Patients Of group-B Research Articles

Comparison of Outcome of SAC Ligation Versus No SAC Ligation in Pediatric Patients Undergoing Inguinal Orchidopexy for Incompletely Descended Palpable Testes: A Randomized Control Trial

Background and Objective: The case of undescended Testis (UDT) is one of the most common condition presented to a pediatric surgeon. The standard procedure to rectify UDT is known as Orchidopexy. The main objective of this study is to examine and compare the results of orchidopexy surgeries conducted with or without sac ligation in palpable undescended testis of pediatric patients.Methods: This randomized controlled trial was done over a period of 12 months (July 2018 to July 2019) atthe Department of Pediatric Surgery, Children's Hospital & Institute of Child Health, Lahore. The selection of cases was made dependent upon fulfillment of departmental criteria and approval by ethical review committee. Consequently, 280 cases divided into two equal groups i.e. Group-A and Group-B (140 cases in each group) were shortlisted for the study after detailed scrutiny. The allotment of patient to above mentioned groups was randomized by lottery method. The patients in Group-A underwent orchidopexy with ligation of sac while the patients of Group-B were operated without sac ligated. The surgeries were performed under general anesthesia by consultant surgeons of same caliber and competence. Moreover, in order to quantify and analyze the results of surgeries parameters such as Mean Operative Time, Postoperative Manifestations and recurrence of UDT were recorded on proforma. Subsequently, SPSS version 25 statistical software was utilized for calculating the mean and standard deviation of numerical variables such as age and operative time. Additionally, the frequency and percentage of variables such as recurrent UDT were also calculated. Chi-square test was applied to recurrent UDT and development of inguinal hernia. It is highlighted that P-value ≤0.05 was taken as significant.Results: Among 140 patients of sac ligation group, 40.7% were 1-4 years old and among 140 patients of nosac ligation group, 42.9% were 1-4 years old. In sac ligation group, 60.0% patients had right undescended testis while in no sac ligation group, 67.1% patients had right undescended testis. In sac ligation group, the mean operative time was 37.81 + 8.82 minutes while in non-sac ligation group; the mean operative time was24.34 + 4.12 minutes. In sac ligation group, no patient had post-operative hernia while in non-sac ligation group, 1.4% patients had post-operative hernia (p=0.15). In sac ligation group, 1.4% patients had recurrent UDT while in non-sac ligation group, 2.1% patients had recurrence. (p= 0.65)Conclusion: Study concluded that non-sac ligation technique is more effective than sac ligation technique interms of operative time and should be preferred for patients by surgeons.Keywords: Orchidopexy, undescended testes, testicular atrophy, inguinal hernia, recurrence

OUTCOME OF EARLY INITIATION OF POST-SURGERY FEEDING AFTER COLOSTOMY REVERSAL IN CHILDREN

Background: Children undergoing colostomy reversal surgery often face uncertainties regarding the optimal timing for reintroducing feeding postoperatively. Early initiation of post-surgery feeding is of interest due to its potential to hasten recovery and reduce hospital stay. The impact of early feeding initiation is unclear. Objective of this study was to find out the outcome in terms of hospital stay and post-surgery complications of early initiation of post-surgery feeding after elective colostomy reversal in children. Methods: From 6 Jun 2022 to 10 Oct 2023, a non-randomized controlled trial was conducted at Bahawalpur, analyzing 93 children under 15 years with status colostomy following elective reversal. Patients were allocated to Group-A (traditional oral feeding) or Group-B (early oral feeding) at the surgeon’s discretion, with outcomes including post-surgery hospital stay duration and complications. Results: Out of a total of 93 patients, 49 (52.7%) were boys and 44 (47.3%) girls. Overall, mean age was 4.86±3.27 years. Anastomotic shock was noted among 6 (6.5%) patients while 9 (9.7%) patients had superficial surgical site infection. None of the patients needed repeat surgery for any post-surgery complications. No significant difference in terms of anastomotic leak (p=0.3983), and superficial surgical site infection (p=0.4980) were observed. Significantly shorter duration of post-surgery hospital stay was recorded among patients of Group-B when to compared to Groups-A (6.49±1.14 vs 8.90±1.27, p<0.0001). Conclusion: Early initiation of enteral feeding post elective colostomy reversal in children resulted in significantly reduced duration of post-surgery hospital stay. Pak J Physiol 2024;20(1):30-2

