Stapled haemmorhoidopexy versus open haemorrhoidectomy: our initial experience

Background & Method: We conducted a double blinded study at Index Medical College Hospital & Research Centre, Indore. The sample size was determined to be minimum of 120 cases as based upon previous years admission due to acute bronchiolitis. Initially, 146 cases were included in the study out of which 23 cases dropped out of the study after giving consent by guardian for participation in the study as they left against medical advice from the hospital. Result: The mean difference of CSS between 0 minutes to 60 minutes of nebulisation between groups in all cases was 0.4 ± 0.6, between 60 minutes and 4 hours was 0.8 ± 0.6, between 4 to 8 hours was 0.7 ± 0.6, between 8-12 hours was 0.6 ± 0.4, between 12-24 hours was 1.6 ± 0.9 and between 24-48 hours was 1.9 ± 0.9.The mean values and resultant p-value of ANOVA of various nebulising agents used for improvement in CSS shows significant association between various nebulising agents used along with improvement in CSS at the end of assessment at 48 hours of treatment. Conclusion: This study was conducted to establish the efficacy of each nebulisation agent (i.e.  adrenaline, 3% hypertonic saline and normal saline) currently used and compare the outcomes as there is not enough evidence amongst Indian population on level of efficacy of each drug in causing improvement in symptoms and signs in various severities of bronchiolitis in early childhood. Comparison of significant improvement in mean difference in CSS at various intervals in all cases compared between groups by post hoc test revealed non-significant difference (p-value 0.700) between 3% hypertonic saline and normal saline. Keywords: nebulisation, adrenaline, bronchiolitis & clinical.

Introduction: Seasonal hyper-acute panuveitis (SHAPU) is a sight-threatening disease and its management is challenging. Objective: To study the profile and evaluate the visual outcome of the patients of clinicallydiagnosed cases of SHAPU after treatment. Subjects and methods: A retrospective interventional hospital-based study was carried out involving 21 subjects with clinically-diagnosed SHAPU. The data were retrieved from the record section of the hospital and analyzed. The variables studied were demographic pattern, clinical condition, duration of presentation and visual acuity before and after the treatment. Statistics: The data were analyzed using Epi Info version 2000. Percentage prevalence, mean values with standard deviation, relative risk, 95% CI and p value were calculated. P value of < 0.05 was considered to be significant. Results: Among the 21 cases, the numbers of male and female were 11 (52.4 %) and 10 (46.7 %) respectively. A comparative analysis of gender in children and adults did not show any significant difference (RR=0.47, 95% CI = 0.22 - 1.01, Fisher exact test: p = 0.14). The mean for all ages was 7 ± 12.68 years, while the mean age in pediatric cases was 4.5 ± 3.91 years. Thirteen (61.9%) cases occurred in children below fifteen years. Fifteen (71.4 %) cases reported during September and October. Presenting visual acuity of all cases was less than 3/60. All of them received medical treatment. By the end of the 4th week, seven (33.3 %) patients regained vision to 6/18. Conclusion: SHAPU is more prevalent in pediatric age group. It is equally prevalent among males and females. The visual acuity can improve with early medical treatment. Keywords: SHAPU; panuveitis; steroid; phthisis bulbi DOI: 10.3126/nepjoph.v2i1.3702 Nep J Oph 2010;2(1) 35-38

