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Background High perianal fistula treatment remains challenging, mainly due to the variability in success and recurrence rates as well as continence impairment risks. So far, no procedure can be considered the gold standard for surgical treatment. Yet, strong efforts to identify effective and complication-free surgical options are ongoing. Fistulotomy can be considered the best perianal fistula treatment option, providing a perfect surgical field view, allowing direct access to the source of chronic inflammation. Controversy exists concerning the risk of continence impairment associated with fistulotomy. The present study aimed to assess the outcomes of fistulotomy with immediate sphincteric reconstruction regaring fistula recurrence, incontinence, and patient satisfaction. Methods This interventional study was performed at the General Surgery Department of Zagazig University Hospital during the period from July 2018 to December 2019 on 24 patients with a clinical diagnosis of high transsphincteric fistula-in-ano. The fistulous tract was laid open over the probe placed in the tract. After the fistula tract had been laid open, the tract was curetted and examined for secondary extensions. Then, suturing muscles to muscles, including the internal and external sphincters, by transverse mattress sutures. Results Our study showed that 2 patients develop incontinence to flatus ∼ 8.3%.and only one patient develop incontinence to loose stool, 4.2%. Complete healing was achieved in 83% and recurrence was 16.6%. Conclusion Fistulotomy with immediate sphincteric reconstruction is considered to be an effective option in the management of high perianal fistula, with low morbidity and high healing rate with acceptable continence state.

Background:Lichtenstein tension free repair of inguinal hernia a very effective repair but fibrosis generated around the mesh prosthesis may be hazardous to the vas deference and testicular blood supply thus impairing testicular function especially if done on both sides. Patient and methods:78 patients with bilateral inguinal hernia recruited in this prospective trial for evaluation of the effect of bilateral Lichtenstein tension free repair of inguinal hernia on testicular function we held comparison between preoperative and 6 months postoperative findings of; testicular volume, testicular blood flow (resistive index) semen analysis and free testosterone level as primary outcome and surgical site occurrences and recurrence rate as secondary outcome. Results: mean Age, BMI, Operative time were 33.1? 8.8 years , 27.6? 3.1, and 98.4?11.4 respectively, majority of hernia presentation was indirect hernia, we got 2 cases of chronic pain, one case of hydrocele and no recurrences, regarding testicular volume, resistive index, semen analysis and testosterone level noticed non-significant differences between pre and post repair results. Conclusion:In regard to testicular function, bilateral Lichtenstein tension free repair of inguinal hernia is an effective safe method, especially if laparoscopic repair is not available.

Postoperative pain management is a challenge in opioid-dependent patients as this patient group is often undertreated for pain. An appropriate dose of an appropriate opioid should be administered to these patients to control the pain and prevent the development of withdrawal symptoms. The aim of this study was to evaluate the analgesic and adverse effects of pethidine versus morphine in postoperative pain relief in opioid-dependent patients after major surgery. Eighty opioid-dependent patients undergoing major surgical operations were included in our study. Forty patients received intravenous morphine (up to 0.15 mg/kg) or intramuscular pethidine (up to 1.5 mg/kg) for 48 h postoperatively. Withdrawal symptoms were recorded using the Clinical Opioid Withdrawal Scale (COWS) at 30 and 60 min after drug administration. The effectiveness and tolerability profile of pethidine was compared with that of morphine at 6, 12, 24 and 48 h after the initiation of treatment. Analgesic efficacy was recorded using a visual analogue scale (VAS), and drug safety was estimated using sedation scores and adverse drug reactions. Pethidine and morphine had similar analgesic effects at 6 and 12 h postoperatively, but morphine had better analgesic effects at 24 and 48 h. Morphine was associated with fewer adverse reactions and less prominent withdrawal symptoms than pethidine. Morphine is a more effective and better tolerated analgesic than pethidine in the management of postoperative pain in opioid-dependent patients.

Digital reference service is an emerging trend of traditional reference service. Easily accessible digital reference service has become one of the hallmarks ofthe library and information services. The paper highlights how new visage oftraditional reference service is developing as a natural solution to keep pace withcomprehensive technological environment. The basic concepts,elements of digital reference service and give in detail modes, the advantages,limitations, and some details regarding various digital reference services leads to several libraries.

Health is not only determined by biological factor but also by both cultural and social environment. So the social determinants are very important factor of health. The social determinants of health are the conditions in which people are ?born, grow, live, work, age,? and which shape their health status.The main objective of this study wasto know the affecting factors and social determinant factors of health seeking behaviour in the study area and to know the people?s perception regarding health and disease. The researcher used such as interview schedule (face to face interview technique using semi structure questions), case study. In this study the researcher has used the survey method for selection of the respondent. The finding reveals that folk tradition and culture mostly close to the health seeking behaviour of the people. Cultural influence was major factor of health among the people. Culture shapes the people what to do, where to go etc. regarding the illness treatment. Therefore, in the process of health seeking behaviour the people influence from the factor of geography, availability, education, income, poverty, gender disparity, social support and network, we feelings, interaction, taking of decision, social ties, share of information, emotion, togetherness of activity and integration of this whole activity etc.