A Comparative Clinico-Pathological Study on CRP Positive Patients W.S.R. to Amavata (Rheumatoid Arthritis) and it’s Management with Vatari Guggulu and Pathyadi Churna

Abstract: Introduction- C-Reactive Protein (CRP) is an acute-phase of inflammatory protein, a highly conserved plasma protein that is named for its reaction with the capsular C-polysaccharide of Pneumococcus. 1 It is an Annular (Ringshaped) Pentameric protein found in blood plasma, whose circulating concentration rise in response to inflammation and of hepatic origin that increases interleukin-6 secretion by macrophages and T-cells.2 Due to this type of inflammatory changes there are stiffness, Pain, Swelling of joints along with generalized symptoms of fever etc. present in the disease like Amavata (Rheumatoid Arthritis). Materials and methods- 30 patients of Group-A (15) and Group-B (15) patients were registered from OPD and IPD of Govt. Ayurvedic College & Hospital, Balangir presented with Subjective Parameter as Sandhi Ruja, Sandhi Shotha, Sandhi Stabdhata, Jwara, Aruchi and Daurbalya and Objective Parameter as CRP>6mg/L, ESR, Hb%, DLC,TLC and Lipid profile test. After diagnosis they were under trial with Ayurvedic formulations of Vatari guggulu given 500mg thrice daily after food in Group A and Pathyadi Churna given 5gm twice daily after food with ushnajala for a period of 30 days with respectively. The subjective and objective parameters were assessed in 10 days interval to interpret the result by statistical evaluation. Observation and results:- It has been observed that the result of trial drug Group-A patients is Significant (p<0.05) to reduce both Subjective and Objective parameter after 30 days of treatment as campair to Group-B patients.

Comparison of intra-articular steroid injection versus hydrodilatation with saline and corticosteroid for the treatment of refractory adhesive capsulitis of the shoulder.

Objective: To compare the outcome of intra-articular steroid injection versus hydrodilatation with saline and corticosteroid for the treatment of refractory adhesive capsulitis of the shoulder. Study Design: Randomized Controlled Trial. Setting: Department of Orthopaedic Surgery, Sahiwal Teaching Hospital Sahiwal. Period: February 2021 to January 2022. Material & Methods: A total of 156 patients with refractory adhesive capsulitis were randomized. In Group-A, patients were treated with intra articular steroid injection alone and in Group-B, patients were treated with hydrodilatation using corticosteroid and saline. The patients were followed up at 3rd, 6th and 12th week and their functional outcomes was assessed in terms of pain and range of motion (disability) using “Shoulder Pain and Disability Index (SPADI)” scoring system. Results: In a total of 156 patients, 81 (51.9%) were females. The mean age was 51.4±10.6 years (ranged between 33 to 68 years). History of steroid intake was reported in 30 (19%) patients. The mean pain scores on the basis of SPADI scoring at 3-week (p=0.0001), 6-week (p=0.0001) and 12-week (p<0.0001) were significantly less in Group-B when compared to Group-A. The disability scores on the basis of SPADI scoring at 3-week (p<0.0001), 6-week (p<0.0001) and 12-week (p<0.0001) were significantly less in Group-B when compared to Group-A. In comparison to Group-A, functional outcomes were significantly better among patients of Group-B at 6-week (p<0.0001) and 12-week (p<0.0001) intervals. Conclusion: Hydrodilatation along with corticosteroid injection were better treatment options when compared to intra-articular steroid injection alone for reduction in pain and improvement in range of motion among patients with refractory frozen shoulder.

LEFT VENTRICULAR DIASTOLIC DYSFUNCTION AND ITS PATTERN IN TYPE 2 DIABETIC PATIENTS WITH AND WITHOUT MICROALBUMINURIA

Objective: To find out and compare left ventricular diastolic dysfunction and its pattern among patients with type-2 diabetes mellitus (T2DM) with and without micro-albuminuria. Methodology: This comparative cross section study was conducted in the outpatient department of Peshawar Institute of Cardiology from August 2021 to January 2022. A total of 228 T2DM normotensive patients, aged 30 to 65 years were enrolled and divided into two groups. Group-A contained 114 T2DM with no-albuminuria and Group-B had 114 T2DM micro-albuminuria patients. Socio-demographic, anthropometric, laboratory character­istics and echocardiographic parameters of all patients were noted. Qualitative variables were analyzed using chi-square test while quantitative variables were analyzed using t-test. P value <0.05 was considered statistically significant. Results: Out of a total of 228 patients, 122 (53.5%) were male. Overall, mean age was noted to be 49.18+8.8 years. In comparison to group-A, duration of diabetes was significantly more among patients of group-B (p<0.001). Renal functions were significantly preserved in Group-A in comparison to Group-B (p=0.003) as shown by eGFR. Left ventricular diastolic dysfunction was found to be 49.1% among patients of Group-A in comparison to 71.1% in Group-B and pattern of left ventricular diastolic dysfunction showed a significant difference between patients of both study groups (0.004). Conclusion: Left ventricular diastolic dysfunction was significantly high among T2DM patients with micro-albu­minuria. Significant associations were found in terms altered left ventricular diastolic echocardiographic features among T2DM patients with micro-albuminuria.

