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Outcome of Chronic Anal Fissures Treated With Glyceryl Trinitrate at Aga Khan University Hospital Nairobi

Thesis Info

Author

Johnbosco, Ilkul H.

Department

General Surgery (East Africa)

Program

MMed

Institute

Aga Khan University

Institute Type

Private

City

Karachi

Province

Sindh

Country

Pakistan

Thesis Completing Year

2009

Thesis Completion Status

Completed

Subject

Medicine

Language

English

Added

2021-02-17 19:49:13

Modified

2024-03-24 20:25:49

ARI ID

1676728056187

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Background: The medical treatment for chronic anal fissure is modeled to eliminate sphincter spasm and hypertonia so that blood flow to the anal sphincter improves and the fissure heals. Efficacious pharmacological therapy avoids complications related to surgical treatment including incontinence and the risks of surgery and anesthesia. Conservative treatment of chronic anal fissure has been reported with wide variation in the healing rates. However there are few reports of conservatively treated chronic anal fissures fromAfrica, with only one paper identified in this study. Furthermore, the influence of clinical characteristics of fissures on the healing rates and recurrences have not been widely reported. Objective: To determine the healing rates of conservatively treated chronic anal fissure and to document the influence of fissure characteristics on healing and recurrence. Setting: The Surgical Outpatient Clinic at the Aga Khan University Hospital, Nairobi, Kenya. Patients and methods:Fifty (50) consecutive patients satisfying the criteria for chronic anal fissure were treated with local application of 0.2% glyceryl trinitrate (GTN) paste twice a day for 8 weeks and followed up for six months. Features of chronicity were defined and each given a score of 1. Patients with a score of 2 or less were compared to those with a score of 3 and above in terms of healing and recurrence. Results: Thirty nine patients of the 50 analyzed (78%) healed after the 8 weeks of treatment. At six months follow up 10 patients (26%) had relapsed. This translated to an overall success rate of 58%. Three factors significantly affected healing of a chronic anal fissure- presence of indurated fissure edges (p=0.001, OR 12.19, 95 % CI 2.57-57.94), presence of symptoms for more than three months (p=0.014, OR 8.03, 95 % CI 1.52-42.52) and a score of 3 and above (p=0.004, OR 11.45, 95 % CI 2.13-61.67). There was no feature of chronicity that predicted recurrence of chronic anal fissure after initial healing. Conclusion: GTN paste led to healing in the majority of patients. Features of chronicity may be helpful in predicting response to treatment. In the present study patients with a chronicity score of 2 and below respond better than those with a score of 3 and above.
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۲۸۔ ہوٹل میں ایک شام

ہوٹل میں ایک شام

جونہی نرم ہوا ہوٹل کے پردوں سے ٹکرائی

ایک لذت بھری صدا نے میرے کانوں کی لوئوں کو چوما

’’دال، بھنڈی، ٹنڈے، آلو قیمہ، چکن کڑاہی‘‘

’’جی صاحب۔۔۔۔!‘‘

’’کیا کھائیں گے آپ‘‘

میں نے دال کا کہا اور باہر دیکھنے لگا

تندور پہ ہنگامہ آرائی کا منظر

جیسے کسی محاذ پر شورِ قیامت

نان بائی لبوں پہ مسکراہٹ سجائے

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