Home > A Double-Blind Randomized Controlled Trial Comparing Effectiveness of 0. 2% Topical Nifedipine Versus 0. 2% Topical Glyceryl Trinitrate in the Treatment of Chronic Anal Fissure
A Double-Blind Randomized Controlled Trial Comparing Effectiveness of 0. 2% Topical Nifedipine Versus 0. 2% Topical Glyceryl Trinitrate in the Treatment of Chronic Anal Fissure
Background: The medical management of chronic anal fissure varies among clinicians because no single treatment has yet approached an overall healing rate similar to lateral sphincterotomy. However, chemical sphincterotomy has the advantage of not carrying the presumed high risk of faecal incontinence. Glyceryl Trinitrate is commonly used in our practice with varied response. This study set out to evaluate the effectiveness of a locally compounded preparation of 0.2% topical Nifedipine in the treatment of chronic anal fissure and to compare the investigational product to 0.2% Glyceryl Trinitrate in overall healing rate and relieving pain. Design: Single centre, parallel, double-blind randomized controlled trial. Setting: The surgical outpatient department at Aga Khan University Hospital (Nairobi). Participants: Patients with chronic anal fissure were recruited from the surgical outpatient department. Intervention: A computer generated randomization sequence was used to allocate treatment. Patients were randomly allocated to receive Glyceryl Trinitrate or Nifedipine, both applied 12 hourly topically to the perianal region for a period of eight weeks. Main Outcome measure: The primary outcome measure was overall healing rate of chronic anal fissure after eight weeks of treatment. Secondary outcome measures were cumulative healing rate, time to resolution of pain and occurrence of headache. Results: There was no significant difference recorded between the test and control drugs with regard to age, gender, duration of symptoms, fissure position or entry VAS pain score. Seventy five patients (Glyceryl Trinitrate n=38; Nifedipine n=37) were randomized. The mean age was 36.3 years (SD 11.9) with a mean duration of symptoms of 37.4 weeks (SD 36). Males comprised 48.6 percent of the patients. Seven patients were excluded from analysis because of loss to follow up or missing data, leaving 68 (n=33; n=35) patients for intention to treat analysis. Healing rate was higher (p=0.001) with Nifedipine (94.3 percent) as compared with Glyceryl Trinitrate (60.6 percent). The mean time to healing was shorter (p<0.001) in patients treated with Nifedipine (6.5 ± 1.2 weeks) compared with Glyceryl Trinitrate (9.1 ± 1.9 weeks). The mean pain scores after two and four weeks of treatment differed (p<0.001) with quicker resolution in the Nifedipine group. On completion of treatment at eight weeks, pain scores were significantly lower in both groups (0.25 in Glyceryl Trinitrate and 0 in Nifedipine versus 7.0 and 7.8, respectively). Headaches were more frequent (p<0.001) with Glyceryl Trinitrate (69.7 percent) as compared with Nifedipine. Conclusion: Topical application of 0.2% Nifedipine was more effective than
مولانا سید فخرالدین احمد شیخ الحدیث مولانا سید فخرالدین احمد صاحب کی وفات دینی و علمی دنیا کا بڑا حادثہ ہے، مرحوم ہندوستان کے نامور عالم دین دارلعلوم دیوبند کے شیخ الحدیث اور جمعیۃ علماء ہند کے صدر تھے، ان کی پوری زندگی دینی علوم کی خدمت میں گذری، تقریباً نصف صدی تک مدرسہ مسجد شاہی مراد آباد اور دارالعلوم دیوبند میں ان کا فیض جاری رہا، جس سے سیکڑوں تشنگان علم سیراب ہوئے، مولانا سید حسین احمد صاحب مدنی ؒ کے بعد دارالعلوم کے شیخ الحدیث کے منصب پر فائز ہوئے، درس و تدریس کے ساتھ ملک و ملت کے بھی مجاہد بھی تھے، خلافت اور ہندوستان کی آزادی کے تحریکوں میں نمایاں حصہ لیا اور قید و بند کی مصیبتیں جھیلیں، تدین و تقویٰ میں سلف صالحین کا نمونہ تھے، اﷲ تعالیٰ ان کے مدارج بلند فرمائے۔ (شاہ معین الدین ندوی، اپریل ۱۹۷۲ء)
Imam Khattabi is considered as a glorious scholar of the fourth century. He has written several books in various scholarly traditions. One of them an important book is "Ghareeb ul Hadith". In this, he has not only interpreted the difficult words but also referred to as Ayaat, Ahadith and verses etc. Then, he also described the jurisprudential commandments existed in these Ayaat and Ahadith. Furthermore, in many places, hadith terms, legal maxims and wisdom of law are also part of this book. This book also holds a significant correlation with knowledge of Imam Khattabi's teachers because he mentioned the ahadith and sayings of scholars with his own chain. Due to these qualities of this book, not only did the scholars of language use it, but also magnificent mohaddiseen, jurists, explainers and researchers have also quoted it in their own books. Of course, it will not be unwise to say that like previous scholars and mohaddiseen this book is also important and need for today's scholars.
Introduction: Neonatal Mortality in hospitalized patient is one of the major concerns globally. Despite of many initiatives, it is still a health challenge. In Afghanistan, neonatal mortality rate (NMR) is estimated as 45/1000 live births which is alarming and one of the highest rate in the world. This study aimed to identify the causes of mortality and its associated factors among neonates in French Medical Institute for Children, Kabul Afghanistan. Methodology: We conducted an analytical retrospective hospital based study to achieve the current study objectives. We extracted the records of 110 neonates who have died during hospitalization at FMIC due to somatic and/or organic diseases from January 2013 to December 2014. A structured checklist was developed to collect information for different variables. Data was analyzed with the help of Statistical Package for Social Sciences (SPSS) Version 19.0. Chi-square test of independence was run for association between predictors and outcome variables. The study is approved by Institutional Ethical Review Board of Ministry of Public Health. Results: Among all the causes, Septicemia was found to be the leading cause of neonatal mortality and 60% of the neonates had died due to this cause. Following Septicemia, Pneumonia was the next leading cause of neonatal deaths and around 21% of the participants had died due to this second leading cause of mortality. On the other hand, meningitis contributed 10.91% in neonatal deaths. Around 7.27% of the deaths were due to complication of prematurity i.e. respiratory distress syndrome. One of the complications of prematurity was necrotizing Entero colitis which leads to 5.45% neonatal deaths. Ten percent of neonatal mortality was due to birth asphyxia, 10.91% because of meconium aspiration ix syndrome, and only 1.82% deaths due to TGA with closing PDA which is cyanotic type of congenital heart diseases in our study. In addition, this study has also showed that mortality due to Septicemia was significantly associated with birth weight and gestational age. Our research was unable to explore the socioeconomic factors associated with mortality due to Pneumonia.Conclusion: Neonates are the high risk population in Afghanistan. This study has estimated proportions of neonatal mortality due to Septicemia and Pneumonia as 60% and 21% respectively. Immediate and long term actions are required to change the current situation and improve the overall neonatal health at home, facility and hospital levels. The recommendations have implications for ministry of public health to devise relevant and appropriate interventions and policies