Background: Herniorrhaphy and hernioplasty are the two most common modalities used with different degree of success and complication rates in the treatment of inguinal hernia. Several studies show that use of mesh is superior to the non-mesh operations in inguinal hernia surgery.It is generally believed that the use of biomaterials should be limited to non-infected surgical fields.Now the concept regarding use of mesh in complicated hernias is changing as shown by many studies. Current study is being planned to observe the outcomes of the mesh hernioplasty in treatment of complicated inguinal hernias in emergency so that in future appropriate and safe technique may be suggested for repair of complicated hernias in emergency setting. Objectives: To compare the outcome of hernioplasty and herniorrhaphy in emergency for the treatment of complicated (Irreducible/obstructed) inguinal hernias regarding wound infection and hospital stay. Material & Methods:… Study Design: Randomized control trial. Setting: Surgical ward, Sheikh Zayed Hospital, Rahim yar khan. Period:09 months from 01-01-2016 to 30-09-2016. Sample Size: A total of 64 patients with 32 patients were included in each group, with confidence level of 95% and power of 80% and anticipated mean level of hospital stay in group 1 of 5±3.4 days versus 3±2.1 days in group 2. Sampling Technique: Non-probability, consecutive sampling. Results: In this study there were total 64 cases with 32 in each group. The mean age was 41.69±11.06 years and the mean duration of hernia obstruction was 12.83±4.97 hours. There was no significant difference in terms of age, duration of hernia and hernial obstruction between both groups. Seroma was seen in 5 (7.81%) out of 64 cases while wound infection was seen in 8 (12.50%) of cases. Seroma was seen in 2 (6.25%) out of 30 cases in herniorrhaphy as compared to 3 (9.38%) out of 32 cases with hernioplasty with p value of 0.64. Wound infection was seen in equally 4 (12.50%) out of 32 cases in both groups with p value of 1.0. Duration of hospital stay was 4.66±1.36 in patients with herniorrhaphy as compared to 4.53±1.37 days with hernioplasty with p value= 0.82. There was no significant difference in terms of age groups, duration of hernia and its obstruction between both groups regarding seroma. There was also no significant association among any of the confounding factors regarding the wound infection and length of the hospital stay between the both groups. Conclusion: We can perform hernioplasty as compared to herniorrhaphy for complicated inguinal hernia with similar complications and better success rates in the same emergency setting.

Aim: This retrospective analysis of the GFR values of the individual moieties obtained by using a novel software with modified GATE’S formula in the in house software created at SSSIHL, compared and evaluated with the value derived by the combined GFR value of the single kidney GFR as obtained from the Icon software loaded in the gamma camera. Materials and Method: This retrospective study of 10patients diagnosed with unilateral double moiety and 5 patients with bilateral duplication was undertaken to validate the modified GATE’S formula in house software created at SSSIHL. This group had 12 males in the age range of 03-66 years with the mean age of 26.5 ± 2 years and 3 females in the age range of 29 – 31 years with mean age of 31 ± 2 years. Renal scans were done using Siemens dual head gamma camera (E.CAM). The radiopharmaceutical 99mTc-DTPA 5 mCi was injected as a bolus intravenously for the adult patients and 3 mCi was injected for the children. The images were obtained and processed by using GFR/Renal differential processing protocol in icon software. Later the raw data of the scan study transferred to the workstation loaded with the in house software created at SSSIHL with modified GATE’S formula created by us. The individual moiety GFR values were calculated using the software with modified Gate’s formula developed in MATLAB GUI algorithm and tabulated. Then the combined value of individual moiety GFR values compared with that of the individual whole kidney GFR value obtained by the Icon software protocol. Result: The T test evaluation done in the online statistical calculator of Maths Portal org revealed that the mean values of the two groups showed no significant difference at p < 0.05. The calculated t value is smaller than the critical value (0.0217 < 2.024), so the means are not significantly different. Pearson Correlation performed between the above two samples using statistical online calculators also showed the correlation coefficient of r = 0.9247 and a mean difference of 0.09 indicating that the high correlation between them. The observed significance p value < 0.0001 at t value of 10.27, showed no significant difference detected between the two samples. Conclusion: It can be concluded that the in house software created at SSSIHL with modified GATE’S formula method of GFR calculating software showed identical values with that of the GFR calculated with the original Gate’s formula. This was found to be useful in calculating the GFR of individual moieties separately in the cases of Double moieties in both Unilateral and Bilateral involvement effectively. The utility and usefulness of the separate estimation of individual moieties GFR needed for Nephron Sparing Surgery.