Comparison of Frequency of Sore Throat and Cough after Prophylactic Lignocaine and Beclomethasone in Adults

Objective: To compare the frequency of sore throat and cough after prophylactic Lignocaine versus Beclomethasone in adults undergoing tracheal intubation.
 Study Design: Prospective longitudinal study.
 Place and Duration of Study: Anesthesia Department, Combined Military Hospital, Lahore Pakistan, from Jun to Sep 2019.
 Methodology: A total of 180 patients of both gender scheduled for elective surgery under general anaesthesia with endo-tracheal intubation were recruited for this study. Ninety patients of Group-A received Lignocaine, while 90 patients of Group-B received Beclomethasone. After 24 hours of the procedure, sore throat and cough were assessed from both groups and noted.
 Results: The age range in this study was from 18 to 50 years, with a mean age of 34.22±5.31 years in Group -A while 36.57±7.22 years in Group-B. Sore throat was seen in 22(24.4%) patients in Lignocaine-Group (Group-A) as compared to 9(10.0%) patients in Beclomethasone-Group (Group-B) (p=0.010). Cough was seen in 18(20.0%) patients in the Lignocaine-Group as compared to 5(5.6%) patients in the Beclomethasone-Group (p=0.003).
 Conclusion: This study concluded that spraying Beclomethasone on the endotracheal tube reduces the frequency and severity of postoperative sore throat and cough in patients given general anaesthesia with endotracheal intubation.

Effect of Activity (ADL) Modification on Reduction of Pain in Patients with Chronic Non-Specific Low Back Pain

Introduction & Objective: : Low back pain is the commonest cause of activity limitations and absence of work in developing country like Bangladesh. The aim of this study was to chalk out the association between ADL modification with chronic low back pain. Materials & Methods: : This Randomized Clinical Trial was performed in the Department of Physical Medicine and Rehabilitation, JRRMCH, Sylhet. Eighty patients of 30 to 60 years old, fulfilling the selection criteria were included in this study. Patients were divided into two groups after randomization by lottery method. Patients of Group-A were treated with NSAID, Anti-ulcerant & Activity (ADL) Modification while patients of Group-B were treated with NSAID and Anti-ulcerant only. Patients of both groups were treated for six weeks. Main outcome measures were Subjective Pain Intensity Score, VAS, Tenderness Index, Disability due to pain, Spinal Mobility Index and Oswestry Disability Index. Results: Majority of the patients of both groups were 30 to 40 years old (52.5% in Group-A and 47.5% in Group-B). Males were predominant in both groups. While majority belongs to middle socio-economic class, occupationally farmers were majority in both groups (22.5% in Group-A and 20% in Group-B). VAS was better in patients who received instructions about activity (ADL) modification than those who did not receive them. Subjective Pain Intensity Score and Tenderness Index improved in both groups but their difference was not statistically significant. Disability due to Pain and Spinal Mobility Index, both the variables improved at the end of 3rd week and their difference was statistically significant (P<0.05). Conclusion: From the study it can be concluded that Activity (ADL) Modification helps to reduce pain in patients with chronic non-specific low back pain. Medicine Today 2022 Vol.34(2): 140-144

Comparative Evaluation of Efficacy of Chemical Versus Surgical Anal Sphincterotomy in patients with Acute Anal Fissure

