancotton and a smaller plastibell thread size causes earlier fall-off. Ringretention and bleeding were the commonest complications with 25.8 and17.1% occurrence respectively. Recommendations: There is need to design algorithms consisting of acombination of these factors affecting the time of plastibell ring fall-offin order ensure the earliest possible time of fall-off. Conclusion: Conclusively, the study showed that the plastibell ring fallsoff earlier for younger infants, with the use of sitz bath, and in case of asmaller plastibell thread.

Management of Chronic Fissure in Ano: A Case Study on Conservative vs. Surgical Treatment Approaches

The conservative treatment arm includes dietary modifications, stool softeners, topical analgesics, and sitz baths. This approach focuses on symptom relief, promoting healing, and preventing recurrence. In contrast, the surgical intervention arm involves procedures like lateral internal sphincterotomy (LIS) or advancement flap repair. These techniques aim to address the underlying sphincter hypertonicity or poor blood supply to the fissure site. The case study will present two patient profiles: one managed conservatively and the other surgically. Parameters such as pain scores, healing rates, time to symptom resolution, and recurrence rates will be compared between the two groups. Additionally, quality of life metrics and patient satisfaction will be assessed. Insights from this case study can aid clinicians in selecting the most appropriate treatment modality for chronic anal fissures, considering factors such as severity, patient preference, and potential risks. Ultimately, the study seeks to contribute valuable evidence to the ongoing debate surrounding the optimal management strategy for this prevalent colorectal condition. Furthermore, the impact on the patient's quality of life and satisfaction with the chosen treatment approach is examined. Through a multidisciplinary approach involving gastroenterologists, colorectal surgeons, and the patient, this case study highlights the importance of individualized care and shared decision-making in managing chronic fissure in ano.

Perbedaan Perawatan Perineum Metode Sitz Bath Ekstrak Daun Pegagan (Centella Asiatica) dan Ekstrak Bunga Telang (Clitoria Ternatea) Terhadap Penyembuhan Luka Perineum Pada Ibu Postpartum

The puerperium is the time between the birth of the placenta and return of organs to their pre-pregnancy state. The postpartum period generally lasts 6-12 weeks after delivery. During the postpartum period, mothers need more attention, because as many as 50% of postpartum mothers experience tears in the birth canal. It is very important to do perineal care because the suture scars of the birth canal can be the entry point for germs and can cause infection. The purpose of this study was to determine the differences in perineal wound healing using the Sitz Bath method using Centella Asiatica leaf extract and butterfly pea flower extract (Clitoria Ternate) in Postpartum Mother. This research is a quantitative research with the type of pre-experimental research with the design of the research design used is the One Shoot Case Study design. The results of this study showed that perineal treatment using the sitz bath method using gotu kola leaf extract and pelang flower extract had a significant difference in perineal wound healing with a significance value (0.043 &lt;0.05), The application of perineal care using the sitz bath method using gotu kola leaf extract and butterfly pea flower extract has been shown to be effective in healing perineal wounds. It is hoped that midwifery services need to develop postpartum care by applying several complementary therapies to help accelerate wound healing.

Early diagnosis and appropriate management of vaginal leiomyoma in rural areas

HIGHLIGHTS Extrauterine leiomyoma, including vaginal leiomyoma, is an exceedingly rare condition with complex pathogenesis and management Clinical evaluation and high-quality imaging are required to confirm the diagnosis of vaginal tumor. If there are insufficient facilities, referrals must be made. Operative management using vaginal approach was described for treating vaginal leiomyoma. ABSTRACT Objective: To describe the challenges of early diagnosis and appropriate management of vaginal leiomyoma in rural areas. Case Report: A 26-year-old woman, P1A0, was referred from a rural hospital and presented a chief complaint of vaginal mass. The patient was admitted to the tertiary hospital with suspected malignant vaginal tumor and underwent a biopsy, which revealed leiomyoma on pathological examination. Despite conservative treatment, the mass continued to grow, unaffected by the menstrual cycle, causing discomfort. Following a second hospital admission, the patient underwent surgical management of extirpation and vaginal reconstruction. The microscopic finding of the tumor showed myositis cell proliferation with hyperplastic growth, monotonous nuclei, and variable cell shapes, supporting the diagnosis of vaginal leiomyoma. During postoperative monitoring, there was no vaginal bleeding. Thereafter, on the day following surgery, it was found that the right labium major was swollen. This was treated with anticoagulants, topical NSAIDs, and a sitz bath. The patient was discharged from the hospital in good condition and had an uneventful postoperative recovery. Conclusion: Although the incidence of vaginal leiomyoma is uncommon, precise early diagnosis and appropriate management might improve outcomes, particularly in rural areas.