Background: Surgical management of haemorrhoids is reserved for stage III and IV haemorrhoids. Both Milligan-Morgan technique (CH-Conventional Haemorrhoidectomy) and stapled haemorrhoidopexy technique are used as surgical therapy. Our prospective, comparative study of conventional haemorrhoidectomy versus stapled haemorrhoidectomy was designed in present institution.Methods: This prospective randomised comparative study was carried out in present Surgery Dept from July 2016 to December 2017 with total 60 sample size. All data were analysed according to applicable statistical methods. The results were compared to previous studies so as to arrive at a conclusion.Results: The mean duration of surgery with stapled method was 30.76±3.13 minutes and with conventional method was 49.36±4.08 minutes which was significantly high in conventional method. VAS scores for pain at 12 hours, 24 hours, 72 hours and 7 days for stapled group were 2.63±0.76, 1.66±0.88, 0.90±0.71 and 0.50±0.43 while that for the conventional group were 5.63±0.72, 4.56±1.22, 3.26±1.25 and 2.00±0.69. At all points of time the VAS was significantly lower in stapled group. The mean duration of hospital stay of the patients with stapled method was 3.10±0.75 days and with conventional method was 6.06±0.94 days, which was significantly high in conventional method. The mean time to return to normal activities of the patients with stapled method was 8.16±1.93 days and with conventional method was 12.60±1.67 days, which also significantly high in conventional method.Conclusions: Present study inferred that stapled haemorrhoidopexy is faster, minimally invasive for treatment of haemorrhoids as compared to Conventional haemorrhoidectomy. It is associated less pain and provides a more satisfactory alternative to Conventional surgery because of reduced hospitalisation and earlier return of patient to daily activities, with no significant differences in short term follow up.

Abstract Introduction Percutaneous vertebroplasty has been used for treatment of intractable painful fractures of vertebral bodies. With the help of refined procedures and standard techniques, the interventional radiologist can now offer help to orthopedics and neurosurgeons in these cases, which include treatment of vertebral compression fracture. Vertebroplasty is aimed at reducing the pain induced by collapse. Vertebroplasty is the standard mode of treatment for vertebral collapse, and in our study, bipedicular vertebroplasty was compared with unipedicular approach as bipedicular vertebroplasty is the routinely used approach. Aim To compare efficacy of unipedicular percutaneous vertebroplasty with that of bipedicular percutaneous vertebroplasty. Material and Methods A total of 52 vertebroplasties were done over a period of 2 years. Out of 52 patients, 28 patients underwent unipedicular vertebroplasty and 24 patients underwent bipedicular vertebroplasty. Visual analogue scale (VAS) scores were used to assess the pain prior to vertebroplasty and after vertebroplasty. Efficacy of the two procedures were assessed by comparing VAS scores. Results There was no statistically significant difference observed in the preprocedure and postprocedure VAS scores (p-value < 0.0001, < 0.0001, respectively). The mean procedure time was lesser in unipedicular vertebroplasty (41.9 ± 3.90) than bipedicular vertebroplasty (54.5 ± 3.4). Conclusion Unipedicular vertebroplasty is as effective as bipedicular vertebroplasty, as there is insignificant difference in postprocedure VAS scores between the unipedicular and bipedicular vertebroplasty.

The purpose of this study was to evaluate the inspiratory and expiratory muscle strength of individuals affected by stroke and to compare it with the predicted values in the literature considering their corresponding age. Respiratory muscle strength was evaluated in 22 elderly people who had sequels of stroke, four with right hemiparesis, 16 with left hemiparesis and two with bilateral, of ages ranging from 34 to 82 years. The collected data were submitted to statistical analysis using a Mann–Whitney test to evaluate if there was a significant difference in the average data collected when compared with a mean of the predicted data in the literature. Fourteen men and eight women were evaluated, who obtained mean values of 71.85 cmH2O and 57.75 cmH2O, respectively, for a maximal inspiratory pressure (MIP), and when compared to the predicted values for men and women, 105.41 cmH2O (p-value 0.0019) and 80.57 cmH2O (p-value 0.00464) were significantly lower. For a maximal expiratory pressure (MEP), the mean value obtained for men was 62.28 cmH2O and 49.5 cmH2O for women, whereas the predicted values in the literature were 114.79 cmH2O (p-value < 0.0001) and 78, 46 cmH2O (p-value 0.0059), respectively. In the statistical analysis, it was possible to notice that the studied population did not reach the predicted age indexes and that there was a significant difference between the median columns. In conclusion, there is a weakness in the respiratory muscles of hemiparetic men and women due to stroke.