Background: One of the common causes requiring hospital admission on surgical floor is anal fissure. The quality of life is immensely affected due to painful defecation and bleeding per rectum. Due to poor response to chemical management, acute anal fissure is now treated with surgical methods. Lateral internal sphincterotomy has now become definitive surgical procedure in the treatment of anal fissures. Aim: To compare the efficacy of chemical and surgical lateral internal sphincterotomy in patients of acute anal fissure. Methods: This study was conducted in surgical unit 1 from January 2020 to December 2020. A sample size of 100 were segregated in two groups of 50 each. Group-a was treated withlocal application of glyceryl trinitrate 0.2 percent ointment and group-b was treated with surgical lateral internal sphincterotomy. Results: Patients were ranged between 15-60 years of age. Mean age of the patients was 36.64±10.05 and 33.42±11.47 in group-a and b respectively. In group-a, 13 patients (26%) and in group-b 15 patients (30%) were male and 37 patients (74%) in group-a and 35 patients (70%) were female. Efficacy was observed in 16 patients (32%) of group-a and 50 patients (100%) of group-b. The p value of <0.001 was found to be statistically significant. Conclusion: In conclusion, surgical sphincterotomy was significantly more effective in providing postoperative pain relief (p<0.001). However, chemical sphincterotomy is a non-invasive, cost-effective, easier to apply, well tolerated and effective therapy for anal fissure and is a first line treatment especially in patients who are unwilling or unfit for surgery. Key words: chemical sphincterotomy, lateral internal sphincterotomy, acute anal fissure

Comparison the Efficacy of Ketamine on the Patients Undergoing Elective Surgery for Prevention of Postoperative Shivering

Introduction: Patients frequently suffer from shivering following surgery. The shivering experienced by the patients may be a natural, thermal regulatory response to central hypothermia or as a result of the release of cytokines during the surgical process. This is unpleasant and occurs following surgery in 30-65% of patients who have received general anesthetics. Shivering increases the muscular activity, O2 consumption, CO2 production and may result in hypoxaemia, hypercarbia and lactic acidosis. It is not only uncomfortable but also cold sensation which is even worse feeling than pain sensation. Objective: To assess the Comparison the efficacy of ketamine on the patients undergoing elective surgery for prevention of postoperative shivering. Material & Methods: In this prospective study was conduct at the dept. of Anaesthesia, Shaheed Tajuddin Ahmad Medical College Hospital, Gazipur, Bangladesh from January to June-2021. Fifty (50) patients included in our study. The inclusion criteria were women aged between 30-65 years and ASA-PS classes I and II. Patients preoperative period were fasted at least 6 hrs and on arrival at OT I/V line was inserted; pulse, BP respiratory rate and SpO2 were recorded. Results: In our study fifty two (52) patients demographic data concerning the patient age, weight as well as duration of anaesthesia and type of surgery were comparable in two groups which are fairly matched. In preoperative situation in Group A mean pulse rate was 79 ±2.4, in Group B 82 ±1.5, mean anterial pressure 92.71±1.05 (Group A), 94.01±1.14 (Group B), SpO2 99±0.56 Group A, 98 ±0.26 (Group B) which showed no significant difference between the groups. In the postoperative period, incidences of shivering were 80.07% & 50% in Group-A and Group-B which are highly significant between the groups P<.001 Cardiovascular parameters SAP, DAP, MAP and SpO2 between the groups were not significant P>.05. The study showed that patients of Group-B were less shivering with good recovery. Conclusion: In concluded that the post-operative shivering are the most common complaints. The aetiology of postoperative shivering is multifactorial including anesthetic, patients and surgical factors. Antishivering prophylaxis may be justified in patients who are at great risk of developing post-operative shivering after general anaesthesia. The incidence of major side effects is not significant in ketamine group and contributes to some extent to post-operative analgesia.

Interdependence of Ischemic Heart Disease with Diabetes and Hypertension, A Clinically Comparative Study

Aims and objectives: The aims and objectives of this study were to raise awareness among persons who have ischemic heart disease and other underlying conditions such as diabetes and hypertension. Methodology: Total 150 individuals of age 50-60 years old were selected for this study. In control group 25 male and 25 females were selected. On the other hand, 75 male and 25 female were in Group-B. All patients of Group-B visited in Cardiology Department of MTI Lady Reading Hospital and Abbottabad International medical college Abbottabad with different cardiac complications like chest pain, high blood pressure, short breathing and sweating etc. Results: In this study different variables were considered and compare these parameters within the group by applying p<0.05 significant regression test. BMI, systolic and diastolic blood pressure, oxygen saturation, intensity of chest pain, smoking habit and random serum glucose levels of both male and female were measured. A significant changes (p<0.05) regarding above parameters in individuals of Group-B were noted as compared with normal individuals of Group-A. Conclusion: In conclusion, there were strong and concrete evidences that diabetes and hypertension are a major risk factors for cardiovascular complications therefore these two metabolic abnormalities were correlated with ischemic illness. There were multiple evidences that structural and biochemical cardiac abnormalities begin in the pre-diabetic state. Keywords: systolic and diastolic blood pressure, oxygen saturation, diabetes mellitus, ischemic heart disease

