Surgical Treatment of Iatrogenic Low Variety Anal Stenosis with Diamond Flap Anoplasty – A Prospective Study

Background: Anal stenosis results from loss of anoderm with subsequent fibrosis and scarring of underlying tissue. The condition represents a technical challenge in terms of surgical management. It is a serious complication of anorectal surgery, most commonly seen after surgical haemorrhoidectomy. However, stenosis can also occur after perianal circumferential burn due to application of herbal medicine by village doctors. Objective: This study was conducted to see the outcome of diamond-flap anoplasty for the treatment of moderate to severe anal stenosis. Patients and interventions: Unilateral diamond flaps anoplasty was performed for moderate to severe anal stenosis. Final anal calibre of 25 to 26 mm was targeted. The demographic characteristics, causes of anal stenosis, number of previous surgeries, anal stenosis severity, postoperative complications and the time of return to work were recorded. Results: From July 2012 to January 2017, 18 patients (12 males, 67% and 6 female patients, 33%) with a mean age of 34 years (range, 25-52) were treated. 15 of the patients had a history of previous haemorrhoidectomy and 3 had circumferential perianal chemical burn due to application of herbal medicine by village doctors. Five patients (28%) had moderate anal stenosis and 13 (72%) had severe anal stenosis. Preoperative, intraoperative, and 12-month postoperative anal calibration values were 9 ± 3 mm (range, 5-15), 25 ± 0.75 mm (range, 24- 26), and 25 ± 1 mm (range, 23-27). The clinical success rate was 98.9%. No severe postoperative complications were observed. Conclusion: Diamond-flap anoplasty is a highly successful method for the treatment of anal stenosis caused by previous haemorrhoidectomy and perianal circumferential chemical burn by herbal medicine. J Shaheed Suhrawardy Med Coll 2020; 12(2): 67-71

Produtos naturais e os riscos à mucosa oral e face: um protocolo de revisão de escopo

O objetivo deste protocolo é garantir a transparência do processo da revisão de escopo, pré-definindo os objetivos, os métodos, os critérios de elegibilidade das fontes de evidências e os dados relevantes a respeito das reações adversas em mucosa oral e face provocadas pelo uso dos produtos naturais. Este protocolo foi registrado na Open Science Framework e seguiu as recomendações do Manual do Instituto Joanna Briggs. A estratégia de busca será estruturada para o PubMed e posteriormente adaptada para as outras bases de dados, como Scopus, Web of Science, Embase, LILACS e LIVIVO, além da literatura cinzenta (Google Scholar e OpenGrey), utilizando os seguintes termos e suas palavras relacionadas: “Biological Products”, “Natural Products”, “Phytotherapy”, “Chemical Burn”, “Adverse Effect”, “Oral mucosa” e “Face”. Adicionalmente, será feita a busca nas listas de referências dos artigos incluídos. Relatos de caso que apresentem reações adversas à mucosa oral e à face, sem distinção de sexo, idade ou etnia dos pacientes serão incluídos na revisão. Estudos clínicos, in vitro, em modelos animais, revisões de literatura e artigos de opinião serão excluídos. A seleção dos estudos será conduzida em duas fases por dois examinadores independentes e participação do terceiro revisor em caso de discordância. Os dados também serão extraídos de maneira independente, com o uso de formulário desenvolvido pelos próprios autores, e apresentados em tabela e/ou figuras e de forma narrativa. Este protocolo auxiliará no desenvolvimento da revisão de escopo, para mapeamento e sumarização das evidências.

Fingertip Necrosis due to Chemical Burn from Glacial Acetic Acid: A Case Report

Glacial acetic acid is a high-purity acetic acid that is mainly used as a solvent in chemical production and for various purposes in the food and pharmaceutical industries. It is safe enough to be used for chemical peeling when diluted, and has been used in folk remedies for warts, athlete’s foot, and eczema. Indeed, such conditions are the most common reason for exposure to glacial acetic acid. In the present report, we describe the case of a 10-year-old girl who presented with pain and necrosis of the distal phalanx of her left index finger. Two days prior, her fingers had been wrapped overnight with a paste of flour mixed with glacial acetic acid to treat warts. We irrigated the affected area with normal saline, applied a mupirocin ointment, and administered prostaglandin E1. However, the necrosis progressed rapidly. After 10 days, the girl’s fingertip was amputated, and a hypothenar free flap was performed. The case represents a severe chemical burn resulting from the misuse of glacial acetic acid, requiring surgical treatment.

Pattern of Burn Injury in Children Presented to Dhaka Shishu (Children) Hospital

Background: Children are mostly affected in burn injury at our country like other low and middle income countries (LMICs). Approximately 90% of the burns occur in under developed countries, which generally lack the necessary infrastructure to reduce the incidence and severity of burns. Objectives: This study was done to investigate the pattern of burn cases admitted to Dhaka Shishu (Children) Hospital (DSH). Methods: This was a retrospective study conducted over the period of one year from January 2019 to December 2019 at Dhaka Shishu (Children) Hospital, Dhaka, Bangladesh. The data was collected from the patients record section of the hospital. Patients characteristics (e.g. age, sex), causes and severity of injury, outcome, hospital stay and seasonal variation were analized in this study. Results: A total of 91 patients were admitted during study period of one year. This study consisted of 53 male patients (58.24%) and 38 female patients (41.76%) with male to female ratio of 1.3:1. The most frequently hospitalized burn patients were in the age group 3-5 years, which accounted for 30.77% of patients. Burns were more common during winter season followed by autumn season, with 43 cases (47.25%) and 18 cases (19.78%) respectively. The highest number of admissions was during the month of December. Scald burn was the most common cause of burn injury in our study which accounted for 83 cases out of 91 cases (91.2%). Flame burn occured in 3(3.29%) patients. There were 2 cases of electric burn and 2 cases of contact burn during this study period. One patient was with chemical burn. Scald burn was the most common cause of burn injury in this study which accounted for 83 cases out of 91 cases (91.2%). Flame burn occured in 3(3.29%) patients. There were 2 cases of electric burn and 2 cases of contact burn during this study period. One patient was with chemical burn. Conclusion: The most frequently hospitalized burn patients were in the age group 3-5 years and more common during winter season. Most of the burn occured in children are scald in our country due to accidental fall of worm liquid. Superficial epidermal and dermal burns are treated conservatively, but deep burns may require surgical treatment. DS (Child) H J 2020; 36(2): 134-137