Overview of Kshar-sutra in treatment of Ano-rectal diseases- review of cases treated at ACTH in 2011-2012: Retrospective study

Background Anorectal disorders including Fissure in Ano, Fistula in Ano and hemorrhoids are among the most common digestive complications. To our knowledge there is no any retrospective study of previous medical record data of Ayurveda Campus and Teaching Hospital (ACTH), Institute of Medicine, Tribhuvan University, Kirtipur, Kathmandu, Nepal available on the prevalence of major anorectal problems. Therefore, this retrospective was carried out to analyze the medical record of Shalya department OPD in fiscal year 2011-12 A.D. to estimate the prevalence of anorectal problems among the patients of anorectal complaints. Materials and Methods: This was a retrospective study conducted from January 2020 to December 2020 A.D. All the patients visiting the Department with anorectal complaints were screened. Name, sex, age, address and diagnosis was entered into Microsoft excel 2016 from registers of medical record; and analyzed in SPSS Version 2021 after coding the variables in excel. The findings were presented with percentage and frequency in pie and bar diagram. Results: Overall, anorectal cases (n=1067) were enrolled and analyzed in the study. The findings of major anorectal diseases like Fissure in Ano, Fistula in Ano and Hemorrhoids were commonly found in age group of 21-30 year; and followed by 31-40 year and 41-50 year. Fistula in Ano was also significantly found in the old age group of 61-70 year. Furthermore, the prevalence of Fissure in Ano, Fistula in Ano, Internal and External Hemorrhoids were 20%, 32%, 31.2% and 12% among ano-rectal problems in this hospital during this fiscal year respectively. Conclusion: Anorectal diseases are one of the common diseases observed in adolescent and adult patients which is more common in male than female. The prevalence of hemorrhoids is higher among Fissure in Ano and Fistula in Ano. Ksharasutra is the most effective procedure for treatment of these anorectal diseases.

Raisins with clarified butter or ghee for the relief of acute and chronic constipation - A Clinical Study

Background: Constipation is a very distressful symptom, affecting to all age group. The only treatment is laxatives, which is having many adverse effects mainly dependency on laxatives. Purpose: To evaluate the laxative effect of raisins and to get relief from daily dependency on laxative medicines for acute and chronic constipation Methods: Interventional / Experimental study of raisins and clarified butter or ghee performed at ‘Vishwaraj Hospital’ Pune, Maharashtra, India from March 2021 to June 2021, after appropriate ethical approval obtained from the Vishwaraj Hospital’s Ethics Committee (Registration number- ECR/1138/Inst/MH/2018). Fifty one patients of constipation who were on laxatives or PR enema enrolled in this study, diagnosis confirmed by gastro-enetrologist. Laxatives had been asked to stop before enrollment. Questionnaire form were given at the time of enrollment and telephonic follow up for OPD patients and by visiting to admit patients had been taken on 2nd day after consumption of raisins and clarified butter or ghee then on 7th and 15th day. Forms were collected once they were visit to their respective doctors for follow up. Results: Statistical tool used in this study is the 95 % confidence interval. The variables of interest were 1) percent of patients have restarted laxatives or not and 2) number of days required to get relief from constipation. 94.12 % of patients (n=48) did not restart laxatives after consumption of raisins and clarified butter or ghee and the population percent of patients that might not restart laxatives would be 88% to 100% with 95 % confidence. Also the number of days to get relief from constipation after consumption of raisins and clarified butter or ghee for a patient in population would be 3-4 days with 95 % confidence. Conclusion: Raisins and CB or ghee had given relief from acute and chronic constipation; worked very well on irritable bowel syndrome, fissure in ano, hemorrhoids and helped to stop PR bleeding and bloating causes by these diseases. Patients got relief from constipation on 3rd and 4th day. This study concluded that raisins with clarified butter or ghee can be taken instead of laxatives or enema to get relief from constipation; this might be the great substitute for laxatives and per rectum enema.

Ayurvedic Management of Parikarthika (Acute Fissure in Ano) – A Case Study

Among anorectal diseases, Parikarthika (Fissure in ano) is considered one of the most painful diseases. Now a days the incidence rate of this disease became more due to the irregular food habits as well as unproper modern life style changes. Due to this its recent occurrence in all types of age groups irrespective of gender. This case study described the effective management of acute fissure in ano which was managed with ayurvedic treatment modalities. A 23-year male patient came with symptoms of pain and burning during and after defecation and also having the presence of blood streak while passing of stool. The patient was diagnosed as acute fissure due to the presence of a cut longitudinal ulcer in lower part of anal canal at the 6 o’clock position. Ayurvedic treatment approach both internally and externally were followed. Jatyadi Ghritham Pichu application followed by a lukewarm water sitz bath was advised as external treatment. The complete improvement was found in this within 12 days of treatment. No reoccurrence was noted even after 3rd month of follow up.