MULTIPLE VACUUM SYRINGE BLOOD ASPIRATION PROCEDURE (MVSBAP): A NEW HORIZON OF RAKTAMOKSHANA PROCEDURE IN PANCHAKARMA THERAPY OF AYURVEDA

Panchakarma is a specialized branch of Ayurveda that primarily deals with the body's purification (Shodhana) of doshas. As we know, the word Panchakarma refers to five special therapeutic procedures like Vamana, Virechana, Vasti, Nasya and Raktamokshana. Raktamokshana is an effective bloodletting therapy. Classically it is described as of six types, i.e. (1) Shringa, (2) Jalauka, (3) Alabu, (4) Shiravedha, (5) Prachchhana and (6) Ghatiyantra. In the present study, a clinical trial has been done, especially in the disease of Gridhrasi, with particular reference to Sciatica by combining Parchchhana and Ghatiyantra, a modified form of Raktamokshana therapy, called Multiple Vacuum Syringe Blood Aspiration Procedure (MVSBAP). Sciatica is painful neuralgia of the Sciatic Nerve in which pain starts from the gluteal region and buttock and comes down through the back of thigh, knee, calf and outer border of the foot. Sixty patients were selected for the clinical trial using a simple random sampling method from the OPD and IPD of Government Ayurveda College and Hospital, Varanasi, Uttar Pradesh, India. Two groups are made like Group-A and Group-B, each consisting of 30 patients. Patients of Group-A are treated with only traditional Ayurvedic medicines, and patients of Group-B are treated with MVSBAP and traditional Ayurvedic medication. After one month of final treatment, assessment is done on statistical parameters, which show pretty better results in Group-B patients. The application of MVSBAP in the disease of Gridhrasi draws a new horizon to the ailing humanities.

A Clinico-Pathological Study on Pleehodaraw.s.r. to Splenomegaly and its Comparative Management with Sarapunkha Ksharaand Sarapunkha Ghana Vati

Introduction-Udara rogasare classified into 8 types according to different Acharyas.Pleehodarais one among them.The main cause behind the development of Udara rogais ‘Mandagni’. In Ayurveda Pleehodaramay be correlated with Splenomegaly. Sarapunkhaa herbal drug mentioned in Ayurvedaclassics is effective in Pleehodara.So, a comparative single blind study of Sarapunkha Ksharaand Sarapunkha Ghana Vatiare taken into consideration for clinical trial for present study. Aims:To study about the comparative clinical efficacy of Sarapunkha Ksharaand Sarapunkha Ghana Vatiin the management of Pleehodara.Material and Methods-This is a single-blind comparative clinical study with a pre-test and post-test design. The patients were Randomly categorised into two groups.30 patients of Group-A(15) and Group-B(15) patients were registered from OPD and IPD of Govt. Ayurvedic College and Hospital, Balangir presented with Subjective parameters and Objective Parameters. After diagnosis they were under trial withAyurvedicformulations of Sarapunkha Ksharagiven 500mg twice daily after food in Group A and Sarapunkha Ghana Vatigiven 2tab(1 tab-500mg) twice daily after food with luke warm water for a period of 30 days respectively. The subjective and objective parameters were assessed in 10 days interval to interpret the result by statistical evaluation.Observation and Results: It had been observed that the result of trial drug Group-A patients was significant (<0.05) to reduce both subjective and objective Parameters after 30 days of treatment as compare to Group-B patients.Conclusion:On comparison between two groups, Sarapunkha Kshara had shown more effect thanSarapunkha Ghan Vati.No adverse effects were noticed during clinical trial in both groups

Comparative study of use of 32-F, multi-perforated tube drainage of subcutaneous plane versus no drainage, in laparotomy

