Masood Jawaid

Topical diltiazem hydrochloride and glyceryl trinitrate in the treatment of chronic anal fissure.

OBJECTIVE To compare the symptomatic relief, healing and side-effects of topical diltiazem (DTZ) and glyceryl trinitrate in the treatment of chronic anal fissure. STUDY DESIGN Randomized controlled trial. PLACE AND DURATION OF STUDY The Surgical Outpatient Department of Civil Hospital, Karachi, from March 2006 to February 2007. METHODOLOGY Patients with chronic anal fissure were included in the study and randomized to two groups. One group was administered topical 2% diltiazem hydrochloride and other was given 0.2% glyceryl trinitrate (GTN), perianally twice daily for 8 weeks. Patients with anal fissure due to other diseases like inflammatory bowel disease, malignancy, sexually transmitted diseases, previous treatment with local ointment or surgery; patients who required anal surgery for any concurrent disease like hemorrhoids, pregnant women and patients with significant cardiovascular conditions were excluded. There were four follow-up sessions during the course of treatment. Healing and side-effects were recorded. Analysis was done by SPSS version 10 on intention-to-treat basis. Chi-square was used where appropriate. RESULTS Eighty patients with symptomatic chronic anal fissure were included in the study and equally divided into two groups. After 8 weeks of treatment healing occurred in 31 of 40 patients treated with diltiazem and 33 of 40 patients treated with GTN (p = 0.576). There were less side-effects with DTZ (n=13) than with GTN (n=29, p < 0.001]. In particular, headache occurred more commonly with GTN (n=27) than with DTZ (n=9, p < 0.0001). CONCLUSION Diltiazem hydrochloride and glyceryl trinitrate were equally effective in healing chronic anal fissure. Diltiazem caused fewer side-effects particularly headache than glyceryl trinitrate ointment. Diltiazem may be the first-line treatment for chemical sphincterotomy for the chronic anal fissure.

On-call emergency workload of a general surgical team

Background: To examine the on-call emergency workload of a general surgical team at a tertiary care teaching hospital to guide planning and provision of better surgical services. Patients and Methods: During six months period from August to January 2007; all emergency calls attended by general surgical team of Surgical Unit II in Accident and Emergency department (A and E) and in other units of Civil, Hospital Karachi, Pakistan were prospectively recorded. Data recorded includes timing of call, diagnosis, operation performed and outcome apart from demography. Results: Total 456 patients (326 males and 130 females) were attended by on-call general surgery team during 30 emergency days. Most of the calls, 191 (41.9%) were received from 8 am to 5 pm. 224 (49.1%) calls were of abdominal pain, with acute appendicitis being the most common specific pathology in 41 (9.0%) patients. Total 73 (16.0%) calls were received for trauma. Total 131 (28.7%) patients were admitted in the surgical unit for urgent operation or observation while 212 (46.5%) patients were discharged from A and E. 92 (20.1%) patients were referred to other units with medical referral accounts for 45 (9.8%) patients. Total 104 (22.8%) emergency surgeries were done and the most common procedure performed was appendicectomy in 34 (32.7%) patients. Conclusion: Major workload of on-call surgical emergency team is dealing with the acute conditions of abdomen. However, significant proportion of patients are suffering from other conditions including trauma that require a holistic approach to care and a wide range of skills and experience. These results have important implications in future healthcare planning and for the better training of general surgical residents.

Author’s failure to read and follow instructions leads to increased trauma to their manuscripts

Authors under pressure to publish to meet some academic requirement are one of the most dangerous pressure group which the editors of good quality peer review biomedical journals have to face every day. Their failure to read and follow instructions for authors which are published on every journal website, lack of training facilities in research methodology, medical writing, and low computer literacy rate leads to increased trauma to their manuscripts. The authors must realize that from submission to final publication manuscripts go through various stages i.e. internal review, editor’s triage, similarity index check, formatting, external review, revision of the manuscripts in the light of reviewers comments and suggestions. It all takes time and there is no short cut. They must plan at least for six to eight months from the date of submission to acceptance and publication and avoid getting trapped by predatory journals which offer quick publication on payment.

