The current review explores the development and effectiveness of hemorrhoidectomies from March 2006 until February 2010. The objective was the comparison and synthesis of the comparative effectiveness, patient-related outcomes, and safety of surgical interventions in the treatment of grade III and IV haemorrhoids. We performed an electronic search of MEDLINE, EMBASE, and Cochrane databases and supplemented this with manual search of journals including Diseases of the Colon and Rectum and Annals of Surgery. A total of 17 pivotal reports were reviewed, including RCTs, retrospective comparative studies, and clinical guidelines. These procedures, which include Milligan–Morgan hemorrhoidectomy (MMH), Longo stapled hemorrhoidopexy (SH), Ligasure hemorrhoidectomy, Doppler-guided hemorrhoidal artery ligation (HAL), and laser, are analyzed in the present review. Results SH and Ligasure involve less postoperative pain and faster recovery than MMH, but there is doubt about higher recurrence and cost. HAL Appears as a safe outpatient procedure; the use of diode laser in the hemorrhoidal tissue might have potential but it needs further modifications. Despite progress, there are no alternatives to MMH because of the high rates of long-term success. This review outlines strengths and weaknesses of current surgical strategies and highlights the importance of larger, more long-term studies to define best practice.

Background: Ocular sarcoidosis is a systemic inflammatory disease that can result in severe visual impairment if not diagnosed and treated early. This study aimed to evaluate the clinical presentation, diagnostic indicators, treatment modalities, and outcomes in patients with ocular sarcoidosis. Materials and Methods: A total of 40 patients (50 eyes) diagnosed with ocular sarcoidosis were enrolled in this prospective study conducted at Narayana Medical College, Nellore, between January 2009 and December 2009. Patient demographics, clinical features, ocular signs, laboratory investigations, and treatment outcomes were assessed over a follow-up period of 6 months. Data were analyzed using descriptive statistics. Results: The mean age of the patients was 34.9 years, with a predominance of female patients (62.5%). Defective vision was the most common symptom (95%), followed by pain (60%). Ocular signs included granulomatous keratic precipitates (92.5%) and anterior chamber reaction (90%). Systemic investigations revealed bilateral hilar lymphadenopathy in 50% of the patients. The majority of patients were treated with topical steroids (100%), and 90% received oral steroids. At the 6-month follow-up, 37.5% showed improvement in visual acuity, while 12.5% experienced deterioration. Conclusion: Ocular sarcoidosis presents predominantly with defective vision and inflammatory signs such as granulomatous keratic precipitates and anterior chamber reaction. Early diagnosis and treatment, primarily with steroids, are critical for improving visual outcomes. However, long-term management remains essential due to potential recurrence and complications.

The concept of evaluation of professionalism has gained momentum in the UK in recent years, following concerns about poorly performing doctors. Multi source feedback was designed with an aim to evaluate the professional behavior of a doctor, which is generally hard to assess as it is multivariate. In the UK, Team Assessment Behavior (TAB) is one of the assessment tools used under the umbrella term of Multisource Feedback (MSF) in postgraduate and undergraduate medicine. As TAB is a relatively new tool which has been developed and tested within the UK, we have described the process of TAB along with defining the barriers that may prevent it and the MSF from being an effective tool.

Spasticity is a physiological consequence of an injury to the nervous system. It is a complex problem which can cause profound disability, alone or in combination with the other features of an upper motor neuron syndrome and can give rise to significant difficulties in the process of rehabilitation. This can be associated with profound restriction to activity and participation due to pain, weakness, and contractures. The treatment of spasticity is fundamental in the management of neurological disabilities. Optimum management is dependent on an understanding of its underlying physiol ogy, an awareness of its natural history, an appreciation of the impact on the patient and a comprehensive approach to minimizing that impact. The aim of this article is to highlight the importance, basic approach and management options available to the general practitioner in such a complex condition.

Leg ulcers are a common presentation in the elderly population associated with a negative impact in the quality of life. Several factors including venous and arterial insufficiency, immobility and obesity all contribute to an increased incidence in this age group. A thorough assessment including comprehensive history of ulcer development, examination of the ulcer site, size, shape, appearance and vascular assessment with Doppler ultrasound are all essential in deciding type of treatment. Various treatment modalities are available for the management of different types of leg ulcers although no clinical trials comparing the efficacy of one treatment over the other have been done. Some of them have not got strong evidence to show that they actually improve healing, still awaiting further research.

Background: Anemia is a common clinical problem in patients with chronic kidney disease and is associated with increased morbidity and mortality. Erythropoietin is a hormone synthesized in kidney responsible for red blood cell maturation in the bone marrow. It is deficient in majority of patients with advanced kidney disease predisposing to anemia. Therapeutic alternatives are recombinant human erythropoietin (epoietin alfa), darbepoetin, other similar agents all now collectively known as ‘erythropoiesis stimulating agents and red blood cell transfusions. Objective: The aim of this review is to assess that whether Erythropoietin (EPO) treatment is beneficial or harmful in the management of anemia associated with CKD. Methods: This review is based on randomized controlled trials, observational studies and meta-analyses published between 1989 and 2008 and focusing EPO use in anemia of CKD. Articles were searched in MEDLINE, PubMed, and other electronic databases as well as in online journals. Keywords "Kidney failure, chronic and "erythropoietin" for studies up to 1996, and "epoetin alfa" for subsequent years. Results: 470 citations were identified in our search. Of these 470 citations, 26 were selected for review. Conclusion: Randomized controlled trials suggest an association between higher hemoglobin level and improved quality of life but the association with survival is less clear. Observational studies have generally shown increased survival with higher hemoglobin level randomized trials have not shown such benefits. The overall quality of life is improved when anemia is treated with EPO, but aiming for a target value of 13.5 g/dl of hemoglobin per deciliter provided no additional quality-of-life benefit.

This article outlines the main principles of the Mental Capacity Act 2005 (MCA). The introduction briefly explains the background to the development of the legislation and introduces some of the principles underpinning the Act before going on to look at the Best Interest check list, the protection from liability offered practitioners by the act and the safeguards offered to service users by the legislation.

Ectopic pregnancy is a public health issue and a life-threatening condition in Sub-Saharan Africa due to high risk of sexually transmitted infections. While surgical option of management is often advocated for cases of ruptured ectopic gestation, unruptured cases can be managed medically especially where fertility is of a major concern. The case presented is that of a 30-year-old GIP0+0 who presented at a private health facility with mild right sided lower abdominal pain and spotting per vaginal of 2days duration at a gestational age of 7weeks and 2days, she was hemodynamically stable. A pelvic Ultrasound done showed a right sided gestational sac with no cardiac activity and an empty uterus. Serum β HCG done was 913mIU/ml. She was managed as a case of unruptured ectopic gestation with intramuscular methotrexate injections and she had a complete resolution of the ectopic gestation as evidenced by the disappearance of the symptoms and biochemical assessment of the level of serum β HCG which dropped to zero.