Background: We are concerned about the wound management and wound healing amongst post-operative patients, as wound complications increase the morbidity of patients post-surgery. Most common wound complications post-surgery are wound seromas, hematomas and surgical site infections (SSIs). SSIs lead to increased hospital stay and increased morbidity alongside increasing unnecessary patient suffering and a decreased quality of life. The underlying principle for the use of subcutaneous drains is based on the belief that removal of serum or debris and eradication of dead space in subcutaneous plane will bring down the rate of infection and wound complications.Methods: A randomized control study was conducted at the General Surgery Department at SGT Medical College, Gurgoan, Haryana. In total, 60 patients were selected (after taking informed written consent) among those admitted to the Surgery Department for laparotomy procedure. Patients were divided randomly into two groups i.e., group-A (study group) and group-B (control group). In group-A patients, subcutaneous wounds were closed over a drain (32-F multi-perforated drain), while in group-B patients no drain was used. Intra-operative and post-operative findings were recorded and analysed to draw study conclusions.Results: SSIs were observed significantly higher among patients without subcutaneous drain (group-B). Patients of group-B had significantly higher incidence of seroma and pus as compared to group-A patients. Experience of pain was reported higher among the patients without subcutaneous drain (group-B).Conclusions: Subcutaneous drains play an important role in reducing the incidence of SSIs, wound complications, wound pain; thereby lead to better healing of the surgical wound.

One inch incision-mesh plug repair versus laparoscopic trans-abdominal preperitoneal repair of the primary indirect inguinal hernia: a prospective comparative study

Background: Management of inguinal hernia by minimally invasive incision and minimal dissection with optimal outcomes remains an unmet need for general surgeons. The most common hernia repair procedures are Lichtenstein hernioplasty and laparoscopic hernia repair; TAPP and TEP. The modification of mesh plug repair (MPR); one inch incision-MPR (OI-MPR); could achieve optimal outcomes comparable to that of laparoscopic hernia repair. The objective of the study was to assess OI-MPR approach for management of primary indirect inguinal hernia and its outcomes in comparison to laparoscopic TAPP repair.Methods: During the period from September 2017 to March 2019, 63 patients with indirect inguinal hernia were selected randomly to one of two groups; group-A included 35 patients underwent one inch incision-mesh plug repair (OI-MPR), group-B included 28 patients underwent laparoscopic TAPP.Results: The mean operative time of group-A was 31.74±4.74 min which was significantly shorter than that of group-B (81.22±7.44 min). The mean hospital stay duration in group-A was 0.57±0.18 day and in group-B, it was 1.18±0.39 day. The patients of group-A returned to normal physical activities earlier than the patients of group-B. The duration of postoperative pain was shorter and less severe in group-A than that of group-B. Regarding complications, there was no statistically significant difference found between both groups.Conclusions: One inch incision-MPR is a simple, feasible and cost-effective approach with low morbidities and low burden on the patients and the healthcare facilities.

Comparing the effect of insulin infusion alone and in combination of insulin infusion with salbutamol nebulization in treatment of hyperkalemia in diabetic and non-diabetic patients

Objective: To evaluate the clinical efficacy and comparison of potassium lowering effect of insulin infusion alone and insulin infusion with salbutamol nebulization. Methods: This interventional study was conducted in a tertiary care hospital, for a period of one year. A total of 190 patients with hyperkalemia were divided into two groups. Group-A (diabetic [D] and non-diabetic [ND] patients) received salbutamol 20 mg three times daily (TDS) (nebulizer 5mg/2.5mL) administered over a period of 15 minutes with 10 units of regular insulin (diluted with 25% dextrose in non-diabetic only) over 30 minute TDS via infusion. Group-B (diabetic and non-diabetic patients) received 10 units of regular insulin (diluted with 25% dextrose in non-diabetic patients only) administered over 30 minute TDS via infusion. Potassium and glucose level was measured in patient blood sample after 0, 6, 12 and 24 hrs of treatment. Results: The potassium level was decreased by 30.09% (D) and 31.98% (ND) in Group-A, whereas by 31.98% (D) and 20.49% (ND) in Group-B, after 24 hrs. Whereas blood glucose level in diabetic patients of Group-A and Group-B was found to decrease up to 28.85 % and 40.78 % respectively after 6 hours. Both the treatments were found to be effective without any complication i.e. hypoglycaemia and hypokalaemia. Moreover, renal, liver, cardiac and respiratory function test also did not show significant changes after treatments when recorded bihourly Conclusion: From the results, salbutamol nebulizer with insulin is more effective in the treatment of hyperkalemia in diabetic and non-diabetic patients.