Effects of early warm water sitz bath on urinary retention and pain after haemorrhoidectomy: A randomized controlled trial

BackgroundHaemorrhoids are a common chronic anorectal disease, and haemorrhoidectomy is the standard treatment for advanced (grade III and IV) haemorrhoids. Warm water sitz has commonly been used to stimulate urination, cleanse wounds, and decrease pain. Although urinary retention and pain usually occur within the first 24 h after surgery, the warm water sitz bath is provided 24 h after haemorrhoidectomy, which might be a missed opportunity to optimize the quality and efficiency of the care provided. ObjectiveTo investigate the effect of early warm water sitz bath on the day of haemorrhoidectomy surgery on preventing urinary retention and reducing wound pain. DesignThis was a longitudinal double-blind study with a permuted block randomization design. Setting(s)This study was conducted in a surgical ward of a medical center. An average of 18 patients receiving hemorrhoid surgery in that ward every month. ParticipantsA total of 64 participants (32 each in the experimental and control groups) were enrolled. (The first recruitment date is January 16, 2020.) MethodsPatients who received haemorrhoidectomy for grade III or IV haemorrhoids from January to December 2020 were enrolled. The experimental and control groups received the same conventional treatment and care before the haemorrhoidectomy. The experimental group started warm-water sitz bath 6 h after the surgery, and the control group started warm water sitz bath on post-haemorrhoidectomy day 1 as usual. Urinary retention was defined as use of Foley catheter during the hospital stay or remaining urine volume ≧ 300 ml using the bladder scan. A numerical rating scale was used to rate the pain level. Each participant was evaluated 6 times in total until hospital discharge. The data were analysed by descriptive statistics, chi-square test, and independent samples t test. Generalized estimating equations and intention to treat were used to identify changes in urinary retention and pain over time and missing data, respectively. ResultsThere was no significant difference in the degree of change in the number of people with urinary retention between groups. A change in the wound pain index was noted; the study group had a statistically significant lower pain score than the control group (B = −0.81, 95 % CI: −1.44 to −0.18). ConclusionsEarly warm water sitz bath was a safe and effective strategy to decrease post-haemorrhoidectomy pain, but not urinary retention. Nurses could provide early warm water sitz bath for post-haemorrhoidectomy patients' comfort. RegistrationClinicalTrials.gov ID: NCT04535765

Sucralfate plus Metronidazole ointment is as effective as Diltiazem ointment for treatment of acute fissure in ano – an open label randomized clinical trial

Background and objectives. Fissure in ano is one of the most common colorectal diseases seen by surgeons in daily practice. Currently medical management is the first line therapy for treating acute fissure in ano. Apart from general measures, various drugs like nitrates and calcium channel blockers are also used for topical application. Recently topical application of sucralfate and metronidazole are being advocated for in the same way, although there isn't much evidence for their effectiveness. In this study we have compared the efficacy of sucralfate (7% and Metronidazole (1%) ointment to the most commonly used diltiazem (2%) ointment for healing in acute fissure in ano and control of pain. Materials and methods. The present study was a randomized clinical trial with total 96 patients, 47 in the Sucralfate + Metronidazole group and 49 in the Diltiazem group. Both drugs were prescribed for 4 weeks in addition to general measures like sitz bath, laxatives and oral fluids. Patients were followed up at 2 and 4 weeks. Control of symptoms like pain, bleeding and healing of ulcers in both groups were assessed. Frequency or graphs were used for qualitative variables and Mean+/-SD for quantitative variables. Chi-square and t-test was applied for comparison of the two groups, and p-value &lt;0.05 was taken for statistical significance. Results. Most patients were male and belonged to age group 30-50 years. Most patients in both groups improved on conservative treatment. The difference observed in key outcome parameters like control of pain, bleeding and healing of fissure in both groups weren’t found to be statistically significant. Sucralfate and Metronidazole didn’t have any incidence of adverse effects and was cheaper in price compared to diltiazem ointment. Conclusions. Sucralfate and Metronidazole was as effective as diltiazem in treating of acute fissure in ano and can be recommended if allergy and adverse reactions to diltiazem are encountered.