Introduction: Cigarette smoking is one of the major cause and established risk factor of premature death due to respiratory and cardiovascular illness worldwide. Risk of coronary heart disease is increased by two-to four folds in smoking and tobacco chewing. Smoking and tobacco chewing leads to change in the concentration of serum total cholesterol, triglycerides, LDL, VLDL and HDL. In our present study, the main objective was to assess the blood lipid profile among smokers and tobacco chewers to ascertain cardiovascular risk in Nepal. Methods: It was a hospital based case control study carried out using data retrieved from the register maintained in the Department of Biochemistry of Institute of Medicine Teaching Hospital, Kathmandu, Nepal between 1st January, 2008 and 31st December, 2009. Of the 150 subjects enrolled in this study, 50 were current smokers, 50 were tobacco chewers and 50 were normal healthy controls. The variables collected were age, gender, total cholesterol, triglycerides, HDL, LDL, VLDL. The One way ANOVA was used to examine the statistical significant difference between groups. Post Hoc test LSD used for the comparison of means of control versus case groups. A p-value of <0.05 (two-tailed) was used to establish statistical significance. Results: The mean values of serum total cholesterol (257.5±22.6 mg/dl), LDL (186.6±24.0 mg/dl), TG (139.4±39.8 mg/dl) were significantly higher in smokers when compared to controls. In contrast to that HDL (42.9±1.5 mg/dl) was lower when compared to controls (44.8±1.9mg/dl). The mean values for TG (141.5±34.9 mg/dl), total cholesterol (260.3 ±21.2 mg/dl), LDL (188.5±26.0 mg/dl) in tobacco chewers was significantly higher when compared to controls. Conclusions: The lipid profiles are raised in tobacco chewers and smokers which may lead to higher incidence of cardiovascular disease.  Medical Journal of Shree Birendra Hospital; January-June 2013/vol.12/Issue1/29-31DOI: http://dx.doi.org/10.3126/mjsbh.v12i1.9089           

Most novice programmers consider learning to program as a difficult and challenging field of study for them. As a result, high dropout and failure rates in programming one courses reported. One of the reasons is that most programming (1) courses don’t give equal attention to syntax and semantics of programming language and algorithmic thinking. In this study, a web application based on Problem Analysis and Algorithmic Model (PAAM) was prepared and acquainted in the programming (1) course. The application focuses on problem analysis and algorithmic thinking. The influence on genders' opinion after offering the PAAM model in the programming (1) course determined by organizing a survey. The mean values of the male and female survey respondents compared by performing the T-test. The purpose is to determine if there is any significant difference between the mean values. Results show that students appreciated the web application in the programming (1) course. Male students discerned more positive responses in the survey questions compared to female students. The T-test result shows a significant difference between the values of respondents because the p-value for equal variances assumed is (.000), which is less than p = 0.05. The application encourages a new approach based on four steps (problem statement → problem analysis → problem-solving skills → code) for novices. The application helps students to understand programming structures, program design and comprehension.

Aim: Foramen mentale is the anatomical formation in which the vein and nerve package feeds and provides sensory innervation to the chin and lower anterior lip area. During implant surgery and osteotomy operations, it is important to know the anatomical morphometric characteristics because of mental nerve damage. This study aims to determine whether mental foramen differ depending on age and gender. Method: 100 patients (50 females-50 males) who applied to neu faculty of dentistry and received kıbt for various reasons between 2020-2021 were included in the study. spss program was used for statistical analysis. a p value of <0.05 was considered significant. Results: The mean superoinferior diameter of the right and left mental foramen was 3.20 mm and 3.21 mm, respectively. The mean values were 3.12 mm and 3.18 mm for right and left mental foramen, respectively. It was found that the right and left mental foramen are located between the 1st and 2nd premolars. Anteroposterior and superoinferior diameters of the right and left foramen do not differ according to the localization of the mental foramen (p> 0.05). It was found that the parameters except the superoinferior diameter of the right mental foramen did not show a statistically significant difference according to gender (p> 0.05). It was found that the right mental foramen superoinferior diameter of males was statistically higher than females. (p <0.01). It was found that the anterosuperior and superoinferior diameters of the mental foramen did not vary according to age (p> 0.05). Conclusion: According to the result we obtained from this study, it was determined that the superoinferior diameter of the mental foramen was higher in men. This result will guide for those working in the field of anatomy, oral maxillofacial surgeons and oral maxillofacial radiologists.