English

BACKGROUND Diabetic foot is the most common and most feared complication of diabetes and is more significant than nephropathy, retinopathy, heart attack, and stroke combined. Diabetes-associated problems are the second common cause of lowerlimb amputations in India. Foot disorders like ulcerations, infection, Gangrene are the leading causes of hospitalization in patients with diabetes mellitus in India.1 METHODS A prospective study, carried out on 100 diabetic patients with foot ulcers over a period of one year from April 2019 to March 2020 at Sri Venkateswara Medical College hospital. The extent of foot infection was assessed based on Wagner’s classification and were studied based on the culture and sensitivity obtained and the efficacy of the antibiotic used. RESULTS The data analysis of 100 patients has given the following results. 70 % (70 patients) of them were culture positive, and 30 % (30 patients) were culture negative. Culture positive patients were divided into two groups with 35 patients each. Group A started on empirical therapy, Group B on sensitive antibiotic therapy. Repeat swab taken on day 7 from the previously culture-positive patients (70 patients), it was found that 30 out of 35 patients of group-A (empirical therapy) were still culture positive with a similar or newer organism, only 5 patients were culture negative, whereas in 35 patients of Group-B (sensitive antibiotic therapy) only 5 patients were culture positive with a similar or newer organism, remaining 30 patients were culture negative. Sensitive antibiotic therapy was found to be effective than empirical therapy in treatment of diabetic foot ulcers. CONCLUSIONS Culture and sensitivity from the wounds play a critical role in prescribing appropriate antibiotic at the time of admission itself rather than starting the empirical treatment. KEYWORDS Diabetic Foot, Culture and Sensitivity, Empirical Antibiotic Therapy

Effectiveness of Combining Internal Sphincterotomy in Patients Undergoing Open Hemorrhoidectomy

Hemorrhoids are one of the most common presentations of the anal canal [1]. Various treatment modalities have been described over the years. However, still hemorrhoidectomy offers the best chances of permanent cure of symptomatic hemorrhoids.[1, 2] The main complication of hemorrhoidectomy is the pain in the first postoperative week which is very uncomfortable to the patient [3]. The main cause of unpleasant post-hemorrhoidectomy pain is due to the spasm of the internal sphincter that is exposed after open hemorrhoidectomy[4, 5, 6]. Internal Sphincterotomy reduces post hemorrhoidectomy pain by abolishing the hypertonicity (spasm/pressure) of the internal anal sphincter and subsequently reduces the related post hemorrhoidectomy complications[7, 8, 9] The main aim of this study was to compare the postoperative pain and other postoperative complications in two groups of patients treated with open hemorrhoidectomy and open hemorrhoidectomy with internal sphincterotomy. In this Randomised-Control-Trial from October 2018 to April 2020, Group-A underwent open-hemorrhoidectomy and Group-B underwent open-hemorrhoidectomy and internal-sphincterotomy. They were analysed for Visual-Analog-Scale (VAS) for postoperative pain at 12 hours, 24 hours, 48 hours, Day 7, Wexner’s Score for fecal incontinence, duration of postoperative hospitalisation, return to work. Mean postoperative VAS of Group-A at 12 hours, 24 hours, 48 hours, Day-7 was 7.30, 5.03, 2.93, 1.47 respectively. For Group-B, postoperative VAS at 12 hours, 24hours, 48 hours, Day-7 was 6.10, 3.83, 2.00, 1.00 respectively. Mean duration of postoperative hospitalisation in Group-A was 3.6 days and Group-B was 2.6 days. Mean Wexner’s Score for fecal incontinence in Group-A was 0.00 and Group-B was 0.20. Mean duration of return to work in Group-A was 17.43 days and Group-B was 10.23 days. Results were analysed and were found to be statistically significant. Patients of Group-B (open hemorrhoidectomy with internal sphincteroto

Efficacy of Per Rectal Non-Steroidal Anti-inflammatory Drugs to Prevent Post Endoscopic Retrograde Cholangiopancrea-tography Pancreatitis: A Comparative Study