Clinical Study on the Effectiveness of Xian Fang Huo Ming Yin for Treating Cutaneous Infections and Promoting Wound Healing in Patients with Perianal Abscess

Objective: To explore the effect of the Xian Fang Huo Ming Yin (XFHM) for treating cutaneous infections and promoting wound healing in patients with perianal abscesses. Methods: Sixty-one patients with perianal abscesses who were admitted to our hospital (Xinghua City People’s Hospital) from May 2022 to May 2023 were selected and randomly divided into two groups, a control group (30 cases) and a study group (31 cases). Both groups received surgical treatment. The control group received conventional treatment and warm water fumigation, sitz bath, and surgical dressing change after surgery, while the research group received XFHM based on the control group. XFHM was taken orally and replaced with warm water for fumigation and sitz bathing. Both groups received treatment for 4 weeks but discontinued sitz bathing after 2 weeks. Various clinical indicators between the two groups were compared. Results: The total clinical effective rate and wound recovery rate of the study group were higher than that of the control group. There were differences in the wound pain scores, surrounding tissue edema, and wound secretions at different time points. Both groups experienced wound pain. The scores of wound pain, surrounding tissue edema, and wound secretions of the study group were lower than those of the control group, 7 and 14 days after surgery. The serum interleukin 6 (IL-6), tumor necrosis factor-alpha (TNF-α) levels, and pH values of the study group were lower than those of the control group 10 days after surgery (P &lt; 0.05). Conclusion: The application of XFHM for treating cutaneous infections and promoting wound healing in patients with perianal abscesses improved the treatment outcome, alleviated clinical symptoms, and promoted healing.

Integrative management of high transsphincteric fistula-in-ano with a rectal opening: A case report

Abstract Transsphincteric fistula is a type of complex anal fistula, often considered a refractory surgical condition, which has the potential to produce complications, such as recurrent infections, abscess formation, and incontinence. A 48-year-old male farmer was diagnosed with a high transsphincteric fistula abscess with a secondary rectal opening based on clinical examination and magnetic resonance imaging findings. Under saddle block, incision and drainage of fistula abscess was performed, followed by threading of Apamarga Kshara Sutra (medicated seton) between the abscess cavity and the primary internal opening at 6 o’clock on the dentate line. Another internal opening was also identified in the lower rectum, left as it is. Panchavalkala Kwatha for sitz bath once a day, Varunadi Kwatha 20 mL twice a day orally, Kachanar Guggulu (500 mg) two tablets three times a day, and Apamarga Kshara Tail (AKT) dressing was prescribed for 124 days to facilitate optimal healing and management. Prophylactic as well as therapeutic antibiotics and analgesics were administered for 7 days. The fistula took 103 days for complete healing with a unit healing time of 0.251 day/cm3. Medicated seton on the dentate line facilitated drainage of the infected gland and healed the secondary rectal opening. Ischiorectal abscess cavity healed by secondary intention. This case report demonstrates that a high transsphincteric fistula-in-ano with a rectal opening can be successfully managed without fistulotomy to treat the secondary rectal opening. Chemical debridement of the infected anal gland was achieved by a medicated seton, and a new seton was replaced every 7 days until the cutting and healing of the fistula track. It also facilitated the drainage of the exudate. Wound management by AKT and adjuvant medicament supported faster recovery.

A Singal Case Studyon Coccygodynia

Pain in the coccyx region is known as coccydynia or coccygodynia. Coccygeal pain has been documented since the 16th century, according to Simpson, coccygeal pain has been recognised for hundreds of years, treating it can be challenging and occasionally contentious due to the complex nature of coccygeal pain. Its genesis is influenced by numerous physiological and psychological factors. With or without conservative treatment, most occurrences of coccydynia recover within weeks to months, but in a small number of people, the pain can last a long time and be incapacitating. Female gender and obesity have been linked to an increased chance of acquiring the condition. The anatomy, physiology, diagnosis and therapy of coccydynia are briefly discussed in this Study. For individuals with intractable coccyx discomfort, a multidisciplinary strategy including physical therapy, ergonomic modifications, drugs, injections, and potentially psychotherapy has the best chance of recovery. A 26 years old Female patient came in OPD with Symptoms of Pain and tenderness in coccyx region, aggravated with sitting position. In past history a patient is fall down from vehicle in direct vertical position, at this incidous mild discomfort in lower back region, after that gradually increase pain in coccyx region within two days. Patient could not able to seat proper and pain remain constant. So, she came to Govt. Akhandanand Hospital for ayurvedic treatment.The patient was treated with ayurvedic medicines Yogaraj Guggulu, Dashmoolkwath, Tab.bocomo and advise to take sitz bath with luke warm water and use wedge shape cushion on sitting position. The patient was advised to follow up initially after 7 days and later after every 15thdays. After 7 days there were mild pain and no tenderness. After that pain gradually decrease. The pain was completely gone on the third follow up and no any other complaints related to coccydynia.