EARLY OUTCOME OF LASER INTERNAL SPHINCTEROTOMY VERSUSOPEN INTERNAL SPHINCTEROTOMY IN THE TREATMENT OF ANAL FISSURES

INTRODUCTION : Fissure-in-Ano is one of the common and most painful anorectal conditions encountered in surgical practice. Inspite of several conservative treatment options, surgical treatment in the form of Lateral Internal Spincterotomy (LIS) remains the gold standard of treatment for anal ssure. However we compare Laser lateral internal sphincterotomy with Open lateral internal Sphincterotomy for better postoperative pain relief and lesser hospital stay. AIM: Early outcome of laser lateral internal Sphincterotomy versus open lateral internal sphincterotomy in the treatment of anal ssures. MATERIALS AND METHODS: The study was conducted on 50 cases of Laser lateral internal sphincterotomy compare with 50 cases of Open lateral internal sphincterotomy in Maharani Laxmi Bai Medical College, Jhansi between January 2020 to July 2021. RESULTS:In our study in Group A 6% were in 16-20 years, 52% in 21-30 years, 20% in 31-40 years, 20% in 41-50 years and 2% 51-60% years and Group B 2% in 16-20 years, 34% in 21-30 years, 32% in 31-40 years, 18% 41-50%, 10% in 51-60 and 4% in >60. Group A mean postoperative VAS pain score in 6 hours 5.12±0,328, 12 hours 4.32±0.768, 24 hours 3.74±0.777, 36 hours 2.76±1.379 and 48 hours 2.3±1.418. In Group B mean postoperative VAS pain score in 6 hours 5.2±0.452, 12 hours 2.7±1.741, 24 hours 1.76±1.451, 36 hours 0.58±0.971 and 48 hours 0.28±0.671. Group A 44% presented with Perianal swelling, 42% Prutis Ani and 40% atus incontinence. In Group B 6% presented with amount of blood loss 6%, 18% Perianal swelling, 6% infection, 18% atus incontinence. The mean postoperative pain score was signicantly less in Group B at 12 to 48 hours. Group A mean hospital stay was 5.02±1.237 days and in Group B 2.02±0.141 days. It was signicantly less in Group B. CONCLUSION: Laser lateral Internal Spincterotomy is better than open Lateral Internal Spincterotomy with respect to less postoperative pain and lesser hospital stay and also less postoperative complications in the treatment of anal ssure.

EVALUATION OF EFFICACY OF DARUHARIDRA CHANDANA MALAHARA LEPA AND PANCHAVALKALA MALAHARA LEPA IN PARIKARTIKA WITH SPECIAL REFERENCE TO ACUTE FISSURE IN ANO

Background: Parikartika (Fissure-in-ano) is a clinical condition enrolled with the Laxana’s like Kartanavat (cut- ting type of pain) and Chedanavat Shoola in the anal region and it can be correlated with Anal Fissure associated with Pain, Burning sensation during Defecation and tear in the distal Anal Canal. The Incidence rate of Anal Fis- sure is around 1 in 350 adults they occur equally common in men and women and most often occurs in adults aged 15 to 40. Aims and Objectives: To compare the Efficacy of Daruharidra Chandana Malahara with Pan- chavalkala Malahara in the Management of Parikartika (Acute fissure in ano). Materials and Methods: For the Present study, cases were selected from OPD and IPD of Shalya Tantra with the Classical Clinical Features like Kartanvat and Chedanavat Shoola in the anal region. Intervention: Daruharidra Chandana Malahara Lepa and Panchavalkala Malahara Lepa, applied Locally into Two Groups with each Group having 20 Patients for 7 days along with Triphala Choorna (1tsp) HS. Results: Copesetic Relief was seen in Signs and Symptoms and Im- proved Quality of Life after Treatment. Conclusion: The Study Was Proved that Parikartika was Effectively Managed by Daruharidra Chandana Malahara Lepa comparatively Panchavalkala Malahara Lepa. Keywords: Parikartika, Fissure-in-ano, Daruharidra Chandana Malaharal Lepa, Panchavalkala Malahara Le- pa.

Effect of Murivenna Ointment in the Management of Parikarthika (Acute Fissure in Ano) – A Pilot Study

Parikarthika (Fissure in ano) is one of the most painful condition which is occurring in the ano rectal region. Due to irregular food habits and modern life styles of peoples in the present era has also added to the increase in the rate of incidence of fissure in ano. The aim of the present pilot study was to assess the effectiveness of Murivenna ointment in the management of Parikarthika. This study was conducted in 22 patients diagnosed as acute fissure in ano. Patients Murivenna ointment was applied locally with digitally in fissure bed (Parikartika) of all 22 patients. All patients were advised to follow this twice daily after sitz bath for 4 weeks or till healing of fissure bed whichever is earlier. Adjuvant drug Triphalachurnam 5 gm orally at bedtime with lukewarm water was prescribed daily to all patients with constipation. There was significant relief in symptoms like pain in ano and bleeding per rectum in all patients after 30 days of treatment. The anal sphincter tonicity became normal in 21 patients (95.45%) after 30 days of treatment. Ulcer in ano was completely healed in 19 patients (86.36%) after 30 days of treatment. There was no reoccurrence in all patients after 30 days of follow up. The irritable symptoms like pain and bleeding per rectum were effectively relieved within 14 days of treatment in all patients. It is one of the effective treatments in the management of fissure in ano as it relieved the cardinal symptoms of fissure in ano such as cutting pain and burning pain.

CLINICAL ASSESSMENT OF A LOCAL APPLICATION OF KASISADI GHRITAIN PARIKARTIKA (FISSURE-IN-ANO)

Parikartika is charecterised by sharp cutting pain in the anal region. In parikartika teevrashoola, bleeding is observed, equally extreme pain slimy blood discharge are seen in fissure-in-ano. To test the efficacy of thelocal application of kasisadi ghruta in managing. Classical signs and symptoms of parikartika (fissure in ano) age groups of 20 to 60 years have been recruited for the research. The trial group obtained treatment with kasisadi ghruta local application for 28 days, twice a day. Average relief observed was observed 62.5% for most symptoms shothahara, vedanasthapana, and ropana are in kasisadi ghruta. Properties because of which it helps in healing the ano fissure.