Background and aims: Acute pancreatitis is the most common major post-ERCP complication ranging as high as 10% to 40%. Rectal NSAIDS (Indomethacin or Diclofenac) seem to be the most promising drugs to prevent post ERCP pancreatitis. We performed a trial to investigate the efficacy of indomethacin or diclofenac.
 Methods: A prospective randomized comparative trial was performed at Dhaka from January 2013 to June 2019. Patients undergoing ERCP were randomly selected to group-A and group-B. Diclofenac 50mg suppository was given to group-A patients and Indomethacin 100mg suppository was given to group-B patients during or just after ERCP. The primary outcome was acute pancreatitis following the procedure which was defined by new upper abdominal pain, elevation of pancreatic lipase to at least 3 times the upper limit of normal level 24 hours after ERCP and hospitalization for 02 nights. Retrospective analysis of data of 122 patients who had undergone ERCP in 2012 but had no history of rectal NSAIDS (group C) was done.
 Results: Total 613 patients were included in this study and followed up. Post ERCP pancreatitis developed in 21(8.5%) patients of group-A (n=247), in 19(7.78%) patients of group-B (n=244) and in 20(17.85%) patients of group-C (n=122)(p=0.02). Moderate to severe pancreatitis was found in 08(3.23%) patients of group-A, in 06(2.45%) patients of group-B and in 12(9.83%) patients of group-C(p= 0.01). Administration of these NSAIDS showed clear benefit to reduce occurrence of Post ERCP pancreatitis when compared with no drug group (P=0.01). The efficacy of indomethacin compared with diclofenac was similar (P=0.874).
 Conclusions: Prophylactic use of rectal indomethacin or diclofenac during or just after ERCP significantly reduces the incidence of post ERCP pancreatitis. These NSAIDs are inexpensive, safe and should be used routinely in each patient undergoing ERCP.
 Bangladesh J Medicine July 2021; 32(2) : 99-106

Comparative study between internal and external osteotomy in rhinoplasty

Background: The aim of this study is to compare between internal osteotomy and external osteotomy in patients undergoing rhinoplasty. Methods: The study involved 50 patients, 25 of them had external percutaneous lateral osteotomy, the other 25 patients had internal endonasal lateral osteotomy. The internal osteotomy was done low to high using 4 mm. curved guarded osteotome. The external osteotomy was done low to low using 2 mm sharp osteotome. The grading system of Kara and Gokalan was followed for edema and ecchymosis. Results: The mucosal tear is found in 4 patients of group - A (those who had external osteotomy). (16%), while 20 patients of group-B (those who had internal osteotomy) (80%) had injury to nasal mucosa. In group-A patients only 5 patients (20%) develop periorbital oedema, all were of Grade 2. All the patients of group-B (100%) develop periorbital edema, 2 patients (8%) of grade 4 edema, 10 patients (40%) of grade 3 edema, 12 patients (48%) of grade 2 edema and one patient (4%) of grade 1 edema. The ecchymosis of grade 1 was found in 3 patients of group-A (12%) and in 20 patients of group-B (80%). Conclusion: External osteotomy is preferred over internal osteotomy with less complication rate. It causes much less mucosal injury and significant reduction in periorbital edema and ecchymosis without scar formation.

Comparing SSI In Purse-String Versus Conventional Primary Closure Following Stoma Reversal

Objective: To compare the frequency of Surgical Site Infection ( SSI ) and mean length of hospital stay between the Purse-string closure and conventional primary closure techniques for stoma reversal. Methods: The study was carried out in Surgical Unit-III, Lahore General Hospital Lahore from January 5, 2018 to July 5, 2018. The study designed as a Observational Study. Patients undergoing surgery for Ileostomy were randomly divided into two groups, Group-A (Purse-string closure) and Group-B (Conventional primary closure). All the patients were called for follow up checkup on 14th days after operation and after one month. Both of the groups were checked and recorded for SSI after operation and hospital stay. The data was statistically analyzed by using SPSS v23.0.t test (independent sample) used for the comparison of hospital stay mean. Chi-square was also used for the comparison of the frequencies of SSI. Data were stratified for gender and age. A p-value ≤0.05 was considered as significant. Results: A total of 140 patients were enrolled for this study. Patients were divided into two groups i.e. Group- A (Purse-string closure) and Group-B (Conventional primary closure). In group-A, mean duration of hospital stay was 5.7±1.0 days, while 7.3±1.1 days in group-B, which is statistically significant with a p-value of 0.000. In group-A, surgical site infection was in 4(5.7%) patients, while 11(15.7%) patients of group-B, which is statistically significant with a p-value of 0.046. Conclusion: The frequency of surgical site infection and mean length of hospital stay after stoma reversal, purse-string suturing technique is significantly less than conventional primary closure technique. Key Words: Surgical stoma; Ileostomy; Closure; Infection. How to cite: Nofal S., Arif A., Khan A., Saif. S., Khan W.A., Arif A. Comparing SSI in Purse-String Versus Conventional Primary Closure Following Stoma Reversal. Esculapio 2021; 17(01): 15-19