Risk factors for therapy failure after incision and drainage alone for perianal abscesses in children.

It is well known that recurrent perianal abscesses (PAs) and fistula-in-ano (FIA) are the main causes of therapy failure following incision and drainage (I&D) for PAs. But few studies have focused on the risk factors for therapy failure after I&D for PAs in children. In this study, we retrospectively examine the risk factors for therapy failure after I&D for PAs in children in a pediatric tertiary care institution. A retrospective review of all outpatient children with PA treated by I&D at Beijing Children's Hospital between January 2021 and December 2022 was performed. A follow-up was conducted in October 2023. Patients with other predisposing factors for perianal infection, such as inflammatory bowel disease, hematologic tumor, and anorectal surgery, were excluded from this study. Logistic regression yielding odds ratios (ORs) was used to assess the significance of variables for therapy failure. Of 160 children initially identified, follow-up was available for 146, with a total of 172 treatments. A total of 91% of children were male. The median (interquartile range) age at I&D was 2 (1, 15) months. The median follow-up duration was 20 (14, 25) months. Therapy failure occurred in 25 (15%) treatments performed for the prevention of recurrence of PA and in 35 (20%) treatments for the prevention of development of FIA. In the univariate analysis, a history of PA (P = 0.001), history of I&D (P = 0.014), and multilocal occurrence (P = 0.003) were associated with therapy failure. A sitz bath after I&D (P = 0.016) and regular cleaning of the wound after I&D (P = 0.024) were associated with therapy success. In the multivariate analysis, a history of PA (P = 0.015, OR = 3.374) and multilocal occurrence (P = 0.012, OR = 4.649) were independently associated with therapy failure. Regular cleaning of the wound (P = 0.017, OR = 0.341) and sitz bath (P = 0.001, OR = 0.128) after I&D were independently associated with therapy success. A history of PA and multilocal occurrence were predictor factors for therapy failure before I&D. Regular cleaning of the wound and sitz bath after I&D were protective factors for therapy success. Therefore, regular cleaning of the wound and sitz bath after I&D should be emphasized in all children with PAs, especially in those with a history of PA and multilocal occurrence.

Anal fissures: An update on treatment options.

Anal fissure (AF) is the second most common anorectal complaint in healthcare settings. The presentation might be acute or chronic, characterised by severe pain with defaecation that persists for one to two hours. Non-surgical and surgical interventions are available based on the severity and persistence of the fissure. The aim of this article is to review the pathophysiology, clinical presentation andmanagement of AF under current guidelines. The aetiology of AF is unclear, although it is commonly associated with local trauma or associated chronic conditions. Acute AF is first treated with conservative therapy, including dietary fibre and sitz baths. Addition of topical nitrates, topical calcium channel blockers or botulinum toxin injection is indicated with failure of conservative treatment or at medical discretion. Surgical options are considered if AF persists despite treatment. Most present as hypertonic, but special consideration is needed for hypotonic or secondary presentations.

The Enhanced Activity of a Plant Mixture from the Brazilian Caatinga Biome against Venereal Trichomonads Confirms the Traditional Use

Women living in the semi-arid region of Caatinga in the northeast of Brazil report the use of plant mixtures to treat diseases in the genitourinary tract. Plant extracts were obtained from barks to simulate traditional use. The anti-trichomonads activity as well as the cytotoxic effect of plant extracts were tested. Herein, we confirmed this traditional knowledge by testing plants aqueous extracts against Trichomonas vaginalis and Tritrichomonas foetus, the etiologic agents of human and bovine trichomoniasis. All plant extracts were active individually against at least one trichomonads species except for Prosopis juliflora and Amburana cearensis. Cedrela sp. was the most active against both trichomonads species. Finally, a mixture of plants used in traditional medicine was evaluated for activity. A mixture containing extracts of the plants Ximenia americana, Anadenanthera colubrina var. cebil, Myracrodruon urundeuva, Sideroxylon obtusifolium, and Amburana cearensis was active against the two trichomonads. This finding confirms the traditional practice by women living in the Caatinga region of using a mixture of plants during sitz baths to treat vaginal infections. Altogether, these results highlight the ethnopharmacological use of Cedrela sp. and of the plant mixture for the treatment of venereal diseases by Caatinga residents.