Comparison of hemorrhoidectomy by LigaSure with conventional Milligan Morgan's hemorrhoidectomy.

Objective: To compare the efficacy of haemorrhoidectomy done by using LigaSure with conventional Milligan Morgan haemorrhoidectomy. Methods: This randomized controlled trial was done at Department of Surgery Dow University Hospital Karachi during January 2013 to September 2015. A total of 55 patients were included in the study. Patients were randomly allocated to group A (Haemorrhoidectomy by Ligasure) and group B (Milligan Morgan Haemorrhoiectomy). Efficacies of both procedures were compared by operative time, Blood loss, wound healing, and pain score on immediate, 1st and 7th post operative day. Results: Out of total 55 patients 23 were male and 32 were females. The most common group of age involved was between 40 – 60 years. Third degree Heamorrhoids were present in 37 (67.3%) of patients while remaining 18 (32.7%) had fourth degree Heamorrhoids. Group A included 29 cases while Group B included 26 cases. The mean operating time of Group A was 52.5 with standard deviation of 11.9 while it was 36.6± 9.8 in the other group. The mean blood loss in group A was 51.92 with standard deviation of 15.68 while it was 70.34±25.59 in group B. Overall pain score was less in those patients who underwent Heamorrhoidectomy by Ligasure method. Conclusion: The efficacy of Heamorrhoidectomy by Ligasure is better than the traditional Milligan Morgan Heamorrhoidectomy but we need more clinical trials with large sample size and long term follow ups.

Social network utilization (Facebook) & e-Professionalism among medical students

Objective: To find out the frequency and contents of online social networking (Facebook) among medical students of Dow University of Health Sciences. Methods: The sample of the study comprised of final year students of two medical colleges of Dow University of Health Sciences – Karachi. Systematic search for the face book profiles of the students was carried out with a new Facebook account. In the initial phase of search, it was determined whether each student had a Facebook account and the status of account as ‘‘private’’ ‘‘intermediate’’ or ‘‘public’’ was also sought. In the second phase of the study, objective information including gender, education, personal views, likes, tag pictures etc. were recorded for the publicly available accounts. An in depth qualitative content analysis of the public profiles of ten medical students, selected randomly with the help of random number generator technique was conducted. Results: Social networking with Facebook is common among medical students with 66.9% having an account out of a total 535 students. One fifth of profiles 18.9% were publicly open, 36.6% profiles were private and 56.9% were identified to have an intermediate privacy setting, having customized settings for the profile information. In-depth analysis of some public profiles showed that potentially unprofessional material mostly related to violence and politics was posted by medical students. Conclusion: The usage of social network (Facebook) is very common among students of the university. Some unprofessional posts were also found on students’ profiles mostly related to violence and politics.

How to ensure effective use of media to communicate with healthcare professionals and general public

Image of the medical profession in the public is not so good these days for various reasons. Media, electronic in particular takes pleasure in defaming, humiliating and running malicious campaigns against doctors and healthcare facilities. They run announcement as breaking news and pass sweeping remarks without knowing the full facts of the incidents. Media houses does not employ professionals with some core knowledge on health related issues which they cover. Most of them know nothing about it but they are also reluctant to admit it and pose themselves as experts. Medical profession also shares some blame for all this because they have never organized any orientation courses for health journalists. Yet another reason is the failure of the medical profession to effectively use media to communicate with the healthcare professionals as well as the public. Self-monitoring, accountability, having a good communication strategy, besides other initiatives can go a long way in improving the medical related news coverage thereby enhancing the image of the medical profession as well.

Peer Review: How much weightage should the editor give to reviewer’s opinion?

