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.

Anorectal emergencies: WSES-AAST guidelines

Anorectal emergencies comprise a wide variety of diseases that share common symptoms, i.e., anorectal pain or bleeding and might require immediate management. While most of the underlying conditions do not need inpatient management, some of them could be life-threatening and need prompt recognition and treatment. It is well known that an incorrect diagnosis is frequent for anorectal diseases and that a delayed diagnosis is related to an impaired outcome. This paper aims to improve the knowledge and the awareness on this specific topic and to provide a useful tool for every physician dealing with anorectal emergencies.The present guidelines have been developed according to the GRADE methodology. To create these guidelines, a panel of experts was designed and charged by the boards of the World Society of Emergency Surgery (WSES) and American Association for the Surgery of Trauma (AAST) to perform a systematic review of the available literature and to provide evidence-based statements with immediate practical application. All the statements were presented and discussed during the WSES-AAST-WJES Consensus Conference on Anorectal Emergencies, and for each statement, a consensus among the WSES-AAST panel of experts was reached. We structured our work into seven main topics to cover the entire management of patients with anorectal emergencies and to provide an up-to-date, easy-to-use tool that can help physicians and surgeons during the decision-making process.

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.

Discussion on the Pathogenesis of Hemorrhoids

With the efficient development of social economy, as well as the acceleration of the pace of life, the incidence of hemorrhoids remains high all year round, occupying a relatively high incidence of anorectal diseases. The author will sort out the four most representative theories of pathogenesis, and summarize and analyze them. Understanding the pathogenesis of hemorrhoids can give a deeper understanding of the nature of the disease, and it will help improve the accuracy of clinical diagnosis and treatment, which in turn is beneficial to the improvement of the cure rate.

Mechanism of “Five Meridians Acupuncture” in Treating Postoperative Urinary Retention after Anorectal Diseases

In recent years, with the change of rhythm and eating habits of the public, the number of patients with anorectal diseases has gradually increased, and postoperative urinary retention has also become more common. Urinary retention refers to the symptoms of anorectal diseases and is caused by improper urination and incompletion of urination due to surgical and pain causes that result in bladder and urine filling and are accompanied by lower abdominal distention and pain. In traditional Chinese medicine, acupuncture is simple and effective as a treatment. In this article, we focus on five meridians that pass through the lower abdomen Ren meridian, kidney meridian, spleen meridian, stomach meridian, and liver meridian, namely the “five meridians,” and study the mechanism of action so as to provide new therapeutic ideas for clinical acupuncture treatment of postoperative urinary retention of anorectal diseases.

Insights into the management of anorectal disease in the coronavirus 2019 disease era

Coronavirus 2019 disease (COVID-19) has created major impacts on public health. The virus has plagued a large population requiring hospitalization and resource utilization. Knowledge about the COVID-19 virus continues to grow. It can commonly present with gastrointestinal symptoms; initially, this was considered an atypical presentation, which led to delays in care. The pandemic has posed serious threats to the care of anorectal diseases. Urgent surgeries have been delayed, and the care of cancer patients and cancer screenings disrupted. This had added to patient discomfort and the adverse outcomes on healthcare will continue into the future. The better availability of personal protective equipment to providers and standard checklist protocols in operating rooms can help minimize healthcare-related spread of the virus. Telehealth, outpatient procedures, and biochemical tumor marker tests can help with mitigation of anorectal-disease-related problems. There is limited literature about the clinical management of anorectal diseases during the pandemic. We performed a detailed literature review to guide clinicians around management options for anorectal disease patients. We also highlighted the health challenges seen during the pandemic.

Literary and Analytical Study of the Source Plants of Kshara (Alkali) for Ksharasutra Preparation in the Management of Fistula-in-ano

The different surgical techniques and importance in disease treatment were explored by Sushruta, the father of surgery. Furthermore, Anushastra or parasurgical substances and methods from Ayurveda are distinctive in surgical fields as discovered by Sushruta. According to Susruta Samhita, Kshara or alkali are useful for performing excision/removal, incision/cutting, scraping, alleviating three Doshas and several special procedures, and therefore superior to Shastra (sharp instruments) or Anu Shastra (accessory apparatuses). Also, Kshara is derived from diverse Ayurveda plants and applied in different ways to manage various diseases, including bhagandara (fistula-in-ano) and other numerous anorectal conditions. Ksharasutra, a novel drug delivery system, is now popular in Ayurvedic surgery for anorectal Diseases and involves a thread smeared with kshara (alkali) applied to induce both mechanical and chemical cutting and healing. There are 23 Kshara source plants provided by Sushruta. This study implemented a literary analysis of the three plant sources employed to prepare Kshara sutra used for managing Fistula-in-ano.

Aegrescit medendo. Some common diseases among the inhabitants of Roman Dacia

This study aims to trace a possible list of ailments or diseases that the inhabitants of Dacia might have suffered of during Roman period. The corroboration of the anthropological, archaeological, iconographic and epigraphic sources suggests that eye diseases, musculoskeletal disorders, gallbladder or kidney stones, reproductive system disorders, anorectal diseases and dental problems were common medical conditions among the provincial population. Ultimately, the available sources also reveal that while some patients were willing to undergo surgery, others preferred to appeal to less invasive procedures, which involved taking homeopathic medicine, wearing magical amulets, frequenting thermal spas or Asklepieia.