Finding a good quality reviewer, retaining them and setting up an efficient peer review system are some of the important challenges which the editors are faced universally.1 Things are changing so fast that it is becoming extremely difficult to keep pace with new developments in peer review and often one is confronted with a dilemma as to how much weightage an editor should give to the opinion of reviewers? Although in the historical perspective the editorial peer review developed slowly and haphazardly but it became institutionalized only in 1940.2 Internal and external peer review was put into practice by the journals during 18th century to assist the editors in selection of manuscripts for publication. In the past since most of the journal contents used to be written by the editors themselves, they were not interested in peer review. Stephen Lock published his first book on Peer Review titled “A difficult balance” in 1985. Later the first congress in peer review was held in Chicago in 1989 and since then these peer review congress are being held regularly after every few years in different countries. 2 In the developing low income countries including Pakistan, research culture has not developed much though the situation is now changing for the better. The contribution of these countries to the overall medical literature remains very negligible, hence Editorial

Is there difference in chronic pain after Suture and Stapler fixation method of mesh in Ventral Hernia? Is stapler fixation method quicker? A randomized controlled trial

Background & Objective: Chronic pain occurs in 20–30% of patients after hernia surgery. As a consequence of this chronic pain, almost one third of patients have limitations in daily activities. Frequency and severity of this pain varies with different techniques of hernia repair. The objective of this study was to compare polypropylene suture and skin staples for securing mesh in uncomplicated ventral hernioplasty in terms of acute and chronic postoperative pain and to compare the time taken for mesh fixation between polypropylene sutures and skin stapler in ventral hernioplasty. Methods: This study was conducted in Surgery Department of Dow University Hospital, Dow University of Health Sciences, Ojha Campus and included 53 patients from Jan 2015 to Dec 2016, after taking informed consent. All patients were operated under general anesthesia by the same surgical team. Patients were randomized into two groups; in one group mesh fixed with 2/0 polypropylene suture while in other group mesh stapler was used. Time taken to apply mesh was noted in minutes from laying the mesh over anterior rectus sheath to completion of fixation by either method. The severity of post-operative pain was measured with VAS (1-10) after one week, one month and after one year after surgery. Data was analysed using SPSS version 17. Results: Patient characteristics and operative outcome were similar in the two groups and statistically non-significant in both. Early postoperative pain was more after suture fixation but it was not statistically significant. Mean ± SD pain score was after one week 3.47±2.7 after sutures while 2.91±1.88 after stapler. After four weeks, 0.40±0.49 after suture while 0.35±0.48 after stapler fixation. In both study groups 30–34% of the patients felt some pain in follow-up after one year. Severity of pain was 0.60±0.62 after suture while 1.65±1.94 after stapler fixation which is statistically significant as well (p<0.007). Mean operative time was 15.33±6.33 minutes for suture fixation while 1.56±0.41 minutes for fixation by staples, p-value < 0.001. Conclusion: The method of fixation does not appear to cause significant difference in early post-operative pain but chronic pain is more after stapler fixation of mesh. However, operative time was reduced significantly in staple fixation group as compared to suture fixation group

How to run a successful Journal

Publishing and successfully running a good quality peer reviewed biomedical scientific journal is not an easy task. Some of the pre-requisites include a competent experienced editor supported by a team. Long term sustainability of a journal will depend on good quality manuscripts, active editorial board, good quality of reviewers, workable business model to ensure financial support, increased visibility which will ensure increased submissions, indexation in various important databases, online availability and easy to use website. This manuscript outlines the logistics and technical issues which need to be resolved before starting a new journal and ensuring sustainability of a good quality peer reviewed journal.

Professional competencies required for Editors of Biomedical Journals

Pak J Med Sci September October 2017 Vol. 33 No. 5 www.pjms.com.pk 1050 There have been tremendous developments in the field of Journalology during the last two decades and now it has emerged as an important discipline with numerous sub-specialties. Most of the editors have so far learnt this art through on the job training. The professional competencies required to be an Editor of a biomedical journal to act as an effective scientific editor has a very broad range and often it is not possible for an individual to fulfill all the requirements and he/she has to depend on the teamwork in which people with expertise in different areas put together their efforts to produce a good quality peer reviewed biomedical journal. They are most often members of the Editorial Board or work in an advisory capacity. The editors are supposed to have some knowledge in areas like research methods, publication ethics, different peer review processes, their advantages and disadvantages, how to protect integrity of their journal/professionalism, they must possess sound knowledge to be able to make good decisions, proficiency in language skills and indexing of the journal in different databases. All this certainly is beyond the capability of an individual and most often these editors have to rely on their other team members. Editorial